安徽省三市大气污染物和绿地暴露对初治结核病患者病亡率的影响  

Effects of air pollutants and greenness exposure on the mortality of newly treated tuberculosis patients in three cities,Anhui Province

作　　者：赵嘉文 张永忠 李振华 毛毅铖 张菁菁 胡成洋 张秀军[1] 阚晓红 Zhao Jiawen;Zhang Yongzhong;Li Zhenhua;Mao Yicheng;Zhang Jingjing;Hu Chengyang;Zhang Xiujun;Kan Xiaohong(Department of Epidemiology and Health Statistics,School of Public Health,Anhui Medical University,Hefei 230032,China;Department of Tuberculosis Control,Anhui Chest Hospital,Hefei 230022,China;Department of Science and Education,Anhui Chest Hospital,Hefei 230022,China;Department of Humanities and Medicine,School of Humanities and Medicine,Anhui Medical University,Hefei 230032,China)

机构地区：[1]安徽医科大学公共卫生学院流行病与卫生统计学系,合肥230032 [2]安徽省胸科医院结防科,合肥230022 [3]安徽省胸科医院科教科,合肥230022 [4]安徽医科大学人文医学学院人文医学系,合肥230032

出　　处：《中国防痨杂志》2024年第1期75-84,共10页Chinese Journal of Antituberculosis

摘　　要：目的:探讨大气污染物和绿地暴露对初治结核病患者治疗期间病亡率的影响,从环境监测层面上为结核病患者的健康管理提供科学依据。方法:收集安徽省合肥市、淮南市、黄山市2015年1月1日至2020年12月31日的29519例初治结核病患者的数据。通过环境监测站收集大气污染物细颗粒物[空气动力学直径≤2.5μm的颗粒(particulate matter with an aerodynamic diameter≤2.5μm,PM_(2.5))]、可吸入颗粒物[空气动力学直径≤10μm的颗粒(particulate matter with an aerodynamic diameter≤10μm,PM_(10))]、一氧化碳(CO)、二氧化氮(NO_(2))数据。应用Cox比例风险模型计算大气污染物暴露与初治结核病患者病亡率的风险比(HR)及其95%置信区间(95%CI),同时结合绿地暴露进行亚组分析。结果:29519例结核病患者中,有369例(1.25%)在治疗期间死亡。多因素Cox回归分析结果显示,PM_(2.5)每增加10μg/m^(3),患者的死亡风险上升15.6%(HR=1.156,95%CI:1.146~1.165),PM_(10)每增加10μg/m^(3),患者的死亡风险上升18.3%(HR=1.183,95%CI:1.176~1.190),CO每增加0.10 mg/m^(3),患者的死亡风险上升6.7%(HR=1.067,95%CI:1.060~1.074),NO_(2)每增加10μg/m^(3),患者的死亡风险上升2.8%(HR=1.028,95%CI:1.019~1.037)。将绿地暴露按照四分位数(Q_(1)~Q_(4))由低到高进行分组后,大气污染物对病亡率的影响随绿地暴露的提升逐渐降低[以PM_(2.5)为例,其在250 m和500 m缓冲区归一化植被指数对病亡率的HR值,Q_(1)分别为1.218(95%CI:1.197~1.240)和1.231(95%CI:1.210~1.253),Q_(4)分别下降至1.125(95%CI:1.106~1.146)和1.138(95%CI:1.118~1.159)]。结论:大气污染物暴露是初治结核病患者治疗期间的危险因素,更高的绿化程度能够降低因暴露于大气污染物所导致的死亡风险。Objective:To explore the effect of exposure to air pollutants and greenness on mortality during the treatment of newly treated tuberculosis patients,and to provide a scientific basis for the health management of tuberculosis patients at the environmental level.Methods:Data were collected from 29519 newly treated tuberculosis patients from January 1,2015 to December 31,2020 in Hefei City,Huainan City,and Huangshan City,Anhui Province.Data on atmospheric pollutants fine particulate matter(particulate matter with an aerodynamic diameter≤2.5μm,PM_(2.5)),inhalable particulate matter(particulate matter with an aerodynamic diameter≤10μm,PM_(10)),carbon monoxide(CO),and nitrogen dioxide(NO_(2))were collected through environmental monitoring stations.Cox proportional risk model was applied to calculate the risk ratios(HR)and the 95%confidence intervals(95%CI)for all-cause mortality of air pollutant exposures and newly treated tuberculosis patients,and subgroup analyses were also performed combining with greenness exposure.Results:Of the 29519 tuberculosis patients,369(1.25%)died during treatment.The results of multifactorial Cox regression analyses showed that the risk of death increased by 15.6%with every 10μg/m^(3)increasement in PM_(2.5)(HR=1.156,95%CI:1.146-1.165),18.3%with every 10μg/m^(3)increasement in PM_(10)(HR=1.183,95%CI:1.176-1.190);with every 0.10 mg/m^(3)increase in CO,the risk of death increased by 6.7%(HR=1.067,95%CI:1.060-1.074),and with every 10μg/m^(3)increase in NO_(2),the risk of death increased by 2.8%(HR=1.028,95%CI:1.019-1.037).After being divided into different groups based on greenness exposure from low to high by quartiles(Q_(1) to Q_(4)),the effect of air pollutants on mortality rate gradually decreased with elevated greenness exposures(PM_(2.5),for example,the HR values of normalized vegetation index on disease mortality rate in the 250 m and 500 m buffer zones were 1.218(95%CI:1.197-1.240)and 1.231(95%CI:1.210-1.253)for Q_(1),respectively,and decreased to 1.125(95%CI:1.106-1.146)and

关 键 词：结核 空气污染物 环境暴露 回顾性研究 因素分析 统计学 

分 类 号：R181[医药卫生—流行病学] R52[医药卫生—公共卫生与预防医学]