石家庄市大气NO_(2)短期暴露对儿童神经系统门诊量影响的病例交叉研究

A case-crossover study on association between short-term atmospheric NO_(2) exposure and outpatient visits due to pediatric neurological system conditions in Shijiazhuang

[背景]作为交通污染物的重要组成部分,有研究表明空气污染物中的二氧化氮(NO_(2))对神经系统具有毒性效应,但关于NO_(2)暴露与儿童神经系统疾病关系的相关研究有限。[目的]探讨石家庄市大气中NO_(2)短期暴露对儿童神经系统疾病门诊量的影响。收集2013—2021年河北省石家庄市空气污染物数据、气象数据以及河北省儿童医院神经系统疾病门诊量数据,空气污染物数据包括可吸入颗粒物(PM_(10))、细颗粒物(PM_(2.5))、二氧化硫(SO_(2))、NO_(2)、一氧化碳(CO)的日均质量浓度以及O_(3)的日最大8 h平均浓度;气象数据包括每日平均气压、气温、相对湿度、风速以及日照时间。采用时间分层的病例交叉设计建立条件logistic回归模型分析NO_(2)和儿童神经系统疾病门诊就诊之间的关联性,并根据性别(男、女)以及年龄(0~6岁、7~14岁)进行分层分析。[结果]研究共纳入有效儿童神经系统疾病门诊数据154348人次,NO_(2)的日均浓度为49.3μg·m^(-3)。单污染物模型分析结果显示,NO_(2)会增加儿童神经系统疾病的门诊就诊风险,NO_(2)与儿童门诊就诊的关联在lag0时最高:大气NO_(2)暴露浓度每增加10μg·m^(-3),儿童神经系统疾病就诊量增加1.40%(95%CI:1.05%~1.74%)。分层分析结果显示,大气NO_(2)暴露增加了女童的神经系统疾病门诊就诊风险(ER=1.54,95%CI:1.01~2.08)以及7~14岁年龄组儿童的神经系统疾病门诊就诊风险(ER=2.35,95%CI:1.68~3.02)。在纳入PM_(2.5)(ER=1.96,95%CI:1.49~2.43)、SO_(2)(ER=2.09,95%CI:1.62~2.55)、O_(3)(ER=1.40,95%CI:1.06~1.74)后,NO_(2)暴露对儿童神经系统疾病门诊量的影响仍然具有统计学意义;全污染物模型分析结果仍具有统计学意义(ER=2.53,95%CI:1.97~3.08)。[结论]石家庄市大气NO_(2)短期暴露对儿童神经系统疾病门诊量的影响为急性效应,并且具有独立健康效应,其中7~14岁儿童是NO_(2)暴露危害的敏感人群。

[Background]Nitrogen dioxide(NO_(2)),a crucial component of traffic pollutants,has been shown in studies to exert toxic effects on the nervous system.However,there is a limited body of research examining the relationship between NO_(2)exposure and neurological disorders in children.[Objective]To explore the impact of short-term NO_(2)exposure on the outpatient visits due to pediatric neurological diseases in Shijiazhuang.[Methods]From 2013 to 2021,we collected outpatient data related to neurological diseases at the Children's Hospital in Shijiazhuang,Hebei Province.We also collected air pollution data and meteorological data of the same city.The air pollution data included daily average concentrations of inhalable particles(PM_(10)),fine particulate matter(PM_(2.5)),sulfur dioxide(SO_(2)),NO_(2),carbon monoxide(CO),and daily maximum 8-hour average concentration of ozone(O_(3)).The meteorological data comprised daily average atmospheric pressure,temperature,relative humidity,wind speed,and sunshine duration.Employing a time-stratified case-crossover design,we used conditional logistic regression models to analyze the association between NO_(2)and pediatric outpatient visits for neurological diseases.Stratification analyses were conducted based on gender(male,female)and age groups(0-6 years,7-14 years).[Results]The study included a total of 154348 valid pediatric outpatient visits for neurological diseases.The daily average concentration of NO_(2)was 49.3μg·m^(-3)for the study period.The results from the single-pollutant model indicated that NO_(2)increased the risk of pediatric neurological outpatient visits,with the highest association observed at lag0.Specifically,for every 10μg·m^(-3)increase in atmospheric NO_(2)exposure,there was a 1.40%increase(95%CI:1.05%,1.74%)in pediatric neurological outpatient visits.The stratification analyses revealed that increased atmospheric NO_(2)exposure was associated with an elevated risk of neurological outpatient visits for girls(ER=1.54,95%CI:1.01,2.08)and children aged 7-14 years(ER=2.35,95%CI:1.68,3.02).Even after introducing PM_(2.5)(ER=1.96,95%CI:1.49,2.43),SO_(2)(ER=2.09,95%CI:1.62,2.55),and O_(3)(ER=1.40,95%CI:1.06,1.74)to the models,the impact of NO_(2)exposure on pediatric neurological outpatient visits remained statistically significant.The results of the multi-pollutant model also indicated a significant association(ER=2.53,95%CI:1.97,3.08).[Conclusion]The effect of short-term exposure to atmospheric NO_(2)on the outpatient visits of children with neurological diseases in Shijiazhuang is acute and independent,especially for children aged 7-14.