中文关键词空气污染短期影响时间序列分析哮喘门诊人数 英文关键词air pollutionshort-term effectstime-series analysisasthmahospital outpatient visits

作者	单位	E-mail
王安旭	南开大学环境科学与工程学院, 天津 300350 南开大学城市交通污染防治研究中心, 天津 300071	wang_anxu@126.com
陈曦	天津医科大学公共卫生学院劳动卫生与环境卫生学系, 天津 300070
宋从波	南开大学环境科学与工程学院, 天津 300350 南开大学城市交通污染防治研究中心, 天津 300071
应颂敏	浙江大学医学院附属第二医院呼吸与危重症医学科, 杭州 310006 浙江大学医学院药理教研室, 杭州 310031
李倩	南开大学环境科学与工程学院, 天津 300350 南开大学城市交通污染防治研究中心, 天津 300071
吴琳	南开大学环境科学与工程学院, 天津 300350 南开大学城市交通污染防治研究中心, 天津 300071
毛洪钧	南开大学环境科学与工程学院, 天津 300350 南开大学城市交通污染防治研究中心, 天津 300071	hongjun_mao@hotmail.com

中文摘要 为研究大气细颗粒物污染对哮喘门诊就诊的短期影响及各人群的易感性差异，收集杭州市某医院2013年1月1日至2015年12月31日哮喘门诊（含急诊）资料，以及同期空气污染数据和气象数据，考虑到污染物浓度与呼吸系统疾病就诊人次及气象因素之间的非线性关系，采用时间序列广义相加模型及分层分析的方法研究空气污染对哮喘影响的滞后效应及人群按性别、年龄分层的易感性差异，对平均温度、平均相对湿度及长期趋势等采用自然立方样条函数进行平滑拟合，同时用哑元变量控制星期几效应和节假日效应的影响.在P=0.01水平下PM_2.5、NO₂、SO₂之间均呈显著的正相关性，而气温与3种污染物之间呈显著的负相关性.PM_2.5日均浓度每升高10 μg·m^-3，对哮喘就诊人次影响的相对危险度（relative risk，RR）在滞后5d达到最大值，为1.0056（95% CI：1.0021~1.0091），且具有统计学意义（P<0.05）.在男性人群和18~64岁人群中，细颗粒物浓度对于哮喘就诊人次的影响在滞后3~5 d的RR值均具有统计学意义，在女性人群和≥ 65岁人群中，在滞后5 d时RR值均具有统计学意义.在多污染物模型中，引入NO₂的影响后PM_2.5对哮喘就诊人次的影响在滞后5 d时的RR有所提升.杭州市PM_2.5浓度的升高可能会造成3~5 d内哮喘门诊就诊人次的增加，且对男性人群和老年人群影响更为明显. 英文摘要 To study the short-term effects of air pollution on asthma visits and differences in susceptibility to various groups of people, data for asthma visits from January 1, 2013 to December 31, 2015 were obtained from a Hangzhou hospital. Considering the nonlinear relationships among concentration of air pollutants, respiratory hospital outpatient visits and meteorological factors, Generalized Additive Models (GAM) and stratification analysis were used to explore the lag effects and differences in people stratifications. The natural cubic spline function was used for smoothing the average temperature, the average relative humidity and the long-term trend, using dummy variables to control the effect of the day of the week and of holidays. Correlation of PM_2.5, NO₂ and SO₂ daily mean concentrations were significant (under 0.01) in Spearman correlation analysis, while the correlations of daily mean temperature and 3 pollutants were significantly negative. The lag effects of PM_2.5 concentration on outpatient visits of asthma peaked at 3-5 days. The relative risk of asthma reached maximum at lag day 5 as 1.0056 (95% CI:1.0021-1.0091), with per 10 μg·m^-3 increment of PM_2.5 concentration. The relative risk of asthma outpatient visits of all groups of patients were statistically significant (P<0.05). The relative risk of asthma outpatient visits of males and young and middle-aged group were statistically significant at lag days 3-5, and for females and the elderly, were statistically significant at lag day 5. With the introduction of the effects of NO₂, the relative risk of asthma outpatient visits increased at lag 5 day in co-pollutant models. The authors concluded that the increase of PM_2.5 may be related to the increase of asthma hospital outpatient visits within 3-5 days in Hangzhou, and the effects on male group and elderly group were more definite.

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