天津市气象因素和大气污染物对慢性阻塞性肺疾病就诊人次的影响及其交互效应

Effects of meteorological factors and air pollutants on chronic obstructive pulmonary disease patient visits in Tianjin and their interactive effects

目的探讨气象因素和大气污染物对慢性阻塞性肺疾病(COPD)就诊人次的影响及其交互作用,为开展健康气象预报与服务以及COPD的防治提供依据。方法COPD疾病数据来源于天津市某三甲医院2012年1月1日至2021年12月31日共10年的就诊数据。同期气象数据来自于天津市气象信息中心天津城市气候监测站2012至2021年逐日气象数据。大气环境资料来自于天津市生态环境监测中心。采用R 4.1.2软件应用广义相加模型分析气象因素和大气污染物对COPD就诊人次的影响及其交互作用。结果基于广义相加模型的单因素分析结果显示,24 h内平均气温下降幅度超过5.0℃时,每降低1℃,1 d后COPD日就诊人次增加3.98%;气温日较差大于13.2℃时,每升高1℃,3 d后COPD就诊人次增加1.44%;PM_(10)>233μg/m^(3)或PM_(2.5)>128μg/m^(3)或O_(3)>175μg/m^(3)时,每增加10μg/m^(3),5~7 d后COPD日就诊人次增加1.00%~2.53%。交互作用分析结果显示,冬季24 h内平均气温下降幅度超过5.0℃,PM_(10)浓度≥227μg/m^(3)时,PM_(10)浓度每升高10μg/m^(3),COPD日就诊人次增加27.39%(95%CI:0.50%~63.04%)或PM_(2.5)浓度≥147μg/m^(3)时,PM_(2.5)浓度每升高10μg/m^(3),COPD日就诊人次增加8.83%(95%CI:1.41%~20.24%)。春夏季气温日较差<9℃、O_(3)浓度>193μg/m^(3)时,O_(3)浓度每升高10μg/m^(3),COPD日就诊人次增加4.69%(95%CI:1.71%~7.65%)。结论24 h内平均气温下降幅度、气温日较差以及中度以上环境污染对COPD就诊人次有影响,且气象因素和大气污染物对其影响存在交互作用。

Objective To explore the effects of meteorological factors and air pollutants on chronic obstructive pulmonary disease(COPD)patient visits and their interactive effects,and provide the basis for health weather forecast and service and for prevention and treatment of COPD.Methods The data of COPD were from medical treatment data of a tertiary hospital of Tianjin from January 1,2012 to December 31,2021.Meteorological data of same duration were from Tianjin Meteorological Information Center,Tianjin City Climate Monitoring Station from 2012 to 2021.Air environment data were from Tianjin Ecological Environment Monitoring Center.Generalized additive model(GAM)was used to analyze the the effects and interaction of meteorological factors and air pollutants on COPD patient visits.The used software was R 4.1.2.Results GAM univariate analysis showed that when the average air temperature decreased by more than 5.0℃within 24 h,for each 1℃decrease,daily COPD patient visits increased by 3.98% after 1 d;when the daily temperature difference was greater than 13.2℃,for each 1℃increase,COPD patient visits increased by 1.44%after 3 d;when PM_(10)>233μg/m^(3) or PM_(2.5)>128μg/m^(3) or O_(3)>175μg/m^(3),for every 10μg/m^(3) increase,daily COPD visits increased by 1.00%to 2.53% after 5 to 7 d.The analysis of interaction showed that in winter,the average temperature decreased by more than 5.0℃,and the PM_(10) concentration was≥227μg/m^(3),for 10μg/m^(3) increase,the daily visits of COPD increased by 27.39%(95%CI:0.50%-63.04%);or for each 10μg/m^(3) increase in PM_(2.5) concentration,there was an 8.83% increase in daily COPD visits(95%CI:1.41%-20.24%).In spring and summer,the daily temperature difference was less than 9℃and the O_(3) concentration was>193μg/m^(3),for every 10μg/m^(3) increase in O_(3) concentration,the daily COPD patient visits increased by 4.69%(95%CI:1.71%-7.65%).Conclusion The average temperature drop within 24 h,the daily temperature difference,and the moderate environmental pollution affects COPD patient visits,and there is an interaction between meteorological factors and air pollutants.