大气污染对小学生健康的影响

  目的  了解大气污染物浓度增高对学龄儿童疾病、症状和因病缺课产生的影响，为防止大气污染对学生健康的危害提供参考。  方法  于2014—2017年每年冬季，对杭州某小学792名四年级学生进行健康问卷调查，每日连续开展发病和症状监测。采用基于Pearson回归的广义相加模型分析单污染物浓度增高引起的健康影响，多因素Logistic回归模型分析家庭、居住环境与大气污染物浓度增加对学生健康的综合影响。  结果  415名(52.4%)小学生有既往病史，265名(33.5%)有过敏史。调查期间，PM_2.5、PM₁₀、SO₂和NO₂的平均质量体积浓度分别为(81.0±2.8)(122.2±3.9)(17.9±0.6)(68.9±1.4)μg/m3。PM_2.5、PM₁₀和NO₂滞后3 d时对学生发生疾病和因病缺课的影响最为明显，各污染物每增加10 μg/m3，发生疾病风险RR值分别为1.02(1.01~1.02)，1.04(1.03~1.06)和1.03(1.02~1.04)。SO₂滞后5 d对学生健康影响最为显著。父亲本科及以上文化水平与小学生冬季发生疾病(OR=0.83)和症状(OR=0.84)呈负相关；1年内家具更换(OR=1.78)、宠物饲养(OR=1.94)、1年内反复呼吸道感染(OR=1.82)、1年前过敏性鼻炎(OR=2.24)、冠心病/高血压家族史(OR=1.46)、室内活动时间(OR=1.02)、大气PM₁₀浓度(OR=1.09)与小学生冬季产生症状呈正相关(P值均 < 0.05)。  结论  大气污染物浓度增高对小学生发生疾病、症状以及因病缺课有影响且存在滞后效应。父亲本科及以上文化水平是学生健康的保护因素，室内环境污染和室外大气污染均可导致学生疾病和症状的发生。

The influence of air pollution on the health of primary school students

  Objective  To investigate the effects of ambient air pollution on the school-age children's diseases, symptoms and school absence, and to provide a reference for preventing the harmful effect of air pollution on students.  Methods  Health questionnaires surveys were conducted among 792 students of the fourth grade in a primary school in Hangzhou, and the incidence of diseases and symptoms were continuously monitored every day during the winter of 2014-2017. The generalized additive model based on Poisson regression was used to analyze the health effects caused by single pollution. The multivariate Logistic regression model was used to analyze the comprehensive effects of family, living environment and air pollution on student health.  Results  Totally 415 students(52.4%) had a history of diseases and 265 students(33.5%) had a history of allergy. During the investigation, the average concentrations of PM_2.5, PM₁₀, SO₂ and NO₂ were (81.0±2.8) (122.2±3.9) (17.9±0.6) and (68.9±1.4)μg/m3. Strongest associations were found for lag 3 day of exposure among PM_2.5, PM₁₀ and NO₂ on illness and absence. Increases of 10 μg/m3 in PM_2.5, PM₁₀ and NO₂ were associated with 1.02(95%CI=1.01-1.02), 1.04(95%CI=1.03-1.06) and 1.03(95%CI=1.02-1.04) increases in daily illness rates. SO₂ lag for 5 days had the most significant effect on students' health. Father's education was the protective factor for illness (OR=0.83) and symptoms(OR=0.84). The risk factors for symptoms included furniture replacement within one year(OR=1.78), pet feeding(OR=1.94), respiratory infections within one year(OR=1.82), allergies rhinitis(OR=2.24), family history with coronary heart disease/hypertension(OR=1.46), indoor activity time (OR=1.02) and atmospheric PM₁₀ concentration(OR=1.09)(P < 0.05).  Conclusion  The increase of air pollution concentration has an impact on the illness, symptoms and absence from school, and there is a lag effect. Father's education is a protective factor for the health of students. Indoor pollution and outdoor air pollution can lead to the occurrence of illness and symptoms.