Association between Air Pollution and Mortality of Respiratory Diseases in Wuhan : a Case-crossover Study

目的 运用病例交叉的研究方法探讨大气污染对武汉市居民呼吸系统疾病每日死亡的影响.方法 采用病例交叉(case-crossover)设计的方法研究2005年1月1日至2006年12月31日期间武汉市城区大气污染与居民每日呼吸系统疾病的死亡之间的关系,同时比较不同的对照选择方案研究结果的差异.结果 调整相关气象因素后,采用双向1∶2的对照设计分析表明,大气可吸人颗粒物(PM10)、二氧化硫(SO2)以及二氧化氮(NO2)日平均浓度每增加10 μg/m3,武汉市城区居民呼吸系统疾病死亡发生的OR值分别为1.005(95％CI:1.004～1.006)、1.021 (95％CI:1.019～1.023)和1.054( 95％CI:1.047～1.054)；在不同的对照策略下,PM10、SO2以及NO2与呼吸系统死亡关联均有统计学意义(P＜0.05),且NO2的关联值相对较高.结论 本研究区域内大气PM10、SO2以及NO2浓度的上升促进呼吸系统疾病死亡的增加.     

武汉市大气污染与居民呼吸系统疾病死亡关系的病例交叉研究

目的运用病例交叉的研究方法探讨大气污染对武汉市居民呼吸系统疾病每日死亡的影响。方法采用病例交叉(case-crossover)设计的方法研究2005年1月1日至2006年12月31日期间武汉市城区大气污染与居民每日呼吸系统疾病的死亡之间的关系,同时比较不同的对照选择方案研究结果的差异。结果调整相关气象因素后,采用双向1∶2的对照设计分析表明,大气可吸入颗粒物(PM10)、二氧化硫(SO2)以及二氧化氮(NO2)日平均浓度每增加10μg/m3,武汉市城区居民呼吸系统疾病死亡发生的OR值分别为1.005(95%CI:1.004～1.006)、1.021(95%CI:1.019～1.023)和1.054(95%CI:1.047～1.054);在不同的对照策略下,PM10、SO2以及NO2与呼吸系统死亡关联均有统计学意义(P<0.05),且NO2的关联值相对较高。结论本研究区域内大气PM10、SO2以及NO2浓度的上升促进呼吸系统疾病死亡的增加。     

上海市闸北区大气污染与死亡率的病例交叉研究

目的 探索上海市闸北区大气污染与居民死亡率之间的联系。方法 应用病例交叉设计case-crossover)和STATA 6．0中的条件Logistic回归模型对2000年6月1日-2002年12月31日期间上海市闸北区大气污染与居民死亡率之间的联系进行分析。结果 在调整气象因素并采用1：4双向对称性对照模型中,PM10、SO2及NO2 48h平均浓度每增加10μg／m^3与总死亡率(损伤中毒除外)的OR分别为1．007(95％可信区间1．003-1．011),1．011(95％可信区间1．001-1．021),1．010(95％可信区间1．000-1．020),其中PM10与死亡率的联系在敏感度分析中不随模型参数的改变而不同。PM10与循环系统疾病死亡率有关,NO2与呼吸系统疾病死亡率有关。结论 上海市闸北区大气污染物暴露对居民死亡率有急性效应。     

上海市大气气态污染物与居民每日死亡关系的时间序列研究

目的 分析主要大气气态污染物[二氧化硫(SO2)、二氧化氮(NO2)]急性暴露对上海市城区居民每日死亡的影响.方法 采用时间序列的半参数广义相加模型,在控制死亡的长期趋势、气象因素、"星期几效应"等混杂因素的基础上,分析了上海市城区2001年1月1日-2004年12月31日大气SO2和NO2浓度与居民每日死亡数的关系.结果 大气SO2浓度每增加10μg/m3,上海市城区居民总死亡、心血管疾病死亡和呼吸道疾病死亡数分别增加1.25%(95%CI:0.85%～1.65%)、1.45%(95%CI:0.86%～2.04%)和1.71%(95%CI:0.72%～2.71%);大气NO2浓度每增加10 μg/m3,居民总死亡、心血管疾病死亡和呼吸道疾病死亡数则分别增加1.04%(95%CI:0.72%～1.35%),1.05%(95%CI:0.59%～1.51%)和1.43%(95%CI:0.65%～2.21%).结论 目前的上海市城区大气中SO2和NO2浓度对居民死亡确有影响.     

上海市闵行区大气污染与居民日死亡关系的时间序列研究

[目的]分析大气污染对居民每日死亡的急性效应。[方法]采用时间序列的广义相加模型(GAM),在控制了时间的长期趋势、季节趋势、周效应、气象因素等混杂因素的基础上,研究上海市闵行区2001年1月1日~2004年12月31日大气污染与居民日死亡的关系。[结果]大气中可吸入颗粒物(PM10)、二氧化硫(SO2)以及二氧化氮(NO2)的日均浓度每增加10μg/m3,对应居民死亡相对危险度分别为1.0030(95%CI:1.0005~1.0055)、1.0123(95%CI:1.0051~1.0195)和1.0126(95%CI:1.0059~1.0194)。[结论]上海市闵行区大气污染物PM10、NO2、SO2的浓度变化对居民日死亡人数有影响。     

上海市某区居民脑卒中死亡与大气污染关系的时间序列研究

目的　分析大气污染急性暴露对居民每日脑卒中死亡的影响。方法　采用时间序列的半参数广义相加模型 ,在控制死亡的长期趋势、气象因素、“星期几效应”等混杂因素的基础上 ,分析了上海市某区 2 0 0 1年 1月 1日～ 12月 31日大气污染与居民每日脑卒中死亡的关系。结果　大气PM10 ,SO2 和NO2 4 8h平均浓度每增加 10 μg m3 ,居民因脑卒中而死亡的相对危险度分别为 1 0 0 8(95 %CI 1 0 0 0～ 1 0 16 ) ,1 0 17(95 %CI 0 998～ 1 0 36 )和 1 0 2 9(95 %CI1 0 0 1～ 1 0 5 7)。结论　上海市某区目前的PM10 和NO2 水平对居民脑卒中死亡有影响。     

上海市卢湾区居民日死亡数与大气污染关系的时间序列研究

[目的]分析上海市卢湾区大气污染急性暴露对居民每日死亡数的影响。[方法]分别采用时间序列的半参数广义相加模型(GAM)和广义线性模型(GLM),在控制死亡的长期趋势、气象因素、“星期几效应”等混杂因素的基础上,分析上海市卢湾区2001年1月1日~2004年12月31日大气污染与居民每日死亡数的关系。[结果]在GAM中大气可吸入颗粒物(PM10),SO2和NO2,48h平均浓度每增加10μg/m3,居民死亡的相对危险度分别为1.0003(95%CI1.0000~1.0007)、1.0009(95%CI0.9998~1.0019)和1.0012(95%CI1.0003~1.0021);在GLM中大气PM10,SO2和NO2,48h平均浓度每增加10μg/m3,居民死亡的相对危险度分别为1.0004(95%CI1.0001~1.0008)、1.0008(95%CI0.9998~1.0019)和1.0012(95%CI1.0002~1.0022)。[结论]GAM、GLM拟和结果相似,上海市卢湾区目前的PM10和NO2水平对居民日死亡数有影响。     

气态污染物与上海市浦东新区居民心脑血管疾病死亡相关性的病例交叉研究

目的 评估气态污染物与浦东新区居民每日心脑血管疾病死亡的关联性,为制定相应的干预措施提供依据。方法 收集浦东新区2005年1月1日-2017年12年31日的气象因素、大气污染及居民心脑血管疾病死亡资料,采用时间分层-病例交叉研究的方法,评估气态污染物对浦东新区居民心脑血管疾病死亡的影响。结果 研究期间,上海市SO2与NO2的平均浓度分别为31.96μg/m3和45.21μg/m3。SO2与NO2与浦东新区居民心脑血管疾病死亡存在相关性。SO2与NO2的效应分别在滞后3d（lag3）与当日（lag0）强度最大,SO2浓度每上升10μg/m3,在滞后3d（lag3）时居民每日心脑血管疾病死亡将上升1.12%(95%CI:0.69%～1.56%);NO2浓度每上升10μg/m3,在当日居民每日心脑血管疾病死亡将上升0.85%(95%CI:0.40%～1.30%)。多污染物模型中,在控制了PM10与NO2的影响后,SO2的效应保持稳定,在控制了PM10与SO2的影响后,NO2的效应有所加强。结论 SO2与NO2浓度与每日浦东新区居民心脑血管疾病死亡存在相关性,其中SO2的效应在滞后3d影响最大,NO2在当日影响最大。     

北京市寒潮天气对居民心脑血管疾病死亡影响的病例交叉研究

目的研究寒潮天气对北京市居民心脑血管疾病日死亡人数的影响。方法北京市居民死亡资料来自北京市疾病预防控制中心,气象资料来自北京城市气象研究所。运用病例交叉的设计思想,采用单向回顾性1∶1对照和双向对称性1∶2对照设计,分析北京市1998年1月1日—2000年6月30日期间6次寒潮天气与北京市城8区居民每日心血管疾病、急性心肌梗死和脑血管疾病死亡的关系。病例选取为冬季所有心脑血管疾病死亡病例,选取死亡发生前第7天和发生后第7天作为对照(或者死亡前、后第14天作为对照)。结果研究时间段内共出现6次寒潮,日最低气温下降明显且伴随有湿度下降和气压上升的第3次寒潮期间3种死因的双向对称性对照设计的滞后期均为0d,居民每日心血管疾病、急性心肌梗死、脑血管疾病死亡的OR值分别为1.500(95%CI:1.032～2.181),1.913(95%CI:1.066～3.432)、1.679(95%CI:1.139～2.474)。其他5次寒潮对心脑血管病人的死亡未见明显影响。结论研究期间北京地区的绝大多数寒潮天气未对居民心脑血管疾病的死亡产生明显影响;但是温度降幅大且伴随高气压的寒潮可能会造成心脑血管疾病死亡风险升高,值得关注。     

大气污染物与呼吸系统疾病急诊就诊关系的病例交叉研究

目的 分析大气污染急性暴露对呼吸系统疾病急诊人次的影响.方法 收集2004年1月1日至2005年12月31日北京大学第三医院急诊科呼吸系统疾病急诊资料和北京市环境监测中心大气污染物数据,应用时间分层的病例交叉设计研究方法进行数据分析,同时比较单向回顾性对照设计和双向对照设计研究结果的差异.结果 在调整气象因素并采用单向回顾性(多污染物)模型中,无滞后大气可吸入颗粒物(PM10)、二氧化硫(SO2)、滞后2 d二氧化氮(NO2)日平均浓度每增加10 μg/m3,呼吸系统疾病总急诊的OR值(95%CI)分别为1.010(1.005～1.014)、1.010(1.001～1.018)、0.996(0.983～1.009);双向对称性(多污染物)模型中,其相应OR值(95%CI)分别为1.002(0.998～1.005)、1.011(1.003～1.018)、1.012(1.001～1.022).采用不同对照选择方案,病例交叉设计的研究结果有变化.结论 区域内大气污染物暴露对居民呼吸系统疾病急诊人次有急性效应.     

A case-crossover analysis of air pollution and daily mortality in Shanghai

We used a case-crossover approach to assess the association between air pollution and daily mortality in Shanghai from June 2000 to December 2001. By design, this method can avoid some common concerns about the time-series approach, which was most frequently used to assess the short-term effects of air pollution. Different control periods (unidirectional and bi-directional control samplings) were used for the analysis. With a bi-directional six control sampling approach, the results from a conditional logistic regression model controlling for weather conditions showed that each 10 microg/m3 increase over a 48-h moving average of PM10, SO2 and NO2 corresponds to 1.003 (95%CI 1.001-1.005), 1.016 (95%CI 1.011-1.021), and 1.020 (95%CI 1.012-1.027) relative risk of non-accident mortality, respectively. The association between air pollution and mortality for chronic obstructive pulmonary diseases (COPD) and cardiovascular causes was found to be closer than that for all causes. The results confirmed the deleterious role of the current air pollution level on human health in Shanghai, and provided information on the applicability of case-crossover design in studying the acute health effects of air pollution.     

Reanalysis of the effects of air pollution on daily mortality in Seoul, Korea: A case-crossover design.

We used the case-crossover design to identify any increase in mortality in Seoul, Korea, when there were higher levels of ambient air pollution on case-days than would be expected solely as a result of chance. This empirical study showed that either unidirectional retrospective (selecting only control days prior to death) or prospective (selecting only control days after death) control sampling could cause risk estimates to be confounded by seasonal waves as well as time trends in air pollution levels. In bidirectional control sampling in which exposures at death were compared with exposures both before and after death, the estimated mortality was resistant to confounding by time patterns of air pollution. Using a bidirectional control sampling approach, the results from a conditional logistic regression model controlling for weather conditions showed that the nonaccidental mortality associated with a 50-ppb increment over a 3-day moving average of SO(2) concentrations, including the concurrent day and preceding 2 days, was 1.023 [95% confidence interval (CI), 1.016-1.084]. The relative risk of death was 1.023 (CI, 0.999-1.048) per 50 ppb for 1-hr maximum O(3) and 1.010 (CI, 0.988-1.032) per 100 microg/m(3 )or total suspended particulates. In conclusion, the findings of this study were 2-fold: given the consistency of the observed association between SO(2) and daily mortality across different analysis methods, the association reported here indicates that air pollution is a probable contributor to premature death; and bidirectional control sampling is needed in a case-crossover design applied to air pollution epidemiologic studies to control confounding by seasonal patterns of air pollution as well as time trends.     

The association of daily diabetes mortality and outdoor air pollution in Shanghai, China

The objective of the study reported here was to assess the association between air pollution and daily diabetes mortality in Shanghai. Death records were collected for all individuals who lived in the Zhabei district of Shanghai and died from diabetes from January 1, 2001, to December 31, 2002. The authors used a time-series approach to study the acute effects of air pollution on diabetes mortality after controlling for long-term trends, weather variables, and day of the week. Each increase of 10 microg/m3 in PM10, SO2, or NO2 was found to correspond, respectively, to a 1.006 (95 percent CI: 1.000-1.012), 1.011 (95 percent CI: 0.990-1.032), or 1.013 (95 percent CI: 1.000-1.026) relative risk of diabetes mortality in Shanghai. The air pollutants also were observed to have a greater effect on diabetics than on nondiabetics. These findings provide new evidence for the association between air pollution and diabetes mortality risk, and suggest that diabetics are more susceptible to air pollution than are nondiabetics.     

Effects of air pollution on postneonatal infant mortality among firstborn infants in Seoul, Korea: case-crossover and time-series analyses

Infants are known to be susceptible to the adverse health effects of ambient air pollution. The authors examined the relationship between air pollution and postneonatal mortality from all causes among firstborn infants in Seoul, Korea, during 1999-2003, using both case-crossover and time-series analyses. Using a bidirectional control-sampling approach, the authors compared the effects of various types of air pollution on postneonatal mortality. The relative risk of postneonatal mortality from all causes was 1.000 (95% confidence interval [CI] = 0.998-1.002) for particulate matter with a diameter <10 mum, 1.002 (95% CI = 0.994-1.009) for nitrogen dioxide, 1.015 (95% CI = 0.973-1.058) for sulfur dioxide, 1.029 (95% CI = 0.833-1.271) for carbon monoxide, and 0.984 (95% CI = 0.977-0.992) for ozone for each 1-unit increase of air pollution level in the 1:6 control selection scheme. The authors observed a positive association between air pollution and infant daily mortality except for the studied particulate matter and ozone, although it was not statistically significant. They obtained similar results in the time-series analysis. The risk of postneonatal infant death from all causes was positively associated with all studied air pollutants except ozone. The authors also confirmed that the bidirectional method with many controls will give a more efficient estimator than will a method with fewer controls.     

Comparison of four case-crossover study designs to analyze the association between air pollution exposure and acute myocardial infarction

The case-crossover design is frequently used for analyzing the acute health effects of air pollution. Nevertheless, only a few studies compared different methods for selecting control periods. In this study, the bidirectional method and three time-stratified methods were used to estimate the association between air pollution and acute myocardial infarction (AMI) in Charleroi, Belgium, during 1999–2008. The strongest associations between air pollution and AMI were observed for PM₁₀ and NO₂ during the warm period, OR = 1.095 (95?% CI: 1.003–1.169) and OR = 1.120 (95?% CI: 1.001–1.255), respectively. The results of this study reinforce the evidence of the acute effects of air pollution on AMI, especially during the warm season. This study suggests that the different methods of case-crossover study design are suitable to studying the association between acute events and air pollution. The temperature-stratified design is useful to exclude temperature as a potential confounder.     

Season, sex, age, and education as modifiers of the effects of outdoor air pollution on daily mortality in Shanghai, China: The Public Health and Air Pollution in Asia (PAPA) Study

BACKGROUND: Various factors can modify the health effects of outdoor air pollution. Prior findings about modifiers are inconsistent, and most of these studies were conducted in developed countries. OBJECTIVES: We conducted a time-series analysis to examine the modifying effect of season, sex, age, and education on the association between outdoor air pollutants [particulate matter < 10 microm in aerodynamic diameter (PM(10)), sulfur dioxide, nitrogen dioxide, and ozone] and daily mortality in Shanghai, China, using 4 years of daily data (2001-2004). METHODS: Using a natural spline model to analyze the data, we examined effects of air pollution for the warm season (April-September) and cool season (October-March) separately. For total mortality, we examined the association stratified by sex and age. Stratified analysis by educational attainment was conducted for total, cardiovascular, and respiratory mortality. RESULTS: Outdoor air pollution was associated with mortality from all causes and from cardiorespiratory diseases in Shanghai. An increase of 10 mug/m(3) in a 2-day average concentration of PM(10), SO(2), NO(2), and O(3) corresponds to increases in all-cause mortality of 0.25% [95% confidence interval (CI), 0.14-0.37), 0.95% (95% CI, 0.62-1.28), 0.97% (95% CI, 0.66-1.27), and 0.31% (95% CI, 0.04-0.58), respectively. The effects of air pollutants were more evident in the cool season than in the warm season, and females and the elderly were more vulnerable to outdoor air pollution. Effects of air pollution were generally greater in residents with low educational attainment (illiterate or primary school) compared with those with high educational attainment (middle school or above). CONCLUSIONS: Season, sex, age, and education may modify the health effects of outdoor air pollution in Shanghai. These findings provide new information about the effects of modifiers on the relationship between daily mortality and air pollution in developing countries and may have implications for local environmental and social policies.     

Ozone and daily mortality in Shanghai, China

BACKGROUND: Controversy remains regarding the relationship between ambient ozone and mortality worldwide. In mainland China, the largest developing country, there has been no prior study investigating the acute effect of O3 on death risk. Given the changes in types of air pollution from conventional coal combustion to the mixed coal combustion/motor vehicle emissions in China's large cities, it is worthwhile to investigate the acute effect of O3 on mortality outcomes in the country. OBJECTIVES: We conducted a time-series study to investigate the relation between O3 and daily mortality in Shanghai using 4 years of daily data (2001-2004). METHODS: We used the generalized additive model with penalized splines to analyze mortality, O3 pollution, and covariate data in warm and cold seasons. We considered daily counts of all-cause mortality and several cause-specific subcategories (respiratory and cardiovascular). We also examined these associations among several subpopulations based on age and sex. RESULTS: O3 was significantly associated with total and cardiovascular mortality in the cold season but not in the warm season. In the whole-year analysis, an increase of 10 microg/m3 of 2-day average (lag01) O3 corresponds to 0.45% [95% confidence interval (CI) , 0.16-0.73%], 0.53% (95% CI, 0.10-0.96%), and 0.35% (95% CI, -0.40 to 1.09%) increase of total nonaccidental, cardiovascular, and respiratory mortality, respectively. In the cold season, the estimates increased to 1.38% (95% CI, 0.68-2.07%), 1.53% (95% CI, 0.54-2.52%), and 0.95% (95% CI, -0.71 to 2.60%), respectively. In the warm season, we did not observe significant associations for both total and cause-specific mortality. The results were generally insensitive to model specifications such as lag structure of O3 concentrations and degree of freedom for time trend. Multipollutant models indicate that the effect of O3 was not confounded by particulate matter相似文献