郭恒亮, 王孟飞, 龚喜云, 魏海涛. 2016—2018年河南洛阳市主要大气污染物对心脑血管疾病门诊量的影响[J]. 环境与职业医学, 2021, 38(4): 389-396. DOI: 10.13213/j.cnki.jeom.2021.20445
引用本文: 郭恒亮, 王孟飞, 龚喜云, 魏海涛. 2016—2018年河南洛阳市主要大气污染物对心脑血管疾病门诊量的影响[J]. 环境与职业医学, 2021, 38(4): 389-396. DOI: 10.13213/j.cnki.jeom.2021.20445
GUO Hengliang, WANG Mengfei, GONG Xiyun, WEI Haitao. Influence of main air pollutants on hospital outpatient visits for cardiovascular and cerebrovascular diseases in Luoyang of Henan Province in 2016-2018[J]. Journal of Environmental and Occupational Medicine, 2021, 38(4): 389-396. DOI: 10.13213/j.cnki.jeom.2021.20445
Citation: GUO Hengliang, WANG Mengfei, GONG Xiyun, WEI Haitao. Influence of main air pollutants on hospital outpatient visits for cardiovascular and cerebrovascular diseases in Luoyang of Henan Province in 2016-2018[J]. Journal of Environmental and Occupational Medicine, 2021, 38(4): 389-396. DOI: 10.13213/j.cnki.jeom.2021.20445

2016—2018年河南洛阳市主要大气污染物对心脑血管疾病门诊量的影响

Influence of main air pollutants on hospital outpatient visits for cardiovascular and cerebrovascular diseases in Luoyang of Henan Province in 2016-2018

  • 摘要: 背景

    心脑血管疾病占我国居民死因首位,但目前的研究更侧重于经济发达或污染严重地区,且不同地区研究结果存在差异。

    目的

    探究河南省洛阳市主要大气污染物(PM2.5、PM10、SO2、NO2、CO、O3)对洛阳市心脑血管疾病门诊量的影响。

    方法

    收集洛阳市2016年1月1日—2018年12月31日的心脑血管疾病门诊信息以及同期大气污染物浓度数据和气象数据。利用广义相加模型分别建立单污染物模型、双污染物模型,以及年龄、性别和季节的分层模型,并计算单日滞后(lag0~lag7)和累积滞后(lag0~lag07)的相对危险度(RR)及95%置信区间(CI)。

    结果

    2016—2018年洛阳市的心脑血管疾病门诊量共208355例。同期PM10、PM2.5分别超标277、82d,NO2、CO、O3分别超标48、9、8d,SO2日均浓度不超标。单污染物模型结果显示,PM2.5、PM10、SO2、NO2、CO、O3最佳滞后时间分别是lag0、lag3、lag6、lag2、lag0、lag04,对应的RR及95% CI分别为1.0024(1.0011~1.0037)、1.0017(1.0010~1.0025)、0.9767(0.9696~0.9840)、1.027 7(1.023 6~1.031 9)、1.000 6(1.000 4~1.000 7)、1.004 1(1.001 4~1.006 9)。双污染物模型中,各污染物引入其余污染物前后结果基本都有统计学意义(P < 0.05)。性别分层和年龄分层结果均显示NO2是危害性最大的污染物:NO2对男性和女性心脑血管疾病门诊量影响的最佳滞后时间分别为lag2、lag01,对应的RR及95% CI分别为1.029 3(1.023 5~1.035 1)、1.027 7(1.021 8~1.033 5),对0~40、41~65、65岁以上人群心脑血管疾病门诊量影响的最佳滞后时间为分别为lag4、lag3、lag2,对应的RR及95% CI分别为1.035 9(1.000 9~1.072 0)、1.027 7(1.0215~1.0339)、1.0311(1.0255~1.0367)。季节分层结果显示:PM2.5、SO2、NO2和CO最大效应值出现在春季,对应的RR及其95% CI分别为1.022 0(1.018 8~1.025 3)、1.073 3(1.057 0~1.089 9)、1.062 6(1.053 1~1.072 1)、1.001 5(1.001 1~1.001 9);PM10和O3的最大效应出现在夏季,对应的RR及其95% CI分别为1.013 0(1.0089~1.0171)、1.0184(1.0133~1.0235)。

    结论

    洛阳市2016—2018年大气主要污染物PM2.5、PM10、NO2、CO、O3浓度升高可能导致居民心脑血管疾病门诊量增加,其中NO2是造成风险最高的一种污染物,且各污染物均存在滞后效应。

     

    Abstract: Background

    Cardiovascular and cerebrovascular diseases top the general causes of death among Chinese residents. However, current research focuses more on economically developed or heavily polluted areas, and the research results are inconsistent across regions.

    Objective

    This study investigates the impact of major atmospheric pollutants (PM2.5, PM10, SO2, NO2, CO, and O3) on the number of hospital outpatient visits for cardiovascular and cerebrovascular diseases in Luoyang of Henan Province from 2016 to 2018.

    Methods

    Outpatient information of cardiovascular and cerebrovascular diseases, atmospheric pollutant concentration data, and meteorological data in Luoyang from January 1, 2016 to December 31, 2018 were collected. Generalized additive models (GAMs) were chosen to construct single-pollutant models, double-pollutant models, and stratified models of age, gender, and season. The relative risks (RRs) and 95% confidence intervals (CIs) of single-day and cumulative lag effects were estimated.

    Results

    There were a total of 208355 cardio-cerebrovascular disease outpatient visits in Luoyang from 2016 to 2018. PM2.5 and PM10 daily concentrations exceeded the national standard limits for 277 and 82 d respectively, followed by NO2, CO, and O3 which were unqualified for 48, 9, and 8 d, respectively, and SO2 did not exceed the standard. The single-pollutant models showed that the best lag days for PM2.5, PM10, SO2, NO2, CO, and O3 were lag0, lag3, lag6, lag2, lag0, and lag04, and the corresponding RRs and 95% CIs were 1.002 4 (1.0011-1.0037), 1.0017 (1.0010-1.0025), 0.9767 (0.9696-0.9840), 1.0277 (1.0236-1.0319), 1.0006 (1.0004-1.0007), and 1.0041 (1.0014-1.0069), respectively. In the double pollutant models, there was no significant difference in the effect values of each pollutant before and after the introduction of other pollutants (P>0.05). The results of gender stratification and age stratification analyses showed that NO2 was the most affecting pollutant. The best lag days of NO2 on the outpatient volume of cardio-cerebrovascular diseases in men and women were lag2 and lag01, and the corresponding RRs and 95% CIs were 1.029 3 (1.023 5-1.035 1) and 1.027 7 (1.021 8-1.033 5), respectively. The best lag days of NO2 affecting the number of outpatient visits of cardio-cerebrovascular diseases in patients aged 0-40, 41-65, and over 65 years were lag4, lag3, and lag2, and the corresponding RRs and 95%CIs were 1.0359 (1.0009-1.0720), 1.0277 (1.0215-1.033 9), and 1.031 1 (1.025 5-1.036 7), respectively. The results of seasonal stratification analysis showed that the maximum effects of PM2.5, SO2, NO2, and CO appeared in spring, and the corresponding RRs and 95% CIs were 1.022 0 (1.018 8-1.025 3), 1.073 3 (1.057 0-1.089 9), 1.062 6 (1.053 1-1.0721), and 1.001 5 (1.001 1-1.001 9), respectively; the maximum effects of PM10 and O3 appeared in summer, and the corresponding RRs and 95% CIs were 1.0130 (1.0089-1.0171) and 1.018 4 (1.0133-1.0235), respectively.

    Conclusion

    The increase in the concentration of major atmospheric pollutants (PM2.5, PM10, NO2, CO, and O3) in Luoyang from 2016 to 2018 may lead to an increase in the number of outpatient visits for cardio-cerebrovascular diseases. Among them, NO2 may produce the highest risk. All these pollutants have lag effects.

     

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