上海PM2.5、NO2及空气质量指数与小学生因病缺勤的关系
Associations of PM2.5, NO2, and air quality index (AQI) with sickness absenteeism of primary school students in Shanghai
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摘要:
背景 大气污染可能会增加儿童因病缺勤，并增加相应的社会医疗和经济负担。
目的 探索当前上海市大气污染物及空气质量指数（AQI）与小学生因病缺勤的定量关系。
方法 抽取上海市嘉定、宝山、浦东及普陀四个区的6所小学，收集全体在校学生在2017和2018两个完整学年每日缺勤数和缺勤原因（排除因事或其他突发意外事故），以及同期六校周边大气监测站点日均空气污染物浓度和气象资料。构建广义相加模型，开展时间序列分析，调整温度、相对湿度、降水量、流感暴发时段、星期几效应等混杂因素，分析大气污染物、流感季节及AQI与小学生缺勤发生数的关系。
结果 本研究共纳入分析5 746名学生，在校期间平均每日缺勤人数为12.5人，六校每日总缺勤率为0.20%，冬春季高于夏秋季，流感季节高于非流感季节（均
P < 0.05）。研究期间年度日均PM2.5、NO2分别为（38.7±26.0）、（42.7±18.8）μg·m-3。调整混杂因素进行多变量回归分析显示，NO2每升高10 μg·m-3，因病缺勤人数增加2.3%~3.3%，且对缺勤人数的单日滞后及累积滞后效应可以持续1周，而AQI和PM2.5与儿童缺勤的关系不明显。流感分层分析结果表明，PM2.5、NO2和AQI在非流感季对缺勤影响均有统计学意义，RR （95%CI ）分别为1.021（1.004~1.039）、1.048（1.026~1.071）和1.015（1.001~1.030）。结论 2017—2018学年上海市大气污染中，NO2与在校小学生因病缺勤存在关联。能否单纯依据AQI对在校生开展学生健康管理，需进一步探索。
Abstract:Background The influences of air pollution on sickness absenteeism among school students could be a huge social medical and economic burden.
Objective This study aims to quantify the associations of air pollutants and air quality index (AQI) with sickness absenteeism of primary school students in Shanghai.
Methods Six primary schools were selected in four districts of Shanghai (Jiading, Baoshan, Pudong, and Putuo), and data on daily sickness absenteeism and specific causes of sickness (excluding personal reasons or accidental events) were collected in 2017 and 2018 school years from all the students from the six schools, as well as daily levels of air pollutants and meteorological factors from nearest fixed-site monitoring stations. A generalized additive model was constructed to conduct time-series analysis on the associations of air pollutants and AQI with sickness absenteeism after adjusting for confounding factors including temperature, relative humidity, precipitation, influenza outbreak season, and day-of-the-week effect.
Results A total of 5 746 students were included in this study. The average daily sickness absenteeism in school days was 12.5, accounting for 0.20% of the total students who were supposed to attend school; the average daily sickness absenteeism in winter and spring was higher than that in summer and autumn; the average daily sickness absenteeism in influenza season was higher than that in non-influenza season (all
P < 0.05). During the study period, the annual daily average PM2.5 and NO2 concentrations were (38.7±26.0) μg·m-3 and (42.7±18.8) μg·m-3, respectively. After adjusting for confounding factors, the results of multivariate regression analysis showed that every 10 μg·m-3 increase of NO2 concentration was associated with an increase of sickness absentees by 2.3%-3.3%, and the effects lasted for at least one week, while AQI and PM2.5 had no obvious associations with children's sickness absenteeism. The results of stratification analysis by influenza season showed that PM2.5, NO2, and AQI had associations with sickness leave in non-influenza season, withRR (95%CI ) of 1.021 (1.004-1.039), 1.048 (1.026-1.071), and 1.015 (1.001-1.030), respectively.Conclusion In the 2017-2018 school years in Shanghai, NO2 is associated with sickness absenteeism in primary school students. Further efforts are needed to figure out whether school children's health can be managed purely by AQI.
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