大气污染物对呼吸系统疾病入院影响的病例交叉研究

目的 研究不同浓度细颗粒物（PM_2.5）、可吸入颗粒物（PM₁₀）、二氧化氮（NO₂）、二氧化硫（SO₂）四种大气污染物对东营市东营区呼吸系统疾病（肺炎、慢性阻塞型肺病、肺结核）日入院人数的影响,为制定干预措施提供依据。方法 收集东营区2015年1月1日—2017年12月31日每日大气污染物浓度及呼吸系统疾病入院数据,采用泊松回归分析将分布滞后非线性模型与双向时间分层病例交叉设计相结合,分别计算四种污染物对三种呼吸系统疾病入院作用的RR值。结果 在排除气象因素、星期几效应等混杂因素的影响后,PM_2.5、PM₁₀、NO₂、SO₂日平均浓度每升高10 μg/m³,对肺炎入院影响的最大RR值为1.252（1.090~1.438）、1.094（1.021~1.173）、1.462（1.179~1.814）和1.275（1.079~1.505）,滞后3 d、6 d、4 d和6 d;对慢性阻塞型肺病入院作用最大RR为1.478（1.245~1.754）、1.156（1.046~1.279）、1.774（1.297~2.428）和1.215（1.011~1.461）,滞后4 d、5 d、4 d和0 d;对肺结核病入院作用最大RR值为2.423（1.618~3.630）、1.629（1.288~2.059）、1.892（1.220~2.935）和1.939（1.453~2.590）,滞后3 d、0 d、0 d和5 d。结论 大气污染物浓度短时间内升高可使东营区呼吸系统疾病患者人数增加,不同污染物作用强度和滞后效应并不相同。

A case-crossover study on air pollutants and hospital admission for respiratory diseases

Objective To study the effect of four air pollutants, fine particulate matter (PM_2.5), inhalable particulate matter (PM₁₀), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), on daily hospital admission for respiratory diseases (pneumonia, chronic obstructive pulmonary disease, tuberculosis) in Dongying district of Dongying city, and we provide evidence for interventions. Methods Daily air pollutant concentration and the number of admission for respiratory diseases in Donying district were collected from January 1, 2015, to December 31, 2017. The Poisson regression combined with the distributed lag nonlinear model and two-way time-stratified case-crossover design was used to calculate the RR value of four air pollutants on admission for three respiratory diseases. Results After adjusting the effect of meteorological factors and day of the week, we got the maximum RR of 1.252 (1.090-1.438）, 1.094 (1.021-1.173）, 1.462 (1.179-1.814）, 1.275 (1.079-1.505） for daily PM_2.5, PM₁₀, NO₂, SO₂ increase by 10 μg/m³ at the 3rd, 6th, 4th, 6th lag day on pneumonia admission, the maximum RR of 1.478 (1.245-1.754）, 1.156 (1.046-1.279）, 1.774 (1.297-2.428）, 1.215 (1.011-1.461）at the 4th, 5th, 4th, 0 lag day on chronic obstructive pulmonary disease admission, and of 2.423 (1.618-3.630）, 1.629 (1.288-2.059）, 1.892 (1.220-2.935）, 1.939 (1.453-2.590） at the 3 d, 0 d, 0 d, 5 d lag on tuberculosis admission. Conclusion Short-time increase of air pollutants could increase the hospital admission for respiratory diseases in Dongying district. The effects at different lags varied with different air pollutants.