2014-2019年临沂市日均气温、臭氧浓度与人民医院心血管疾病日门诊量的时间序列研究  

Associations between daily outpatient visits of cardiovascular diseases in People's Hospital and local temperature,ozone concentration in Linyi from 2014 to 2019

作　　者：冯美慧 何群 伯鑫 刘厚凤 吴鑫[4] 杨静[5] 李冬 魏敏 FENG Meihui;HE Qun;BO Xin;LIU Houfeng;WU Xin;YANG Jing;LI Dong;WEI Min(College of Geography and Environment,Shandong Normal University,Jinan,Shandong 250014,China;Linzi District Ecological and Environmental Technology Service Center,Zibo,Shandong 255499,China;College of Chemical Engineering,Beijing University of Chemical Technology/China Institute of Industrial Carbon Neutrality,Beijing 100029,China;Department of Equipment and Medical Engineering,Linyi People's Hospital,Linyi,Shandong 276000,China;Department of Network and Information,Linyi People's Hospital,Linyi,Shandong 276000,China;Sleep Epilepsy Center,Linyi People's Hospital,Linyi,Shandong 276000,China)

机构地区：[1]山东师范大学地理与环境学院,山东济南250358 [2]临淄区生态环境技术服务中心,山东淄博255499 [3]北京化工大学化学工程学院/中国工业碳中和研究院,北京100029 [4]临沂市人民医院设备与医学工程部,山东临沂276000 [5]临沂市人民医院网络与信息部,山东临沂276000 [6]临沂市人民医院睡眠癫痫中心,山东临沂276000

出　　处：《环境与职业医学》2025年第1期38-48,共11页Journal of Environmental and Occupational Medicine

基　　金：国家自然科学基金面上项目(42075183)。

摘　　要：[背景]暴露于高浓度臭氧(O_(3))环境可导致心血管系统疾病(CVD)的高发病率及死亡率,但目前国内关于温度与O_(3)联合效应对疾病的影响研究较少。[目的]明确气温及O_(3)污染对临沂市心血管疾病人群的短期暴露效应。[方法]本研究基于2014—2019年临沂市O_(3)浓度监测数据、CVD患者日常门诊数据及小时与日均空气质量数据,采用分布滞后非线性模型(DLNM)研究温度与O_(3)对临沂市人群CVD的相对风险(RR)和滞后效应,探讨温度与O_(3)交互作用对临沂市人群CVD门诊量的影响。[结果]O_(3)暴露对人群CVD影响呈非线性并存在滞后性,O_(3)浓度为100μg·m−3时,RR峰值为[1.39(95%CI:1.25~1.55)],O_(3)重污染天(>180μg·m^(−3))心血管门诊量增加。性别与年龄对CVD的修饰效应表明O_(3)暴露对男性CVD门诊量增加的RR(95%CI)值[1.40(1.26~1.58)]略高于女性[1.38(1.22~1.57)];对>65岁人群[1.38(1.02~1.55)]RR值高于≤65岁人群[1.22(1.06~1.38)],因而男性及65岁以上人群对O_(3)暴露的心血管疾病风险更为敏感。温度对O_(3)所致人群CVD门诊量的修饰效应表明,暖季O_(3)在低、中、高浓度时均呈现较高的CVD门诊量;冷季O_(3)在低、中浓度(P25,P50)且累积滞后1~3天(lag01~lag03)时的门诊量增加有统计学意义,但RR值低于暖季。[结论]O_(3)污染可增加人群心血管疾病门诊就诊率,且存在性别及年龄修饰。气温对O_(3)暴露的心血管疾病风险存在修饰效应。暖季高温及高浓度O_(3)暴露会增加人群CVD门诊量,且RR值远高于冷季低温的影响。冷季低温条件下,O_(3)暴露浓度在较低值时门诊量较高,冷季低温对人群CVD门诊量的影响高于O_(3)。[Background]Exposure to high concentration of ozone(O_(3))can lead to elevated morbidity and mortality due to cardiovascular diseases(CVD).Few studies in China are available on the combined effects of temperature and O_(3) on CVD.[Objective]To clarify the short-term exposure effects of temperature and O_(3) pollution on residents with cardiovascular diseases in the Linyi City.[Methods]Based on the O_(3) concentration monitoring data,daily outpatient visit data of CVD,and hourly and daily air quality data in Linyi City from 2014 to 2019,a distributed lag non-linear model(DLNM)was used to study the relative risks(RR)and lag effects of temperature and O_(3) on the outpatient visits of CVD in Linyi City,and the effects of the interaction between temperature and O_(3) on cardiovascular diseases were also examined.[Results]The lag effect of O_(3) exposure on CVD was non-linear,with a peak RR(95%CI)value[1.39(1.25,1.55)]at O_(3) concentrations of 100μg·m−3 and a significantly higher risk of CVD on the days of high O_(3) concentration(>180μg·m−3).The modifying effects of gender and age on CVD showed that the RR(95%CI)was greater for males[1.41(1.26,1.58)]than for females[1.38(1.22,1.57)],and higher for those aged>65 years[1.38(1.02,1.55)]than those aged≤65 years[1.22(1.06,1.38)].Males and adults older than 65 were more sensitive to O_(3) exposure.The modifying effect of temperature on CVD combined with O_(3) exposure suggested that the risk associated with warm-season O_(3) exposure was present across all concentration levels.In cold season,the RR of O_(3) exposure was significant at low and medium concentrations(P25,P50)at 1-3 days of cumulative lag exposure(lag01–lag03),whereas the RR value was lower than that in the warm sea-son.[Conclusion]O_(3) pollution poses an increased risk of outpatient visit due to CVD in Linyi,with variations observed based on gender and age.The impact of O_(3) exposure on CVD is modulated by air temperature.Specifically,elevated temperature combined with high O_(3) con-centration

关 键 词：臭氧 气温 心血管疾病 分布滞后非线性模型 临沂市 

分 类 号：R13[医药卫生—劳动卫生]