臭氧污染对居民心脑血管疾病死亡的影响：基于上海市闵行区
Impact of ambient ozone exposure on death from cardiovascular and cerebrovascular diseases in Minhang District, Shanghai
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摘要:
背景 近年来臭氧（O3）污染逐渐成为大气污染的首要问题，通过分析大气O3浓度变化与居民心脑血管疾病死亡风险的关系，可以为O3污染风险评估及制定相关政策提供参考资料。
目的 基于上海市闵行区数据，探讨大气O3污染对居民心脑血管疾病死亡的影响。
方法 收集2016年1月1日—2021年12月31日上海市闵行区居民心脑血管疾病死亡、大气污染物及气象资料。采用基于半泊松回归的广义相加模型进行时间序列分析，讨论O3对总心脑血管疾病、冠心病及中风死亡的当日（lag0）、单日滞后（前3日，lag1~lag3）及累积平均滞后（当日至前3日，lag01~lag03）效应，并分不同年龄、性别、季节进行亚组分析，同时根据气温的25%分位数（
P 25）和75%分位数（P 75）将气温分层，进行分层分析。以O3日最大8 h平均（O3-8 h）质量浓度（浓度）每升高10 µg·m−3引起每日死亡风险增加的超额危险度（ER）及其95%可信区间（CI）估计O3对心脑血管疾病死亡的效应。结果 O3与心脑血管疾病死亡风险的关联在lag2、lag3、lag02、lag03有统计学意义（
P <0.05），在lag03效应值最大。lag03条件下，O3-8 h浓度每升高10 µg·m−3：心脑血管疾病总人群、男性人群、65岁及以上人群死亡风险分别增加1.02%（95%CI：0.36%~1.69%）、1.40%（95%CI：0.47%~2.34%）、0.87%（95%CI：0.19%~1.55%）；冠心病男性人群和中风总人群死亡风险分别增加1.96%（95%CI：0.49%~3.44%）和1.02%（95%CI：0.07%~1.98%）；暖季（4月1日—9月30日）心脑血管疾病及冠心病死亡风险分别增加1.18%（95%CI：0.33%~3.33%）、2.69%（95%CI：0.39%~5.03%），冷季（10月1日至次年3月31日）心脑血管疾病死亡风险增加0.96%（95%CI：0.11%~1.81%）；中、高气温时，心脑血管疾病死亡风险分别增加1.63%（95%CI：0.32%~2.96%）、1.14%（95%CI：0.17%~2.12%）。引入其他污染物（一氧化碳、二氧化氮、二氧化硫、细颗粒物、可吸入颗粒物）构建双污染物模型，结果显示O3对心脑血管疾病总死亡、冠心病及中风死亡风险的影响仍然稳健，与单污染物模型分析结果基本一致。结论 大气O3污染增加上海市闵行区居民心脑血管疾病、冠心病及中风的死亡风险，且存在滞后效应。
Abstract:Background Ozone (O3) pollution has gradually become a primary problem of air pollution in recent years. Conducting epidemiological studies on the correlation between O3 concentration variation and risk of cardiovascular and cerebrovascular diseases can provide reference data for O3 risk assessment and related policy making.
Objective To quantitatively evaluate the effects of O3 exposure on mortalities of cardiovascular and cerebrovascular diseases among residents in Minhang District, Shanghai.
Methods Data of mortalities of cardiovascular and cerebrovascular diseases, air pollutants, and meteorological factors in Minhang District of Shanghai from January 1, 2016 to December 31, 2021 were collected. Associations between O3 concentration and the mortalities due to total cardiovascular and cerebrovascular diseases, coronary heart disease, and stroke were analyzed by generalized additive models with a quasi Poisson distribution with different lag patterns, such as current day effect (lag0), single-day lag effects (lag1-lag3), and cumulative lag effects (lag01-lag03). The subgroup analyses of age, sex, and season were conducted. Furthermore, temperature was divided into low, middle, and high levels based on the 25th percentile (
P 25) and the 75th percentile (P 75) to perform hierarchical analyses. Increased excess risks (ER) of death from target diseases caused by a 10 µg·m−3 increase in daily maximum 8 h concentration of O3 (O3-8 h) and their 95% confidence intervals (CI) were used to indicate the effects of O3.Results The associations between O3 and the risks of death from cardiovascular and cerebrovascular diseases were statistically significant at lag2, lag3, lag02, and lag03 (
P <0.05), with the greatest effect size observed at lag03. The ER values of death from cardiovascular and cerebrovascular diseases in general population, male residents, and people aged 65 years and older, from coronary heart disease in male residents, and from stroke in general population increased by 1.02% (95%CI: 0.36%, 1.69%), 1.40% (95%CI: 0.47%, 2.34%), 0.87% (95%CI: 0.19%, 1.55%), 1.96% (95%CI: 0.49%, 3.44%), and 1.02% (95%CI: 0.07%, 1.98%) for a 10 µg·m−3 increase in O3-8 h concentration at lag03, respectively. During the warm season (from April 1 to September 30), the ER values of death from cardiovascular and cerebrovascular diseases and coronary heart disease per 10 µg·m−3 increase in O3 were 1.18% (95%CI: 0.33%, 3.33%) and 2.69% (95%CI: 0.39%, 5.03%), while the O3 effect was only statistically significant on cardiovascular and cerebrovascular diseases during the cold season (from October 1 to March 31 next year). At the middle and high temperature levels, the ER values of death from cardiovascular and cerebrovascular diseases increased by 1.63% (95%CI: 0.32%, 2.96%) and 1.14% (95%CI: 0.17%, 2.12%) respectively. The two-pollutant models showed similar results after including other pollutants (carbon monoxide, nitrogen dioxide, sulfur dioxide, fine particulate matter, or inhalable particulate matter).Conclusion Ambient O3 pollution may increase the mortality risks of cardiovascular and cerebrovascular diseases, coronary heart disease, and stroke in Minhang District of Shanghai.
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