2016—2020年合肥市大气污染物与急性上呼吸道感染急诊量的关系

杨吉丹; 孙浩翔; 胡月; 赵爽; 康芮含; 胡华青

doi:10.16766/j.cnki.issn.1674-4152.003496

2016—2020年合肥市大气污染物与急性上呼吸道感染急诊量的关系

doi: 10.16766/j.cnki.issn.1674-4152.003496

1.
安徽医科大学第一附属医院全科，安徽合肥 230022
2.
安徽医科大学第一附属医院门诊部
3.
安徽医科大学第一附属医院物资设备处

基金项目:

国家重点研发计划项目 2020YFC2006506

详细信息

通讯作者:
胡华青，E-mail：huhuaqing_ayfy@163.com

中图分类号: R56 X51
计量
- 文章访问数: 145
- HTML全文浏览量: 63
- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2023-07-30
- 网络出版日期: 2024-07-20

Association between air pollution and the number of emergency visits for acute upper respiratory infections in Hefei city, Anhui, 2016-2020

1.
Department of General Practice, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China

摘要

摘要: 目的探讨合肥市大气污染物与急性上呼吸道感染急诊间的关系。方法收集2016年1月1日-2020年12月31日于安徽医科大学第一附属医院急诊就诊的急性上呼吸道感染患者的病例资料、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, 分析大气污染物暴露对急性上呼吸道感染急诊量的影响, 并对性别、年龄进行分层研究。结果 2016-2020年合肥市急性上呼吸道感染总急诊量为55 902人, 且冷季高于暖季。在所有污染物中, SO₂对急性上呼吸道感染影响最大, 在lag07时其滞后效应达到最大, RR及95%CI为1.194(1.072~1.330)。同时, 气态污染物(如SO₂、NO₂)的RR估计值大于颗粒物(如PM2.5、PM10)的RR估计值。性别分层发现, SO₂、NO₂对女性急诊量的影响更大, PM2.5、PM10、O₃对男性急诊量的影响更大。年龄分层发现, PM2.5、PM10、NO₂对>65岁人群急诊量的影响更大, SO₂对18~65岁人群急诊量影响更大。结论合肥市大气污染物浓度升高会增加急性上呼吸道感染急诊就诊风险, 且对不同性别、年龄影响不同。
- 大气污染物 /
- 急性上呼吸道感染 /
- 急诊量 /
- 分布滞后非线形模型
Abstract: Objective To evaluate the association between air pollutants and acute upper respiratory tract infections (AURTI) in the emergency department of Hefei City. Methods Emergency hospital visits for AURTI in public hospitals in Hefei from January 1, 2016 to December 31, 2020, meteorological data and air pollutants data for the same period were collected for the study.After controlling for confounding factors such as meteorological factors, day-of-week effects and holiday effects, the distribution lag nonlinear model was used to quantify the association between daily air pollutants and daily emergency visits.The results were then stratified by gender and age. Results The total number of AURTI emergency department visits in Hefei from 2016 to 2020 was 55 902, and it is higher in the cold season than in the warm season.Among all pollutants, SO₂ had the greatest effect on AURTI, with its lag effect reaching a maximum at lag07, with a RR and 95%CI of 1.194(1.072-1.330).The relative risks (RR) of gaseous pollutants (SO₂, NO₂) were higher than those of particulate matter (PM2.5, PM10).Gender stratification showed that females seemed to be more vulnerable to exposure to SO₂ and NO₂, while males were more vulnerable to PM2.5, PM10 and O₃.In the age stratification, people aged >65 years were more sensitive to PM2.5, PM10 and NO₂, people aged 18-65 years were more sensitive to SO₂. Conclusion Elevated concentrations of air pollutants in Hefei all increased the risk of emergency admissions for AURTI, with different patterns of effects by gender and age.
- Air pollution /
- Acute upper respiratory tract infections /
- Emergency admissions /
- Distribution lag nonlinear model

HTML全文

图 1 2016—2020年合肥市急性上呼吸道感染急诊量与大气污染浓度的时间序列

Figure 1. Time series analysis of acute upper respiratory tract infection emergency visits and air pollution levels in Hefei from 2016 to 2020

下载: 全尺寸图片幻灯片

图 2 大气污染物在连续滞后不同天数时急性上呼吸道感染急诊量的污染物模型分析[RR(95% CI)]

Figure 2. Analysis of pollutant models for acute upper respiratory tract infection emergency visits with varying day lag of air pollutants [RR(95% CI)]

下载: 全尺寸图片幻灯片

表 1 2016—2020年合肥市大气污染物、气象因素和急性上呼吸道感染急诊量

Table 1. Air pollutants, meteorological factors, and emergency visits for acute upper respiratory infections in Hefei City from 2016 to 2020

项目	最小值	M(P₂₅, P₇₅)	最大值
大气污染物
PM2.5(μg/m³)	5.0	40.0(27.0, 61.0)	235.0
PM10(μg/m³)	11.0	70.0(48.0, 97.0)	322.0
SO₂(μg/m³)	2.0	9.0(5.0, 12.0)	58.0
NO₂(μg/m³)	10.0	39.0(29.0, 55.0)	139.0
CO(mg/m³)	0.3	0.8(0.6, 1.0)	2.8
O₃(μg/m³)	6.0	109.0(75.0, 146.0)	309.0
气象因素
平均温度(℃)	-5.9	17.3(8.6, 24.6)	35.6
湿度(%)	33.0	78.0(69.0, 86.0)	99.0
气压(hPa)	987.5	1 012.0(1 003.4, 1 019.3)	1 041.4
急性上呼吸道感染急诊量(人次/d)
总急诊量	0	27(18, 40)	141
男性	0	15(9, 22)	75
女性	0	12(8, 19)	68
0~17岁	0	22(14, 33)	123
18~65岁	0	4(2, 7)	42
>65岁	0	0(0, 0)	3

下载: 导出CSV

表 2 2016—2020年合肥市大气污染物、气象因素及急性上呼吸道感染急诊量的相关性分析

Table 2. Correlation analysis of air pollutants, meteorological factors, and acute upper respiratory infection emergency visits in Hefei from 2016 to 2020

指标	PM2.5	PM10	SO₂	NO₂	CO	O₃	温度	气压	湿度
PM10	0.786^a
SO₂	0.528^a	0.589^a
NO₂	0.571^a	0.682^a	0.536^a
CO	0.840^a	0.664^a	0.565^a	0.618^a
O₃	-0.149	0.146	-0.018	-0.027	-0.156
温度	-0.475^a	-0.221^a	-0.236^a	-0.323^a	-0.348^a	0.645^a
气压	0.439^a	0.264^a	0.336^a	0.381^a	0.345^a	-0.539^a	-0.546^a
湿度	-0.142	-0.349^a	-0.315^a	-0.235^a	-0.015	-0.279^a	0.034	-0.208^a
总急诊量	0.215^a	0.142	-0.077	0.154	0.191	-0.043	-0.151	0.089	0.010
注：^aP < 0.05。

下载: 导出CSV

表 3 最强滞后时间下大气污染物对不同性别、年龄急性上呼吸道感染急诊量的影响[RR(95% CI)]

Table 3. Impact of air pollutants on emergency visits for acute upper respiratory infections by gender and age under maximum lag time [RR(95% CI)]

项目	PM2.5(lag07)	PM10(lag07)	SO₂(lag07)	NO₂(lag07)	CO(lag07)	O₃(lag01)
总急诊量	1.044(1.027~1.060)^a	1.029(1.018~1.040)^a	1.194(1.072~1.330)^a	1.060(1.037~1.085)^a	1.048(1.013~1.084)^a	1.009(1.004~1.014)^a
男性	1.044(1.026~1.063)^a	1.029(1.017~1.042)^a	1.143(1.010~1.294)^a	1.057(1.030~1.084)^a	1.061(1.021~1.103)^a	1.010(1.004~1.017)^a
女性	1.042(1.024~1.061)^a	1.028(1.016~1.041)^a	1.258(1.112~1.423)^a	1.065(1.038~1.093)^a	1.034(0.995~1.075)	1.007(1.001~1.014)^a
0~17岁	1.039(1.022~1.057)^a	1.028(1.017~1.040)^a	1.176(1.046~1.322)^a	1.058(1.032~1.084)^a	1.048(1.011~1.087)^a	1.009(1.003~1.015)^a
18~65岁	1.057(1.031~1.084)^a	1.027(1.009~1.045)^a	1.260(1.061~1.496)^a	1.071(1.033~1.110)^a	1.040(0.984~1.099)	1.008(0.999~1.017)
>65岁	1.138(1.014~1.278)^a	1.101(1.008~1.204)^a	1.352(0.600~3.045)	1.214(1.011~1.457)^a	0.965(0.733~1.268)	1.014(0.966~1.064)
注：^aP < 0.05。

下载: 导出CSV

表 4 不同时间自由度下模型的稳定性[RR(95% CI)]

Table 4. Stability of the model at different degrees of freedom [RR(95% CI)]

df	PM2.5(lag07)	PM10(lag07)	SO₂(lag07)	NO₂(lag07)	CO(lag07)	O₃(lag01)
6	1.049(1.033~1.065)^a	1.037(1.027~1.046)^a	1.279(1.159~1.413)^a	1.078(1.056~1.100)^a	1.048(1.014~1.082)^a	1.011(1.005~1.016)^a
7	1.044(1.027~1.060)^a	1.029(1.018~1.040)^a	1.194(1.072~1.330)^a	1.060(1.037~1.085)^a	1.048(1.013~1.084)^a	1.009(1.004~1.014)^a
8	1.043(1.026~1.059)^a	1.030(1.019~1.041)^a	1.188(1.066~1.324)^a	1.060(1.036~1.086)^a	1.045(1.010~1.081)^a	1.008(1.003~1.014)^a
注：^aP < 0.05。

下载: 导出CSV

参考文献(17)

[1]	肖仕明, 左伟, 昝博仁, 等. 529015例急诊患者的特征和就诊规律分析[J]. 四川医学, 2022, 43(4): 383-391. https://www.cnki.com.cn/Article/CJFDTOTAL-SCYX202204013.htm XIAO S, ZUO W, ZAN B, et al. Analysis of the emergency patients characteristics and visiting patterns based on 529015 cases[J]. Sichuan Medical Journal, 2022, 43(4): 383-391. https://www.cnki.com.cn/Article/CJFDTOTAL-SCYX202204013.htm
[2]	JIN X, REN J, LI R, et al. Global burden of upper respiratory infections in 204 countries and territories, from 1990 to 2019[J]. E Clin Med, 2021, 37: 100986. DOI: 10.1016/j.eclinm.2021.100986.
[3]	LIU Q, QIN C, DU M, et al. Incidence and mortality trends of upper respiratory infections in China and other Asian countries from 1990 to 2019[J]. Viruses, 2022, 14(11): 2550. DOI: 10.3390/v14112550.
[4]	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, XIONG Z, 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
[5]	CHENG J, SU H, XU Z. Intraday effects of outdoor air pollution on acute upper and lower respiratory infections in Australian children[J]. Environ Pollut, 2021, 268(Pt A): 115698. DOI: 10.1016/j.envpol.2020.115698.
[6]	陈思璇, 何永梅, 姚进文, 等. 2018—2020年甘肃省天水市大气污染对急性上呼吸道感染住院患者的影响[J]. 中国预防医学杂志, 2023, 24(9): 964-970. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYC202309015.htm CHEN S, HE Y, YAO J, et al. Effects of ambient air pollution on hospital admissions for acute upper respiratory infections in Tianshui City, 2018-2020[J]. Chinese Preventive Medicine, 2023, 24(9): 964-970. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYC202309015.htm
[7]	吴冰霞, 孙桂芳, 李翔, 等. 石河子市大气污染物及气象因素与儿童肺炎住院人数的相关性研究[J]. 现代医药卫生, 2020, 36(12): 1777-1780, 1784. doi: 10.3969/j.issn.1009-5519.2020.12.001 WU B X, SUN G F, LI X, et al. Correiation study between atmospheric pollutants and meteorological factors and the number of hospitalized children with pneumonia in Shihezi city[J]. Journal of Modern Medicine & Health, 2020, 36(12): 1777-1780, 1784. doi: 10.3969/j.issn.1009-5519.2020.12.001
[8]	LIU Y, WANG Y, DONG J, et al. Association between air pollution and emergency department visits for upper respiratory tract infection in Lanzhou, China[J]. Environ Sci Pollut Res Int, 2022, 29(19): 28816-28828. doi: 10.1007/s11356-021-17932-2
[9]	LIU L, LIU C, CHEN R, et al. Associations of short-term exposure to air pollution and emergency department visits for pediatric asthma in Shanghai, China[J]. Chemosphere, 2021, 263: 127856. DOI: 10.1016/j.chemosphere.2020.127856.
[10]	KIM K N, KIM S, LIM Y H, et al. Effects of short-term fine particulate matter exposure on acute respiratory infection in children[J]. Int J Hyg Environ Health, 2020, 229: 113571. DOI: 10.1016/j.ijheh.2020.113571.
[11]	TORNEVI A, OLSTRUP H, FORSBERG B. Short-term associations between PM10 and respiratory health effects in Visby, Sweden[J]. Toxics, 2022, 10(6): 333. DOI: 10.3390/toxics10060333.
[12]	SHERRIS A R, BEGUM B A, BAIOCCHI M, et al. Associations between ambient fine particulate matter and child respiratory infection: the role of particulate matter source composition in Dhaka, Bangladesh[J]. Environ Pollut, 2021, 290: 118073. DOI: 10.1016/j.envpol.2021.118073.
[13]	ZHANG F, ZHANG H, WU C, et al. Acute effects of ambient air pollution on clinic visits of college students for upper respiratory tract infection in Wuhan, China[J]. Environ Sci Pollut Res Int, 2021, 28(23): 29820-29830. doi: 10.1007/s11356-021-12828-7
[14]	SURYADHI M A H, ABUDUREYIMU K, KASHIMA S, et al. Nitrogen dioxide and acute respiratory tract infections in children in Indonesia[J]. Arch Environ Occup Health, 2020, 75(5): 274-280. doi: 10.1080/19338244.2019.1631245
[15]	ZHAI G, ZHANG L. Impact of fine particulate matter 2.5 on hospitalization for upper respiratory tract infections in Lanzhou urban industrial area, China[J]. Ann Agric Environ Med, 2023, 30(3): 462-467. doi: 10.26444/aaem/171499
[16]	COLONNA K J, ALAHMAD B, CHOMA E F, et al. Acute exposure to total and source-specific ambient fine particulate matter and risk of respiratory disease hospitalization in Kuwait[J]. Environ Res, 2023, 237(Pt 2): 117070. DOI: 10.1016/j.envres.2023.117070.
[17]	ZHUANG J, BAI H, SUN J, et al. The association between fine particulate matter and acute lower respiratory infections in Yancheng City, China[J]. Environ Sci Pollut Res Int, 2021, 28(43): 61723-61731. doi: 10.1007/s11356-021-15102-y