宜昌市PM_(2.5)和PM_(10)短期暴露对不稳定型心绞痛住院风险及超额住院经济负担影响  

Association of short-term exposure to PM_(2.5)and PM_(10)with hospitalization risk and excess expenses burden of unstable angina pectoris patients in Yichang city

作　　者：范传刚[1] 杨忠诚[2] 王早霞[2] 王婧 崔秀青 李翔[1] 罗西[1] 明小燕[2] 谢曙光[1] FAN Chuangang;YANG Zhongcheng;WANG Zaoxia;WANG Jing;CUI Xiuqing;LI Xiang;LUO Xi;MING Xiaoyan;XIE Shuguang(Hubei Provincial Center for Disease Control and Prevention,Wuhan 430079,China;Yichang Municipal Center for Disease Control and Prevention,Yichang 443005,China)

机构地区：[1]湖北省疾病预防控制中心,武汉430079 [2]宜昌市疾病预防控制中心,宜昌443005

出　　处：《中国公共卫生》2023年第8期1032-1037,共6页Chinese Journal of Public Health

基　　金：湖北省卫生健康委员会科研基金面上项目(WJ2021M205)。

摘　　要：目的了解细颗粒物(PM_(2.5))和可吸入颗粒物(PM_(10))短期暴露对不稳定型心绞痛(UAP)住院风险及超额住院经济负担的影响,为UAP的预防控制提供参考依据。方法收集湖北省宜昌市6家综合医院2019年1月1日—2021年12月31日11334例UAP住院患者的病案首页信息以及宜昌市城区5个国控环境空气质量自动监测站每日的污染物监测数据和城区气象数据,采用时间分层病例交叉设计通过条件logistic回归模型分析PM_(2.5)和PM_(10)暴露浓度每变化10μg/m^(3)时UAP患者住院风险的变化情况和超额经济负担。结果湖北省宜昌市11334例UAP住院患者的病例天数为11334 d,匹配的对照天数为38540 d。在单污染物模型中,在Lag0、Lag1、Lag01和Lag02时间段,宜昌市PM_(2.5)和PM_(10)暴露浓度每增加10μg/m^(3),UAP患者住院风险分别增加0.92%和0.89%、0.73%和0.62%、1.00%和0.92%、0.84%和0.85%。在多污染物模型中,排除了二氧化硫(SO_(2))、二氧化氮(NO_(2))、一氧化碳(CO)、臭氧(O_(3))、温度(T)、湿度(RH)以及病例性别、年龄等因素的影响后,宜昌市PM_(2.5)在Lag0~Lag4和Lag01~Lag05时间段对UAP患者的住院风险有显著影响,其中在Lag02时间段的效应最大(ER=1.86%,95%CI=0.46%~3.27%);宜昌市PM_(10)在Lag0、Lag1、Lag01和Lag02时间段对UAP患者的住院风险有显著影响,其中在Lag01时间段的效应最大(ER=1.19%,95%CI=0.23%~2.16%)。分层分析结果显示,PM_(2.5)和PM_(10)对UAP患者住院风险的显著效应在性别亚组和入院季节亚组中依然存在,在男性亚组中,PM_(2.5)和PM_(10)分别在Lag01(ER=2.69%,95%CI=0.40%~5.03%)和Lag0(ER=1.59%,95%CI=0.47%~2.72%)时间段的效应最大;在暖季亚组中,PM_(2.5)和PM_(10)均在Lag02时间段的效应最大(PM_(2.5):ER=6.69%,95%CI=1.47%~12.17%;PM_(10):ER=4.80%,95%CI=2.46%~7.19%)。按中国现行空气质量二级控制标准,研究期间宜昌市因PM_(2.5)和PM_(10)超标导致的UAP患者超额住院数分别为109例和28例,产生UAObjective To explore the association of short-term exposure to particulate matter≤2.5 and≤10μm in aerodynamic diameter(PM_(2.5)and PM_(10))with hospitalization risk and excess expenses burden of unstable angina pectoris(UAP)patients for providing a reference to UAP prevention.Methods Medical records of 11334 UAP patients hospitalized from 2019 through 2021 were collected from 6 hospitals in Yichang city,Hubei province.Local data over the same period on daily ambient air pollutants and meteorological factors were also collected from five national automatic monitoring stations and municipal weather bureau.Time-stratified case-crossover design and conditional logistic regression model were adopted to analyze the association of each 10μg/m^(3)change in ambient air PM_(2.5)and PM_(10)concentration with UAP hospitalization risk and excess economic burden.Results In total,11334 UAP case days were matched to 38540 control days.In single pollutant model analysis,a 10μg/m^(3)increase in PM_(2.5)and PM_(10)was associated with the increased UAP hospitalization risk of 0.92%and 0.89%on lag day 0(Lag0),0.73%and 0.62%on Lag1,1.00%and 0.92%over lag days 0–1(Lag0–1),and 0.84%and 0.85%over Lag0–2,respectively.After adjusting for sulfur dioxide,nitrogen dioxide,carbon monoxide,ozone,temperature and relative humidity in multi-pollutant model analysis,PM_(2.5)was significantly associated with increased UAP hospitalization risk on days from Lag0 to Lag4 and over days from Lag0–1 to Lag0–5 and the highest increased risk was observed over Lag0–2(excess risk[ER]=1.86%,95%confidence interval[95%CI]:0.46%–3.27%);PM_(10)showed a significant impact on UAP hospitalization risk on Lag0,Lag1,and over Lag0–1 and Lag0–2,and with the highest increased risk over Lag0–1(ER=1.19%,95%CI:0.23%–2.16%).Further stratified analysis indicated that the significant association still existed for gender and seasonal subgroup patients.For males,PM_(2.5)and PM_(10)was associated with the highest increased risk over Lag0–1(ER=2.69%,9

关 键 词：不稳定型心绞痛(UAP) 住院风险 超额住院经济负担 细颗粒物(PM_(2.5)) 可吸入颗粒物(PM_(10)) 短期暴露 影响 

分 类 号：R541.4[医药卫生—心血管疾病] R12[医药卫生—内科学]