上海市儿童呼吸系统疾病空气质量健康指数的建立
Construction of an air quality health index for pediatric respiratory diseases in Shanghai
-
摘要:
背景 空气质量健康指数（AQHI）将人群流行病学观察到的多个污染物健康效应指数化，能更好地反映空气污染与健康效应间广泛存在的线性无阈值关系。
目的 探索上海市儿童呼吸系统疾病AQHI（AQHIr）的建立方法并探讨其适用性。
方法 收集2015—2019年上海市徐汇、宝山、虹口、金山和崇明区5家综合医院儿科呼吸系统疾病日门诊人次数，收集距离医院最近的5个空气质量监测点大气污染物（PM2.5、PM10、SO2、NO2和O3）监测资料、空气质量指数（AQI）和气象监测资料（温度、相对湿度、气压和风速），采用基于泊松分布的广义相加模型（GAM），分析大气污染与儿科呼吸系统疾病门诊人次数之间的关联，依据GAM分析结果构建AQHIr。比较AQHIr、AQI与徐汇、虹口和崇明区的3家医院儿科呼吸系统疾病门诊人次数之间的关联性，评价AQHIr的预测效果。
结果 大气污染物对儿科呼吸系统疾病门诊人次数有不同程度的影响：PM2.5、NO2和O3效应在滞后当天（lag0）最显著，污染物质量浓度每升高10 μg·m−3，超额就诊风险分别为1.27%（95%CI：0.88%~1.66%）、0.75%（95%CI：0.40%~1.11%）和3.61%（95%CI：2.71%~4.51%）；PM10和SO2在滞后3 d（lag3）效应最显著，污染物每升高10 μg·m−3，超额就诊风险分别为0.81%（95%CI：0.51~1.12）和5.64%（95%CI：3.37%~7.96%）。除PM10+NO2、SO2+PM2.5和SO2+NO2外，其余污染物两两叠加，对健康影响均有意义（P＜0.05）。依据单污染物和双污染物分析结果，选择PM2.5、NO2、SO2和O3建立AQHIr。比较结果显示，AQHIr每升高一个四分位数间距，儿童超额就诊风险高于AQI相应的指标值。
结论 上海市大气污染物对儿科呼吸系统疾病门诊人次数有影响。依据儿童呼吸系统疾病就诊风险建立的AQHIr能够较好地预测空气污染对儿童呼吸系统的健康影响。
Abstract:Background Air quality health index (AQHI) has been widely used to quantify the health effects of multiple pollutants observed in population-based epidemiological studies, and can better reflect the widespread linear non-threshold between air pollution and health effects.
Objective To explore an AQHI for pediatric respiratory diseases (AQHIr) in Shanghai and evaluate its feasibility.
Methods The daily numbers of hospital outpatient visits for pediatric respiratory diseases from 2015 to 2019 were obtained from five general hospitals in Xuhui, Baoshan, Hongkou, Jinshan, and Chongming Districts of Shanghai. Monitoring data on air pollutants (PM2.5, PM10, SO2, NO2, and O3), air quality index (AQI), and meteorological variables (temperature, relative humidity, air pressure, and wind speed) were collected from five air quality monitoring sites nearest to selected hospitals. Time-series analysis using generalized additive model (GAM) was conducted to estimate the associations between respiratory-related pediatric outpatient visits and the concentrations of air pollutants. The sum of excess risk (ER) of hospital outpatient visits was used to construct AQHIr. To assess the predictive power of AQHIr, the associations of AQHIr and AQI with the number of pediatric respiratory outpatient visits in three hospitals in Xuhui, Hongkou, and Chongming districts were compared.
Results Air pollutants had various effects on respiratory diseases outpatient visits. PM2.5, NO2, and O3 had most significant impacts on lag0 day and the associated ERs of hospital outpatient visits for each 10 μg·m−3 increase in pollutant concentration were 1.27% (95%CI: 0.88%-1.66%), 0.75% (95%CI: 0.40%-1.11%), and 0.36% (95%CI: 0.10%-0.62%), respectively. PM10 and SO2 had most significant impacts on lag3 day and the associated ERs of hospital outpatient visits for each 10 μg·m−3 increase in pollutant concentration were 0.81% (95%CI: 0.51%-1.12%) and 5.64% (95%CI: 3.37%-7.96%), respectively. There were significant effects of combinations of two pollutants among PM2.5, PM10, NO2, SO2, and O3 except for PM10+NO2, SO2+PM2.5, and SO2+NO2 (P<0.05). According to the results of single-pollutant and two-pollutant models, PM2.5, NO2, SO2, and O3 were selected to construct AQHIr. The comparison showed that for every interquartile range increase in AQHIr, the ER for pediatric outpatient visits was higher than that for the value corresponding to AQI.
Conclusion Air pollutants in Shanghai have an impact on the number of pediatric respiratory outpatient visits. The AQHIr based on and outpatient visits for pediatric respiratory diseases can be a sensitive index to predict the effects of air pollution on children's respiratory health.
下载:
