大气颗粒物污染与脑卒中死亡的病例交叉研究

目的 评价大气颗粒物污染对人群脑卒中死亡的急性效应.方法 采用时间分层的病例交叉设计,分析杭州市2002-2004年间大气可吸入颗粒物(PM10)日平均浓度短期增加与人群每日脑卒中死亡的关系,同时分析其他气态污染物(NO2和SO2)的急性健康效应.结果共纳入9906例脑卒中死亡病例,粗死亡率约为83.54/10万.调整气象因素后,3 d内PM10、SO2和NO2日平均浓度每增加10μg/m3,人群脑卒中死亡则分别增加0.56%(95%CI:0.14%～0.99%)、1.62%(95%CI:0.26%～3.01%)和2.07%(95%CI:0.54%～3.62%).多污染物模型中未见有统计学意义的关联.敏感性分析结果显示进行缺失值填补后,单污染物模型中均有关联效应,多污染物模型中则无统计学意义的关联.结论大气颗粒物污染以及SO2和NO2污染物浓度短期升高均与脑卒中死亡增加存在一定关联.

A case-crossover study on air pollutants and the mortality of stroke

Objective To investigate the short-term effect of particulate matter in air on the mortality of stroke. Methods Using time-stratified case-crossover study design,an association was examined between stroke mortality and particulate matter with aerodynamic diameter of ＜10μm(PM10) of 2002- 2004 in Hangzhou city.Meanwhile,the acute health effect of other gaseous pollutants (sulfur dioxide,SO2 and nitrogen dioxide,NO2) was also analyzed.Results A total of 9906 deaths of stroke were included.The crude stroke mortality was 83.54 per 100 000.After being adjusted for meteorological factors,when an increase of 10 μg/m3 in PM10,SO2 and NO2 in three days was noticed,it appeared that the increases of mortality of stroke were 0.56%(95%CI:0.14%-0.99%),1.62%(95%CI:0.26%-3.01%) and 2.07%( 95%CI:0.54%-3.62%) respectively.There was no distinct association in multipollutant models.In sensitivity analysis,the associations were found in all single-pollutant models but not statistically significant in multi-pollutant models after replacing the missing values.Conclusion It is suggested that the short-term elevation in PM10 as well as SO2 and NO2 daily concentrations were related to the increase of stroke mortality in Hangzhou city.