济南市大气污染对儿科呼吸系统门诊量影响的时间序列分析  

Ambient air pollution and daily outpatient visits in pediatric respiratory clinics in Jinan: a time series analysis

作　　者：王桂兰[1] 崔亮亮[2] 程学美[3] 高衍新[3] WANG Gui-lan;CUI Liang-liang;CHENG Xue-mei;GAO Yan-xin(Maternal and Child Health Care Hospital of Jinan,Jinan,Shandong 250002,China;不详)

机构地区：[1]济南市妇幼保健院,山东济南250002 [2]济南市疾病预防控制中心 [3]山东省疾病预防控制中心

出　　处：《中国预防医学杂志》2022年第7期525-531,共7页Chinese Preventive Medicine

摘　　要：目的探讨济南市大气污染物浓度对医院儿科呼吸系统疾病门诊量的影响。方法2018年7月—2021年12月济南市逐日空气污染数据、气象资料和儿科门诊量资料分别来源于济南市环保局、济南市气象局和济南市3所市级医院儿科门诊。采用时间序列的半参数广义相加模型,在控制长期效应、季节趋势、星期几效应、节假日及气象因素的影响后,分析大气中细颗粒物(PM_(2.5)、PM_(10))、二氧化硫(SO_(2))、二氧化氮(NO_(2))的平均浓度及臭氧(O_(3))与儿科门诊呼吸系统就诊量的暴露反应关系及滞后效应。结果研究期内大气污染物PM_(2.5)、PM_(10)、SO_(2)、NO_(2)、O_(3)日均质量浓度分别为51.75、96.72、17.14、37.18和111.78μg/m^(3)。3所医院儿科门诊呼吸系统就诊总量为282050人次,日均就诊220人次。大气污染物日均浓度与儿童呼吸系统疾病门诊量存在关联,且表现出明显的滞后效应。PM_(2.5)、SO_(2)、NO_(2)浓度升高10.00μg/m^(3)时,当日(lag0)呼吸系统疾病超额就诊危险度(extra risk,ER)最高,分别为0.58%(95%CI:0.29%~0.88%)、3.13%(1.47%~4.82%)、1.17%(0.19%~2.16%);而PM_(10)则在暴露滞后第3天(lag03),O_(3)在暴露滞后第5天(lag05)对儿科门诊量影响效应最大,分别为0.26%(0.12%~0.41%)、0.33%(0.11%~0.56%)。SO_(2)在移动平均浓度升高后的2 d内(lag01)对门诊量的累积滞后效应最大,ER值为4.18%(2.31%~6.08%);NO_(2)在当天的累积滞后效应最大,ER值为1.07%(95%CI:0.05%~2.10%);而PM_(2.5)、PM_(10)和O_(3)均在其移动平均浓度升高后的15 d内(lag014)对门诊量的累积滞后效应最大,分别为0.73%(0.15%~1.31%)、1.00%(0.40%~1.61%)、1.15%(95%CI:0.59%~2.43%)。分层分析表明,大气污染物在不同季节(是否采暖期)及对不同性别儿童就诊量的影响不同。结论大气污染对济南市儿童呼吸系统门诊量有显著影响,污染物浓度的升高,会导致儿童呼吸系统门诊量就诊人数的增加。Objective To understand the relationship between ambient air pollution and daily outpatient visits in pediatric respiratory clinics in Jinan(China).Methods The daily air pollution data and daily meteorological data as well as data of daily outpatient visits in pediatric respiratory clinics in three hospitals from July 1,2018 to December 31,2021 were retrospectively collected in Jinan,China.Generalized additive model(GAM)was employed to analyze the exposure-response relationship between atmospheric pollutants,including particulate matter(PM_(2.5),PM_(10)),sulfur dioxide(SO_(2)),nitrogen dioxide(NO_(2)),ozone(O_(3))and daily outpatient visits in pediatric respiratory clinics after adjusting confounding meteorological factor,long-term effect,date effect,seasonal trend and holiday effect.The lag effects were also explored.Results The average daily concentrations of PM_(2.5),PM_(10),SO_(2),NO_(2),O_(3)were 51.75,96.72,17.14,37.18 and 111.78μg/m~3,respectively during the study period.Meanwhile,the total outpatient visits in three pediatric pulmonary clinics were 282050 with an average of 220 per day.The daily concentrations of air pollutants were positively associated with the number of outpatients visits in pediatric respiratory clinics with significant lag effects.When the concentrations of PM_(2.5),SO_(2),NO_(2)increased by 10.00μg/m~3,the extra risks(ER)of pediatric outpatients visits due to respiratory diseases were the highest of 0.58%(95%CI:0.29%-0.88%),3.134%(1.47%-4.82%)and 1.17%(0.19%-2.16%),respectively at lag0 day.However,the highest ER of PM_(10)and O_(3)were found to be at lag03(0.26%)day and lag05 day(0.33%).With the increase of moving average concentration of air pollutants,the biggest cumulative effects of PM_(2.5),PM_(10),SO_(2),NO_(2)and O_(3)on pediatric outpatient visits were on lag015 days(ER=0.73%,95%CI:0.15%-1.31%),lag015 days(ER=1.00%,95%CI:0.40%-1.61%),lag02 days(ER=4.18%,95%CI:2.31%-6.08%),lag02 days(ER=1.07%,95%CI:0.05%-2.10%)and lag015 days(ER=1.15%,95%CI:0.59%-2.43%)for respiratory disea

关 键 词：大气污染物 呼吸系统疾病 门诊量 广义相加模型 

分 类 号：X51[环境科学与工程—环境工程] R725.6[医药卫生—儿科]