上海市大气污染与某医院呼吸系统疾病门诊量关系的时间序列研究

目的]探讨上海市大气污染物对人群呼吸系统疾病门诊量的短期影响。方法]收集2010年1月1日—2012年10月31日上海市某三级甲等医院呼吸系统疾病每日门诊量统计资料和同期上海市大气及气象监测资料,采用时间序列的半参数广义相加模型,在控制了长期趋势、星期几效应、假期效应及气象因素等混杂因素的基础上,分析大气污染物与呼吸系统疾病日门诊量的关系。结果]研究期间,呼吸系统疾病日门诊量为76~382人次。单污染模型中,二氧化硫（SO2）滞后4 d对呼吸系统疾病的影响最明显,二氧化氮（NO2）、可吸入颗粒物（PM10）滞后6 d的影响最明显;SO2、NO2、PM10浓度每增加10μg/m3,呼吸系统疾病日门诊量上升0.69%（RR=1.006 9,95%CI：1.003 5~1.010 3）、0.54%（RR=1.005 4,95%CI：1.002 8~1.007 9）和0.20%（RR=1.002 0,95%CI：1.001 1~1.002 8）。多污染模型中,调整其他污染物后,所有污染物健康效应估计值均较单污染模型降低,并不改变各污染物浓度与呼吸系统疾病日门诊量的正相关关系。结论]大气污染物SO2、NO2、PM10与人群呼吸系统疾病门诊量存在正相关。

Time-Series Analysis on Association between Air Pollution and Outpatient Visits for Respiratory Diseases in a Hospital in Shanghai

Objective] To evaluate the short-term health effects of air pollutants on outpatient visits for respiratory diseases in Shanghai.Methods] Daily data on outpatient visits to a Grade III Class A hospital for respiratory diseases, meteorological data, and air pollution data from January 1, 2010 to October 31, 2012 were collected.A time-series analysis by generalized additive model was conducted to examine the relationship between air pollutants and daily outpatient visits, controlling for time trends, day-of-week effect, holiday effect, and weather conditions.Results] The daily outpatient visits for respiratory diseases ranged from 76 to 382 over the study period.In the single-pollutant model, SO2 concentration with lagged 4 days and NO2 and PM10 concentrations with lagged 6 days showed the most significant influence on outpatient visits.The excess relative risks of daily outpatient visits for a 10- μg/m3 increment in SO2, NO2, and PM10 were 0.69%（RR=1.006 9, 95%CI： 1.003 5-1.010 3）, 0.54%（RR=1.005 4, 95%CI： 1.002 8-1.007 9）, and 0.20%（RR=1.002 0, 95%CI： 1.001 1-1.002 8）, respectively.In the multiple-pollutant models, all pollutants effect estimates were lower compared with the results of the single-pollutant model when other pollutants were adjusted, but the positive correlations still existed between the pollutants and the daily outpatient visits for respiratory diseases.Conclusion] The ambient air pollutant concentrations of SO2, NO2, and PM10 are positively associated with daily outpatient visits for respiratory diseases.