PM2.5暴露对急诊就诊量和救护车派遣量影响的meta分析
Effect of PM2.5 exposure on emergency department visits and ambulance dispatches: A meta-analysis
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摘要:
背景 我国细颗粒物（PM2.5）污染严重，对人体健康造成严重威胁。
目的 利用meta分析定量评估我国PM2.5暴露与急诊就诊量和救护车派遣量的暴露-反应关系。
方法 以空气污染、大气污染、颗粒物、急诊、急救、救护车、PM2.5等为关键词，检索中国知网、万方数据知识服务平台（万方数据库）、维普数据库，以PM、PM2.5、air pollution、particulate、particle、emergency、ambulance等为关键词检索PubMed、Web of Science、Cochrane Library、Embase数据库，纳入方法为时间序列研究或病例交叉研究的文献。检索时间设置为从建库至2020年7月30日，并追加至2021年3月1日。利用Stata 12.0软件进行统计分析，使用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale，NOS）进行文献质量评价，利用随机或固定效应meta分析模型合并效应值，若存在异质性则进行亚组分析和meta回归，对结果进行敏感性分析、发表偏倚检测及校正。
结果 本研究共纳入25篇文献，涉及26项数据，meta分析显示大气中PM2.5浓度每升高10 μg·m-3，急诊就诊量和救护车派遣量的
RR 值分别为1.007（95%CI ：1.005~1.008）和1.004（95%CI ：1.002~1.007）。分别对急诊就诊量和救护车派遣量进行亚组分析，结果均显示病例交叉研究的合并效应值高于时间序列的研究。敏感性分析结果未发生明显改变，说明此次meta分析结果较稳健。Egger法检验结果提示PM2.5暴露对急诊就诊量和救护车派遣量的影响不存在发表偏倚（t =1.53，P > 0.1；t =1.80，P > 0.1）。结论 PM2.5暴露可能与急诊就诊量和救护车派遣量增加有关。
Abstract:Background Fine particulate matter (PM2.5) pollution is serious in China and poses a serious threat to human health.
Objective This meta-analysis is conducted to quantitatively evaluate the association between PM2.5 exposure and both emergency department visits and ambulance dispatches in China.
Methods Air pollution, atmospheric pollution, particulate matter, emergency, first aid, ambulance, PM2.5 in Chinese were used as keywords to search on CNKI, Wanfang Data Knowledge Service Platform (Wanfang Database), VIP database, and keywords like PM, PM2.5, air pollution, particulate, particle, emergency, ambulance in English were used to search on PubMed, Web of Science, Cochrane Library, Embase database. The literature with time series design or case-crossover design were included. The publication time was set from the establishment of the database to July 30, 2021, and finally to March 1, 2021. Stata 12.0 was used for statistical analysis. The Newcastle-Ottawa Scale (NOS) was used for quality evaluation of the included literature. Random or fixed effect meta-analysis was used to merge effects from different studies. Subgroup analysis and meta-regression were further conducted to explore sources of heterogeneity among these studies. Sensitivity analysis, publication bias assessment, and adjustment were also performed.
Results A total of 25 literature were included, consisting of 26 sources of data. The results of meta-analysis showed that an increase of 10 μg·m-3 PM2.5 was associated with an estimated relative risk (
RR ) of 1.007 (95%CI : 1.005-1.008) for emergency department visits and 1.004 (95%CI : 1.002-1.007) for ambulances dispatches respectively. The results of subgroup analysis of emergency visits and ambulance dispatches showed that the combination effect value of case-crossover studies was higher than that of time-series studies. The sensitivity test results showed the estimated associations were stable. The Egger test results showed no publication bias (t =1.53,P > 0.1;t =1.80,P > 0.1).Conclusion PM2.5 exposure could be associated with an increase of emergency department visits and ambulance dispatches.
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