大气污染物对上海市某医院儿科呼吸病门急诊就诊量影响的病例交叉研究

A case-crossover study on the impact of air pollution on the number of pediatric respiratory outpatient and emergency visits in a hospital in Shanghai

目的评估大气污染物(PM_(10),SO_(2),NO_(2))浓度与某综合医院儿科呼吸系统疾病门急诊量的相关性。方法采集2013年5月1日至2022年3月20日浦东新区某医院儿科呼吸系统疾病门急诊就诊资料、上海市大气污染物资料及浦东新区气象资料,采用与分布滞后非线性模型相结合的时间分层-病例交叉研究的方法,探讨大气污染物(PM_(10),SO_(2),NO_(2))与儿科呼吸系统疾病门急诊量的相关性。结果三种大气污染物(PM_(10),SO_(2),NO_(2))浓度与儿科呼吸系统疾病门急诊就诊量呈正相关。其中PM10浓度对儿科呼吸系统疾病门急诊就诊量的影响在累积6d(Lag0~5)的效应最强,SO_(2)与NO_(2)的影响在累积8 d(lag0~7d)的效应最强。PM_(10)浓度每上升10μg/m^(3),累积6d(Lag0~5)儿科呼吸系统疾病就诊量上升1.10%(95%CI:0.97%~1.23%);SO_(2)与NO_(2)浓度每上升10μg/m^(3),累积8d(Lag0~7)儿科呼吸系统疾病就诊量分别上升5.64%(95%CI:5.16%~6.13%)与5.41%(95%CI:5.15%~5.66%)。男性儿科呼吸系统疾病就诊量受到PM_(10)与SO_(2)的影响更大;PM10对0~6岁婴幼儿及学龄前儿童的呼吸系统疾病就诊量效应强于7~14岁学龄儿童,SO_(2)与NO_(2)对7~14岁学龄儿童呼吸系统疾病就诊量效应强于0~6岁婴幼儿与学龄前儿童。结论大气污染物(PM_(10),SO_(2),NO_(2))与儿科呼吸系统疾病门急诊就诊量呈正相关,并表现出滞后与累积特征。男性与0~6岁儿童受大气污染的危害更为严重。

Objective To investigate the correlation between the concentration of air pollutants(PM_(10),SO_(2),NO_(2))and the number of outpatient and emergency visits for pediatric respiratory diseases in a general hospital in Shanghai.Methods Data including pediatric respiratory disease outpatient and emergency visits in a hospital in Pudong New Area of Shanghai from May 1,2013 to March 20,2022 were collected.Daily concentration of air pollutants including PM_(10),SO_(2)and NO_(2)and meteorological data in Pudong New Area during the same period were collected.A case-crossover study with distributed lag non-linear model was conducted to explore the correlation between air pollutants(PM_(10),SO_(2),NO_(2))and the number of outpatient and emergency visits for pediatric respiratory diseases.Results The concentrations of PM_(10),SO_(2)and NO_(2)were positively with the number of outpatient and emergency visits for pediatric respiratory diseases.The strongest cumulative effect was observed on six days lag(Lag0-5)for PM10.For a 10μg/m3 increase of the concentrations of PM10,the corresponding increase of cumulative pediatric respiratory disease outpatients was 1.10%(95%CI:0.97%-1.23%)in Lag0-5.The strongest cumulative effect was observed on eight days lag(Lag0-7)for SO_(2)and NO_(2).For a 10μg/m3 increase of the concentrations of SO_(2)and NO_(2),the corresponding increase of cumulative pediatric respiratory disease outpatients was 5.64%(95%CI:5.16%~6.13%)and 5.41%(95%CI:5.15%~5.66%)in Lag 0-7,respectively.The association of PM10 and SO_(2)with the number of pediatric respiratory disease visits in males was significantly stronger than that in females.The impact of PM10 on the number of pediatric respiratory disease visits in children aged 0-6 was higher than that in children aged 7-14,while the impact of SO_(2)and NO_(2)on the number of pediatric respiratory disease visits in children aged 7-14 was higher than that in children aged 0-6.Conclusion The concentration of ambient PM10,SO_(2),and NO_(2)is positively correlated with outpatient and emergency visits for pediatric respiratory diseases,with obvious lag and cumulative effect.Boys and children aged 0-6 are more susceptible to the hazard of air pollution.