空气污染物对合肥市心律失常患者住院风险影响的时间序列研究

张倩茹; 朱纪荣; 朱美; 葛建军; 李宝珠

doi:10.16766/j.cnki.issn.1674-4152.003179

空气污染物对合肥市心律失常患者住院风险影响的时间序列研究

doi: 10.16766/j.cnki.issn.1674-4152.003179

张倩茹^{1, 2},
朱纪荣²,
朱美³,
葛建军⁴,
李宝珠^1, ,

1.
安徽医科大学公共卫生学院流行病与卫生统计学系，安徽合肥 230032
2.
中国科学技术大学附属第一医院南区心脏大血管外科重症监护室，安徽合肥 230036
3.
安徽医科大学第二附属医院老年医学科，安徽合肥 230601
4.
中国科学技术大学附属第一医院心脏大血管外科，安徽合肥 230036

基金项目:

国家自然科学基金项目 81803310

安徽省转化医学研究所科研基金项目 2021zhyx-C21

安徽省自然科学基金项目 2008085MH240

详细信息

通讯作者:
李宝珠，E-mail: lbz88730@163.com

中图分类号: R541.7 R122.7
计量
- 文章访问数: 274
- HTML全文浏览量: 115
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2022-09-19
- 网络出版日期: 2023-10-19

Time series study on the effect of air pollutants on hospitalization risk of arrhythmia patients in Hefei

ZHANG Qianru^{1, 2},
ZHU Jirong²,
ZHU Mei³,
GE Jianjun⁴,
LI Baozhu^{1
, ,}

1.
Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China

摘要

摘要: 目的探讨合肥市空气污染物暴露对心律失常每日住院人数的影响，为制定适当的干预措施提供科学依据。方法收集2015—2020年期间合肥市每日日平均温度、日平均湿度等气象数据，空气污染物数据和心律失常患者住院人数数据。采用时间序列的分布滞后非线性模型分析2015—2020年合肥市空气污染物对人群发病住院人数的累积效应和滞后效应，并进行亚组分析。结果在控制长期趋势和混杂因素后，本研究显示，PM_2.5、PM₁₀、NO₂和CO对心律失常发病住院人数均有影响；在分组中，PM_2.5、PM₁₀和CO对女性患者、年龄＜65岁患者住院人数有影响，且均存在滞后效应，NO₂对男性患者住院人数有影响且存在滞后性。PM₁₀浓度每升高10 μg/m³，对心律失常住院人数的影响在当天差异有统计学意义，且效应值最大(RR=1.021，95% CI：1.004~1.038)；PM_2.5浓度每升高10 μg/m³, 对心律失常住院人数的影响累积至第1天差异有统计学意义，且累积效应值达最大(RR=1.025，95% CI：1.011~1.041)；NO₂和CO浓度每升高10 μg/m³，对心律失常住院人数的影响均累积至第2天差异有统计学意义，且累积效应值达最大(RR=1.111，95% CI: 1.010~1.223；RR=1.248，95% CI: 1.065~1.462)；SO₂和O₃对心律失常住院人数的影响差异均无统计学意义(均P>0.05)。结论合肥市空气污染物(PM_2.5、PM₁₀、NO₂、CO)浓度升高可导致居民心律失常发病住院风险增加。
- 空气污染物 /
- 住院人数 /
- 分布滞后非线性模型 /
- 时间序列研究
Abstract: Objective To investigate the effect of air pollutant exposure on the daily hospitalization number of cardiac arrhythmias in Hefei, and to provide a scientific basis for the development of appropriate intervention measures. Methods Meteorological data such as daily average temperature, daily average humidity, air pollutants (PM_2.5, PM₁₀, NO₂, SO₂, CO, O₃) and the number of hospitalizations of patients with cardiac arrhythmias were collected in Hefei city from 2015 to 2020. A time-series distributed lag nonlinear model was used to analyze the cumulative and lag effects of air pollutants on the number of hospital cases and hospitalizations in Hefei from 2015 to 2020, and subgroup analysis was performed. Results After controlling for long-term trends and confounding factors, this study showed that PM_2.5, PM₁₀, NO₂ and CO had a significant effect on the number of hospitalizations for arrhythmia onset. In the subgroup, PM_2.5, PM₁₀ and CO had an effect on the number of female patients and patients aged <65 years, and all had a lag effects. NO₂ had an effect on the number of male inpatients with a lag effect. Every increase of PM₁₀ concentration by 10 μg/m³ had a statistically significant difference in the number of hospitalized patients with arrhythmia on the same day, and the effect value was the largest(RR=1.021, 95% CI: 1.004-1.038). When PM_2.5 concentration increased by 10 μg/m³, there was a statistically significant difference in the number of hospitalized patients with arrhythmia on the first day, and the cumulative effect value reached the largest(RR=1.025, 95% CI: 1.011-1.041). When NO₂ and CO concentrations increased by 10 μg/m³, the effects on the number of hospitalized patients with arrhythmia accumulated to the second day, and the cumulative effect value reached the largest(RR=1.111, 95% CI: 1.010-1.223; RR=1.248, 95% CI: 1.065-1.462). The effects of SO₂ and O₃ on the number of hospitalized patients with arrhythmia were not statistically significant (all P>0.05). Conclusion The increased concentrations of air pollutants (PM_2.5, PM₁₀, NO₂, CO) in Hefei can lead to an increased risk of hospitalization for the development of cardiac arrhythmias in the population.
- Air pollutants /
- Number of hospitalizations /
- Distributed lag nonlinear model /
- Time series study

HTML全文

表 1 2015—2020年合肥市空气污染物浓度、气象因素、住院人数情况

Table 1. Air pollutant concentration, meteorological factors and number of inpatients in Hefei from 2015 to 2020

项目	最小值	P₂₅	P₅₀	P₇₅	最大值
空气污染物
PM₁₀(μg/m³)	8.00	48.00	71.00	99.00	361.00
SO₂(μg/m³)	2.00	6.00	9.00	13.00	58.00
NO₂(μg/m³)	9.00	28.00	37.00	52.00	137.00
PM_2.5(μg/m³)	5.00	28.00	42.00	64.00	243.00
CO(mg/m³)	0.30	0.60	0.80	1.00	2.80
O₃(μg/m³)	4.00	57.00	86.00	120.00	269.00
气象因素
日平均气温(℃)	-6.67	8.72	17.56	24.50	34.61
日相对湿度(%)	33.00	69.00	78.00	86.00	100.00
心律失常住院人数
每日人数(人)	0	2	4	5	13

下载: 导出CSV

表 2 2015—2020年合肥市空气污染物浓度与气象因素Spearman相关分析结果(r值)

Table 2. Spearman correlation analysis of air pollutant concentration and meteorological factors in Hefei from 2015 to 2020 (r value)

项目	日平均温度 (℃)	日相对湿度 (%)	PM₁₀ (μg/m³)	SO₂ (μg/m³)	NO₂ (μg/m³)	PM_2.5 (μg/m³)	CO (mg/m³)	O₃ (μg/m³)
日平均温度(℃)	1.000
日相对湿度(%)	0.025	1.000
PM₁₀(μg/m³)	-0.203^a	-0.508^a	1.000
SO₂(μg/m³)	-0.260^a	-0.418^a	0.626^a	1.000
NO₂(μg/m³)	-0.306^a	-0.287^a	0.639	0.440^a	1.000
PM_2.5(μg/m³)	-0.452^a	-0.182^a	0.812^a	0.565^a	0.546^a	1.000
CO(mg/m³)	-0.300^a	-0.006	0.658^a	0.598^a	0.532^a	0.815^a	1.000
O₃(μg/m³)	0.672^a	-0.363^a	0.074^a	-0.133^a	-0.013	-0.202^a	-0.231^a	1.000
注：^aP＜0.05。

下载: 导出CSV

表 3 单污染物模型中污染物浓度每增加10 μg/m³对不同人群心律失常住院人数的相对危险度和95%置信区间

Table 3. Relative risk and 95% confidence intervals for hospitalizations for arrhythmias for every 10 μg/m³ increasein contaminant concentration in a single contaminant model

单污染物模型	男性	女性	< 65岁	≥65岁
当日效应
PM₁₀	1.008(0.984~1.033)	1.037(1.009~1.066)^a	1.037(1.010~1.064)^a	1.007(0.983~1.032)
SO₂	1.052(0.952~1.162)	0.982(0.857~1.126)	1.049(0.926~1.188)	1.005(0.906~1.115)
NO₂	1.105(1.006~1.214)^a	1.007(0.882~1.149)	1.114(0.991~1.253)	1.038(0.939~1.148)
PM_2.5	0.994(0.975~1.012)	1.062(1.037~1.086)^a	1.052(1.029~1.075)^a	0.996(0.977~1.015)
CO	1.076(0.901~1.285)	1.535(1.209~1.950)^a	1.522(1.217~1.902)^a	1.056(0.880~1.266)
O₃	0.972(0.926~1.021)	0.981(0.926~1.040)	0.948(0.895~1.004)	1.003(0.956~1.053)
多日累积滞后最大效应
PM₁₀	1.007(0.970~1.046)	1.051(1.014~1.089)^a	1.040(1.004~1.077)^a	1.004(0.966~1.043)
SO₂	1.024(0.914~1.148)	1.146(0.937~1.401)	1.075(0.891~1.296)	1.006(0.862~1.175)
NO₂	1.168(1.026~1.330)^a	1.129(0.911~1.398)	1.134(0.967~1.330)	1.099(0.980~1.233)
PM_2.5	0.995(0.975~1.016)	1.082(1.054~1.111)^a	1.066(1.029~1.105)^a	1.003(0.983~1.024)
CO	1.130(0.912~1.400)	1.781(1.273~2.492)^a	1.648(1.202~2.259)^a	1.105(0.888~1.376)
O₃	1.020(0.943~1.103)	1.007(0.942~1.077)	1.003(0.929~1.083)	0.995(0.940~1.054)
注：^aP＜0.05。

下载: 导出CSV

表 4 单污染物模型中不同时间自由度敏感性分析

Table 4. Sensitivity analysis of different time degrees of freedom in a single pollutant model

变量	df=6	df=7	df=8	df=9
PM_2.5	1.017(1.004~1.031)^a	1.019(1.006~1.032)^a	1.019(1.006~1.033)^a	1.018(1.003~1.034)^a
PM₁₀	1.020(1.004~1.037)^a	1.021(1.004~1.038)^a	1.020(1.003~1.037)^a	1.019(1.002~1.036)^a
SO₂	1.037(0.963~1.117)	1.024(0.951~1.102)	1.025(0.952~1.103)	1.015(0.944~1.093)
CO	1.230(1.079~1.403)^a	1.235(1.084~1.407)^a	1.227(1.076~1.398)^a	1.217(1.069~1.386)^a
NO₂	1.071(0.998~1.150)	1.070(0.997~1.147)	1.063(0.992~1.141)	1.060(0.989~1.137)
O₃	0.968(0.935~1.001)	0.976(0.943~1.010	0.975(0.942~1.009)	0.975(0.943~1.009)
注：^aP＜0.05。

下载: 导出CSV

参考文献(20)

[1]	FU D G. Cardiac arrhythmias: diagnosis, symptoms, and treatments[J]. Cell Biochem Biophys, 2015, 73(2): 291-296. doi: 10.1007/s12013-015-0626-4
[2]	LIU C, CHEN R J, SERA F, et al. Ambient particulate air pollution and daily mortality in 652 cities[J]. N Engl J Med, 2019, 381(8): 705-715. doi: 10.1056/NEJMoa1817364
[3]	WU Y, LI M, TIAN Y H, et al. Short-term effects of ambient fine particulate air pollution on inpatient visits for myocardial infarction in Beijing, China[J]. Environ Sci Pollut Res Int, 2019, 26(14): 14178-14183. doi: 10.1007/s11356-019-04728-8
[4]	RAJAGOPALAN S, AL-KINDI S G, BROOK R D. Air pollution and cardiovascular disease: JACC state-of-the-art review[J]. J Am Coll Cardiol, 2018, 72(17): 2054-2070. doi: 10.1016/j.jacc.2018.07.099
[5]	KIM I S, YANG P S, LEE J, et al. Long-term exposure of fine particulate matter air pollution and incident atrial fibrillation in the general population: a nationwide cohort study[J]. Int J Cardiol, 2019, 283: 178-183. doi: 10.1016/j.ijcard.2018.12.048
[6]	ZHAN R X, CHEN S, WANG W Y, et al. The impact of short-term exposure to air pollutants on the onset of out-of-hospital cardiac arrest: a systematic review and meta-analysis[J]. Int J Cardiol, 2017, 226: 110-117. doi: 10.1016/j.ijcard.2016.10.053
[7]	ZHENG Q W, LIU H, ZHANG J, et al. The effect of ambient particle matters on hospital admissions for cardiac arrhythmia: a multi-city case-crossover study in China[J]. Environ Health, 2018, 17(1): 60. doi: 10.1186/s12940-018-0404-z
[8]	FANG Y, CHENG H Y, LI X, et al. Short-term exposure to ambient air pollution and atrial fibrillation hospitalization: a time-series study in Yancheng, China[J]. Ecotoxicol Environ Saf, 2021, 228: 112961. DOI: 10.1016/j.ecoenv.2021.112961.
[9]	GASPARRINI A, MASSCLOT P, SCORTICHINI M, et al. Small-area assessment of temperature-related mortality risks in England and Wales: a case time series analysis[J]. Lancet Planet Health, 2022, 6(7): e557-e564. doi: 10.1016/S2542-5196(22)00138-3
[10]	TOOCHCCK C, BAHNER D, BACHMANN D J. Carbon monoxide-induced atrial fibrillation resolved with hyperbaric oxygen[J]. Undersea Hyperba Med, 2020, 47(1): 145-149.
[11]	赵容, 洪也, 郑国峰, 等. 沈阳市大气污染物PM_2.5、PM₁₀、SO₂、NO₂浓度对呼吸系统疾病严重程度的影响[J]. 山东医药, 2022, 62(23): 11-14. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY202223003.htm ZHAO R, HONG Y, ZHENG G F, et al. Effects of PM_2.5, PM₁₀, SO₂ and NO₂ concentrations on severity of respiratory diseases in Shenyang[J]. Shandong Medical Journal, 2022, 62(23): 11-14. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY202223003.htm
[12]	MILOJCVIC A, WILKINSON P, ARMSTRONG B, et al. Short-term effects of air pollution on a range of cardiovascular events in England and Wales: case-crossover analysis of the MINAP database, hospital admissions and mortality[J]. Heart, 2014, 100(14): 1093-1098. doi: 10.1136/heartjnl-2013-304963
[13]	SANTURTÙN A, SANCHEZ-LORCNZO A, VILLAR A, et al. The influence of nitrogen dioxide on arrhythmias in Spain and its relationship with atmospheric circulation[J]. Cardiovas Toxicol, 2017, 17(1): 88-96. doi: 10.1007/s12012-016-9359-x
[14]	CHIU H F, TSAI S S, WENG H H, et al. Short-term effects of fine particulate air pollution on emergency room visits for cardiac arrhythmias: a case-crossover study in Taipei[J]. J Toxicol Environ Health A, 2013, 76(10): 614-623. doi: 10.1080/15287394.2013.801763
[15]	YANG M, ZHOU R Z, QIU X J, et al. Artificial intelligence-assisted analysis on the association between exposure to ambient fine particulate matter and incidence of arrhythmias in outpatients of Shanghai community hospitals[J]. Environ Int, 2020, 139: 105745. DOI: 10.1016/j.envint.2020.105745.
[16]	KVNZLI N, JERRETT M, MACK W J, et al. Ambient air pollution and atherosclerosis in Los Angeles[J]. Environ Health Perspect, 2005, 113(2): 201-206. doi: 10.1289/ehp.7523
[17]	KONDURACKA E, ROSTOFF P. Links between chronic exposure to outdoor air pollution and cardiovascular diseases: a review[J]. Environ Chem Lett, 2022, 20(5): 2971-2988. doi: 10.1007/s10311-022-01450-9
[18]	YUE C, YANG F, LI F W, et al. Association between air pollutants and atrial fibrillation in general population: a systematic review and meta-analysis[J]. Ecotoxicol Environ Saf, 2021, 208: 111508. DOI: 10.1016/j.ecoenv.2020.111508.
[19]	钟宇, 苏国媚, 熊志林, 等. 大气细颗粒物诱导IL-17A表达增强香烟暴露小鼠气道炎症反应的机制[J]. 中华全科医学, 2021, 19(4): 542-546. doi: 10.16766/j.cnki.issn.1674-4152.001856 ZHONG Y, SU G M, XIONG Z L, et al. PM-induced IL-17A expression enhances airway inflammation in cigarette-exposed mice[J]. Chinese Journal of General Practice, 2021, 19(4): 542-546. doi: 10.16766/j.cnki.issn.1674-4152.001856
[20]	ZHANG S G, LU W G, WEI Z Q, et al. Air pollution and cardiac arrhythmias: from epidemiological and clinical evidences to cellular electrophysiological mechanisms[J]. Front Cardiovasc Med, 2021, 8: 736151. DOI: 10.3389/fcvm.2021.736151.