珠江三角洲地区城市大气细颗粒物与臭氧对循环系统疾病就诊风险的交互作用

目的了解珠江三角洲地区城市大气细颗粒物(PM_2.5)与臭氧(O_3)对循环系统疾病就诊情况的影响,并进一步探讨PM_2.5和O_3的交互作用。方法采用时间序列研究方法,选择广州、佛山和珠海市为研究点,从广东省疾病预防控制中心获得2015—2017年3个城市3家三甲医院的每日循环系统疾病门诊就诊数据,从广东省环境监测中心获得每日大气PM_2.5和O_3浓度数据,从广东省气象局获得每日气象数据。采用广义相加模型(GAM)分别分析PM_2.5和O_3平均浓度上升10μg/m^3引起的超额风险(ER)及PM_2.5和O_3的交互作用,并采用Meta分析对多城市的结果进行合并。结果2015—2017年,广州、佛山和珠海市大气PM_2.5浓度每增加10μg/m^3引起循环系统疾病门诊就诊风险的ER分别为2.45%、0.64%和0.95%;3个城市大气PM_2.5和O_3浓度每增加10μg/m^3引起的合并ER分别为1.34%(95%CI:0.25%～2.43%)和-0.17%(95%CI:-0.47%～0.14%)。O_3对PM_2.5与循环系统疾病门诊就诊风险存在修饰效应,其中在O_3浓度低时PM_2.5导致的循环系统疾病门诊就诊风险最高,ER为4.19%(95%CI:1.82%～6.56%);而PM_2.5对O_3与循环系统疾病门诊就诊风险的修饰效应没有统计学意义。结论珠江三角洲地区城市大气PM_2.5可增加居民的循环系统疾病门诊就诊风险,O_3对其存在修饰效应。

Interactions of fine particle matter and ozone on outpatient visits for circulatory system diseases in Pearl River Delta urban areas

Objective To investigate the impact of fine particle matter （PM_2.5） and ozone on outpatient visits for circulatory system diseases and explore their interactions. Methods Time series research method was used in this study. Data on daily outpatient visits for circulatory system diseases of three Level-3 Class-A hospitals in cities of Guangzhou, Foshan, and Zhuhai were obtained from Guangdong Provincial Center for Disease Control and Prevention between 2015 and 2017. Daily ambient PM_2.5 and ozone concentration data from Guangdong Environmental Monitoring Center and daily meteorological data from Guangdong Provincial Meteorological Bureau were collected in the same period. Generalized additive model （GAM） was used to estimate the excess risk （ER） for each 10 μg/m³ increment in PM_2.5 and ozone_, concentrations and further to explore the potential interactions between PM_2.5 and ozone. Additionally, a meta-analysis was conducted to quantitatively combine the ERs of the three cities. Results During 2015- 2017, a 10 μg/m³ increment in PM_2.5 concentration was associated with an increment in the daily outpatient visits for circulatory system diseases by 2.45%, 0.64%, and 0.95% of ER in Guangzhou, Foshan, and Zhuhai, respectively. And a 10 μg/m³ increment in PM_2.5 and ozone concentrations was associated with an increment in the combined ER of three cities by 1.34% （95%CI：0.25%-2.43%） and -0.17%（95%CI：-0.47%-0.14%）, respectively. Additionally, ozone modified the association between PM_2.5 and the daily outpatient visits for circulatory system diseases. Specifically, when ozone concentration was lowest, the ER for PM_2.5 on daily outpatient visits for circulatory system diseases was highest （ER=4.19%,95%CI：1.82%-6.56%）. However, the modification effect of PM_2.5 on the association between ozone and outpatient visits for circulatory system diseases was not statistically significant. Conclusion Atmospheric PM_2.5 could increase the risk of outpatient visits for circulatory system diseases in the Pearl River Delta urban area, and ozone had a modification effect on it.