臭氧对心脑血管疾病急救的短期影响及其季节性差异
|
摘要
目的分析不同季节条件下臭氧对心脑血管疾病急救的短期影响,及该影响在不同类型人群中的差异。方法收集宁波市三个主城区2013-2016年的急救车接诊资料,通过主诉和初步诊断信息筛选出心脑血管疾病病例。采用分布滞后非线性模型分析方法,控制长期趋势、气温、相对湿度等混杂因素影响后,定量分析不同季节时每日最大的连续8小时臭氧浓度(臭氧8小时)和心脑血管疾病急救人次的短期关联。结果研究期间臭氧8小时平均浓度在全年、冷季(11月-次年4月)和暖季(5月-10月)分别为94.5μg/m~3,77.2μg/m~3和111.6μg/m~3。臭氧和心脑血管疾病急救人次的暴露-反应关系近似为无阈值的线性关系。全年和暖季时,臭氧8小时浓度每升高10μg/m~3,当天心脑血管疾病急救人次分别增加0.96%(95%CI:0.21～1.72%)和1.17%(95%CI:0.21～2.13%);男性受到的影响明显大于女性。冷季时均未发现臭氧8小时浓度和心脑血管疾病急救人次之间的关系有统计学意义(P>0.05)。结论臭氧和心脑血管疾病急救人次的暴露-反应关系为无阈值的线性曲线,暖季时效应较强,男性受到的影响强于女性。
Objective To assess the short-term effect of ozone on emergency ambulance dispatches for cardiovascular diseases(CVDs)in vulnerable groups and seasonal variation.Methods The data of daily emergency ambulance dispatches were collected from 2013 to 2016 in three urban districts of Ningbo city,and CVDs were selected by the chief complaint and tentative diagnosis.We used a Distributed lag non-linear model to evaluate the short-term association between daily maximum 8 h average ambient ozone concentration(O_3-8 h)and emergency ambulance dispatches for CVDs in seasonal variation,after controlling long-term trend,ambient temperature,relative humidity and other confounding variables.Results During the study period,the concentration of O_3-8 h in full year,cold season(November-April)and warm season(May-October)were 94.5μg/m~3,77.2μg/m~3 and 111.6μg/m~3,respectively.The results suggested that there is a linear non-threshold dose-response relationship between O_3-8 h and emergency ambulance dispatches for CVDs.In full year and warm season,a 10μg/m~3 increase of O_3-8 h were associated with 0.96%(95%CI:0.21～1.72%)and 1.17%(95%CI:0.21～2.13%)increase of emergency ambulance dispatches for CVDs in lag 0 day,respectively.The male were at higher risk compared to the female.No statistically significant were found in cold season(P>0.05).Conclusion These findings suggested that there is a linear non-threshold dose-response relationship between ozone and emergency ambulance dispatches for CVDs.Greater effects of ozone were observed during the warm season than in the cold season,and the male were at higher risk compared to the female.
Objective To assess the short-term effect of ozone on emergency ambulance dispatches for cardiovascular diseases(CVDs)in vulnerable groups and seasonal variation.Methods The data of daily emergency ambulance dispatches were collected from 2013 to 2016 in three urban districts of Ningbo city,and CVDs were selected by the chief complaint and tentative diagnosis.We used a Distributed lag non-linear model to evaluate the short-term association between daily maximum 8 h average ambient ozone concentration(O_3-8 h)and emergency ambulance dispatches for CVDs in seasonal variation,after controlling long-term trend,ambient temperature,relative humidity and other confounding variables.Results During the study period,the concentration of O_3-8 h in full year,cold season(November-April)and warm season(May-October)were 94.5μg/m~3,77.2μg/m~3 and 111.6μg/m~3,respectively.The results suggested that there is a linear non-threshold dose-response relationship between O_3-8 h and emergency ambulance dispatches for CVDs.In full year and warm season,a 10μg/m~3 increase of O_3-8 h were associated with 0.96%(95%CI:0.21～1.72%)and 1.17%(95%CI:0.21～2.13%)increase of emergency ambulance dispatches for CVDs in lag 0 day,respectively.The male were at higher risk compared to the female.No statistically significant were found in cold season(P>0.05).Conclusion These findings suggested that there is a linear non-threshold dose-response relationship between ozone and emergency ambulance dispatches for CVDs.Greater effects of ozone were observed during the warm season than in the cold season,and the male were at higher risk compared to the female.
引文
[1] 徐甜,王志远,张兵,等.中国环境保护重点城市空气质量指数时空变化特征.中国公共卫生,2016,32(8):1027-1031.
[2] Gryparis A,Forsberg B,Katsouyanni K,et al.Acute effects of ozone on mortality from the "air pollution and health:a European approach" project.American journal of respiratory and critical care medicine,2004,170(10):1080-1087.
[3] Bell ML,Peng RD,Dominici F.The exposure-response curve for ozone and risk of mortality and the adequacy of current ozone regulations.Environmental health perspectives,2006,114(4):532-536.
[4] Jerrett M,Burnett RT,Pope CA,et al.Long-term ozone exposure and mortality.The New England journal of medicine,2009,360(11):1085-1095.
[5] Zhang Y,Huang W,London SJ,et al.Ozone and daily mortality in Shanghai,China.Environmental health perspectives,2006,114(8):1227-1232.
[6] 晋乐飞,冯斐斐,段丽菊,等.臭氧对呼吸系统影响研究进展.中国公共卫生,2015,31(5):685-688.
[7] 董继元,刘兴荣,张本忠,等.我国臭氧短期暴露与人群死亡风险的Meta分析.环境科学学报,2016,36(4):1477-1485.
[8] Chiu HF,Weng YH,Chiu YW,et al.Short-term effects of ozone air pollution on hospital admissions for myocardial infarction:A time-stratified case-crossover study in Taipei.Journal of toxicology and environmental health Part A,2017,80(5):251-257.
[9] 胡悦,郭昳,关茗洋,等.石家庄市大气臭氧浓度与居民急救关系的时间序列分析.环境与健康杂志,2016,33(10):872-876.
[10] 闫美霖,李湉湉,刘晓途,等.我国臭氧短期暴露的人群健康效应研究进展.环境与健康杂志,2012,29(8):752-761.
[11] 吴敏敏,陈仁杰,阚海东,等.中国三城市臭氧对大气颗粒物与日死亡率关系的效应修饰作用.卫生研究,2015,44(5):788-812.
[12] Bhaskaran K,Gasparrini A,Hajat S,et al.Time series regression studies in environmental epidemiology.International journal of epidemiology,2013,42(4):1187-1195.
[13] Gasparrini A,Armstrong B,Kenward MG.Distributed lag non-linear models.Statistics in medicine,2010,29(21):2224-2234.
[14] Kan H,London SJ,Chen G,et al.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.Environmental health perspectives,2008,116(9):1183-1188.
[15] Day DB,Xiang J,Mo J,et al.Association of Ozone Exposure With Cardiorespiratory Pathophysiologic Mechanisms in Healthy Adults.JAMA internal medicine,2017,177(9):1344-1353.
[16] Ren C,Williams GM,Mengersen K,et al.Temperature enhanced effects of ozone on cardiovascular mortality in 95 large US communities,1987-2000:Assessment using the NMMAPS data.Archives of environmental & occupational health,2009,64(3):177-184.
[17] Jhun I,Fann N,Zanobetti A,et al.Effect modification of ozone-related mortality risks by temperature in 97 US cities.Environment international,2014,73:128-134.
[18] 易睿,王亚林,张殷俊,等.长江三角洲地区城市臭氧污染特征与影响因素分析.环境科学学报,2015,35(8):2370-2377.
[2] Gryparis A,Forsberg B,Katsouyanni K,et al.Acute effects of ozone on mortality from the "air pollution and health:a European approach" project.American journal of respiratory and critical care medicine,2004,170(10):1080-1087.
[3] Bell ML,Peng RD,Dominici F.The exposure-response curve for ozone and risk of mortality and the adequacy of current ozone regulations.Environmental health perspectives,2006,114(4):532-536.
[4] Jerrett M,Burnett RT,Pope CA,et al.Long-term ozone exposure and mortality.The New England journal of medicine,2009,360(11):1085-1095.
[5] Zhang Y,Huang W,London SJ,et al.Ozone and daily mortality in Shanghai,China.Environmental health perspectives,2006,114(8):1227-1232.
[6] 晋乐飞,冯斐斐,段丽菊,等.臭氧对呼吸系统影响研究进展.中国公共卫生,2015,31(5):685-688.
[7] 董继元,刘兴荣,张本忠,等.我国臭氧短期暴露与人群死亡风险的Meta分析.环境科学学报,2016,36(4):1477-1485.
[8] Chiu HF,Weng YH,Chiu YW,et al.Short-term effects of ozone air pollution on hospital admissions for myocardial infarction:A time-stratified case-crossover study in Taipei.Journal of toxicology and environmental health Part A,2017,80(5):251-257.
[9] 胡悦,郭昳,关茗洋,等.石家庄市大气臭氧浓度与居民急救关系的时间序列分析.环境与健康杂志,2016,33(10):872-876.
[10] 闫美霖,李湉湉,刘晓途,等.我国臭氧短期暴露的人群健康效应研究进展.环境与健康杂志,2012,29(8):752-761.
[11] 吴敏敏,陈仁杰,阚海东,等.中国三城市臭氧对大气颗粒物与日死亡率关系的效应修饰作用.卫生研究,2015,44(5):788-812.
[12] Bhaskaran K,Gasparrini A,Hajat S,et al.Time series regression studies in environmental epidemiology.International journal of epidemiology,2013,42(4):1187-1195.
[13] Gasparrini A,Armstrong B,Kenward MG.Distributed lag non-linear models.Statistics in medicine,2010,29(21):2224-2234.
[14] Kan H,London SJ,Chen G,et al.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.Environmental health perspectives,2008,116(9):1183-1188.
[15] Day DB,Xiang J,Mo J,et al.Association of Ozone Exposure With Cardiorespiratory Pathophysiologic Mechanisms in Healthy Adults.JAMA internal medicine,2017,177(9):1344-1353.
[16] Ren C,Williams GM,Mengersen K,et al.Temperature enhanced effects of ozone on cardiovascular mortality in 95 large US communities,1987-2000:Assessment using the NMMAPS data.Archives of environmental & occupational health,2009,64(3):177-184.
[17] Jhun I,Fann N,Zanobetti A,et al.Effect modification of ozone-related mortality risks by temperature in 97 US cities.Environment international,2014,73:128-134.
[18] 易睿,王亚林,张殷俊,等.长江三角洲地区城市臭氧污染特征与影响因素分析.环境科学学报,2015,35(8):2370-2377.