2018-2020年天水市大气污染对急性上呼吸道感染住院患者的影响

Effects of ambient air pollution on hospital admissions for acute upper respiratory infections in Tianshui City,2018—2020

目的分析2018—2020年甘肃省天水市大气污染物与急性上呼吸道感染(acute upper respiratory infections,AURI)住院数的关系,为当地政府采取有效措施改善空气质量提供参考价值。方法收集2018年1月1日—2020年12月31日天水市AURI住院患者的病例资料、同期的气象数据和大气污染物数据,采用分布滞后非线性模型控制气象因素、星期几效应、节假日效应等混杂因素,定量分析每日空气污染物与日住院人数的关系及滞后效应,再对性别、年龄和季节进行分层研究。此外,采用双污染物模型和改变时间的自由度来检验模型的稳定性。结果2018—2020年天水市AURI住院患者10094例,日均住院9例。PM_(2.5)在lag07 d、PM10在lag02 d、SO_(2)在lag07 d、NO_(2)在lag06 d时效应量达到最大,其浓度每上升10μg/m^(3),相对危险度(relative risk,RR)及95%CI分别为1.04%(1.00%~1.07%)、1.01%(1.00%~1.02%)、1.45%(1.27%~1.66%)、1.16%(1.11%~1.22%)。女性对PM_(2.5)、NO_(2)更敏感,RR值及其95%CI分别为1.06%(1.01%~1.11%)、1.18%(1.11%~1.26%);男性对PM10、SO_(2)更敏感,RR值及其95%CI分别为1.01%(1.00%~1.02%)、1.49%(1.26%~1.76%)。≥65岁老年人对PM_(2.5)、PM_(10)、NO_(2)更敏感,RR值及其95%CI分别为1.13%(1.03%~1.24%)、1.03%(1.01%~1.06%)、1.22%(1.08%~1.38%);0~<15岁儿童对SO2更敏感,RR值及其95%CI为1.49%(1.29%~1.72%)。PM_(10)、SO_(2)和NO_(2)在冷季的影响更显著,RR值及其95%CI分别为1.01%(1.00%~1.02%)、1.21%(1.02%~1.43%)、1.13%(1.07%~1.19%)。双污染物模型结果显示,在校正共污染物后模型基本保持稳定。结论天水市大气污染物PM_(2.5)、PM_(10)、SO_(2)、NO_(2)的浓度上升均会增加AURI的住院风险,且对不同性别、年龄和季节的影响模式不同。

Objective To explore the effects of ambient air pollutants on hospital admissions for acute upper respiratory infections in Tianshui City in order to provide reference for local governments to improve air quality.Methods Data of patients hospitalized for acute upper respiratory infections in public hospitals in Tianshui from January 1,2018 to December 31,2020 as well as local meteorological data and air pollutants data during the same period were collected.After controlled for confounding factors such as meteorological factors,day-ofweek effects and holiday effects,the distribution lag nonlinear model was used to quantify the association between daily air pollutants and daily hospital admissions and the lagged effects.The effect modifications stratified by gender,age and season were further examined.In addition,two-pollutant model and varied time freedom were used to test the stability of the model.Results The total number of hospital admissions for acute upper respiratory infections in Tianshui during the study period was 10094,with an average daily admission of 9.The effect sizes of PM_(2.5)at lag07,PM_(10)at lag02,SO_(2) at lag07 and NO_(2) at lag06 reached their maximum.For every10μg/m^(3) increase of air pollutants PM_(2.5),PM_(10),SO_(2),NO_(2),the relative risks(RR)and 95% confidence intervals(95%CI)were 1.04%(1.00%-1.07%),1.01%(1.00%-1.02%),1.45%(1.27%-1.66%),1.16%(1.11%-1.22%),respectively.Females were more sensitive to PM_(2.5),NO_(2) with RR values and 95%CI of 1.06%(1.01%-1.11%)and 1.18%(1.11%-1.26%)respectively.While males were more sensitive to PM_(10)and SO_(2)with RR values and 95%CI of 1.01%(1.00%-1.02%)and 1.49%(1.26%-1.76%),respectively.Older adults aged 65 years and over were more sensitive to PM_(2.5),PM_(10)and NO_(2) with RR values and 95%CI of1.13%(1.03%-1.24%),1.03%(1.01%-1.06%)and 1.22%(1.08%-1.38%),respectively.While children aged 0-15 years were more sensitive to SO_(2) with RR value and 95%CI of 1.49%(1.29%-1.72%).The effects of PM_(10),SO_(2) and NO_(2) were more significant in the cold season with RR values and 95%CI of 1.01%(1.00%-1.02%),1.21%(1.02%-1.43%)and 1.13%(1.07%-1.19%),respectively.The two-pollutant model demonstrated that the model remained stable after correction for co-contaminants.Conclusions Elevated concentrations of ambient air pollutants PM_(2.5),PM_(10),SO_(2) and NO_(2) in Tianshui increase the risk of hospitalization for acute upper respiratory infections,with different patterns of effects stratified by gender,age and season.