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2014—2019年临沂市日均气温、臭氧浓度与人民医院心血管疾病日门诊量的时间序列研究

Associations between daily outpatient visits of cardiovascular diseases in People's Hospital and local temperature, ozone concentration in Linyi from 2014 to 2019

    摘要
  • 摘要:
    背景 暴露于高浓度臭氧（O3）环境可导致心血管系统疾病（CVD）的高发病率及死亡率，但目前国内关于温度与O3联合效应对疾病的影响研究较少。
    目的 明确气温及O3污染对临沂市心血管疾病人群的短期暴露效应。
    方法 本研究基于2014—2019年临沂市O3浓度监测数据、CVD患者日常门诊数据及小时与日均空气质量数据，采用分布滞后非线性模型（DLNM）研究温度与O3对临沂市人群CVD的相对风险（RR）和滞后效应，探讨温度与O3交互作用对临沂市人群CVD门诊量的影响。
    结果 O3暴露对人群CVD影响呈非线性并存在滞后性，O3浓度为100 μg·m−3时，RR峰值为1.39（95%CI：1.25~1.55），O3重污染天（＞180 μg·m−3）心血管门诊量增加。性别与年龄对CVD的修饰效应表明O3暴露对男性CVD门诊量增加的RR（95%CI）值1.40（1.26~1.58）略高于女性1.38（1.22~1.57）；对>65岁人群1.38（1.02~1.55）RR值高于≤65岁人群1.22（1.06~1.38），因而男性及65岁以上人群对O3暴露的心血管疾病风险更为敏感。温度对O3所致人群CVD门诊量的修饰效应表明，暖季O3在低、中、高浓度时均呈现较高的CVD门诊量；冷季O3在低、中浓度（P25，P50）且累积滞后1~3天（lag01~lag03）时的门诊量增加有统计学意义，但RR值低于暖季。
    结论 O3污染可增加人群心血管疾病门诊就诊率，且存在性别及年龄修饰。气温对O3暴露的心血管疾病风险存在修饰效应。暖季高温及高浓度O3暴露会增加人群CVD门诊量，且RR值远高于冷季低温的影响。冷季低温条件下，O3暴露浓度在较低值时门诊量较高，冷季低温对人群CVD门诊量的影响高于O3。

     

    Abstract:
    Background Exposure to high concentration of ozone (O3) can lead to elevated morbidity and mortality due to cardiovascular diseases (CVD). Few studies in China are available on the combined effects of temperature and O3 on CVD.
    Objective To clarify the short-term exposure effects of temperature and O3 pollution on residents with cardiovascular diseases in the Linyi City.
    Methods Based on the O3 concentration monitoring data, daily outpatient visit data of CVD, and hourly and daily air quality data in Linyi City from 2014 to 2019, a distributed lag non-linear model (DLNM) was used to study the relative risks (RR) and lag effects of temperature and O3 on the outpatient visits of CVD in Linyi City, and the effects of the interaction between temperature and O3 on cardiovascular diseases were also examined.
    Results The lag effect of O3 exposure on CVD was non-linear, with a peak RR (95%CI) value 1.39 (1.25, 1.55) at O3 concentrations of 100 μg·m−3 and a significantly higher risk of CVD on the days of high O3 concentration (>180 μg·m−3). The modifying effects of gender and age on CVD showed that the RR (95%CI) was greater for males 1.41 (1.26, 1.58) than for females 1.38 (1.22, 1.57), and higher for those aged >65 years 1.38 (1.02, 1.55) than those aged ≤65 years 1.22 (1.06, 1.38). Males and adults older than 65 were more sensitive to O3 exposure. The modifying effect of temperature on CVD combined with O3 exposure suggested that the risk associated with warm-season O3 exposure was present across all concentration levels. In cold season, the RR of O3 exposure was significant at low and medium concentrations (P25, P50) at 1-3 days of cumulative lag exposure (lag01–lag03), whereas the RR value was lower than that in the warm season.
    Conclusion O3 pollution poses an increased risk of outpatient visit due to CVD in Linyi, with variations observed based on gender and age. The impact of O3 exposure on CVD is modulated by air temperature. Specifically, elevated temperature combined with high O3 concentration during warm season escalate the outpatient visits due to CVD, with the outpatient visits being substantially higher than that observed in cold season at lower temperatures. Conversely, in cold season at lower temperatures, the outpatient visits associated with O3 exposure is more pronounced at lower temperatures. Furthermore, the effect of low temperatures in cold season on CVD surpasses that of O3 exposure.

     

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