Mott Joshua A, Mannino David M, Alverson Clinton J, Kiyu Andrew, Hashim Jamilah, Lee Tzesan, Falter Kenneth, Redd Stephen C
Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Int J Hyg Environ Health. 2005;208(1-2):75-85. doi: 10.1016/j.ijheh.2005.01.018.
We investigated the cardiorespiratory health effects of smoke exposure from the 1997 Southeast Asian Forest Fires among persons who were hospitalized in the region of Kuching, Malaysia. We selected admissions to seven hospitals in the Kuching region from a database of all hospital admissions in the state of Sarawak during January 1, 1995 and December 31, 1998. For several cardiorespiratory disease classifications we used Holt-Winters time-series analyses to determine whether the total number of monthly hospitalizations during the forest fire period (August 1 to October 31, 1997), or post-fire period (November 1, 1997 to December 31, 1997) exceeded forecasted estimates established from a historical baseline period of January 1, 1995 to July 31, 1997. We also identified age-specific cohorts of persons whose members were admitted for specific cardiorespiratory problems during January 1 to July 31 of each year (1995--1997). We compared Kaplan-Meier survival curves of time to first readmission for the 1997 cohorts (exposed to the forest fire smoke) with the survival curves for the 1995 and 1996 cohorts (not exposed, pre-fire cohorts). The time-series analyses indicated that statistically significant fire-related increases were observed in respiratory hospitalizations, specifically those for chronic obstructive pulmonary disease (COPD) and asthma. The survival analyses indicated that persons over age 65 years with previous hospital admissions for any cause (chi2(1df) = 5.98, p = 0.015), any cardiorespiratory disease (chi2(1df) = 5.3, p = 0.02), any respiratory disease (chi2(1df) = 7.8, p = 0.005), or COPD (chi2(1df) = 3.9, p = 0.047), were significantly more likely to be rehospitalized during the follow-up period in 1997 than during the follow-up periods in the pre-fire years of 1995 or 1996. The survival functions of the exposed cohorts resumed similar trajectories to unexposed cohorts during the post-fire period of November 1, 1997 to December 31, 1998. Communities exposed to forest fire smoke during the Southeast Asian forest fires of 1997 experienced short-term increases in cardiorespiratory hospitalizations. When an air quality emergency is anticipated, persons over age 65 with histories of respiratory hospitalizations should be preidentified from existing hospitalization records and given priority access to interventions.
我们调查了1997年东南亚森林火灾产生的烟雾暴露对马来西亚古晋地区住院患者心肺健康的影响。我们从砂拉越州1995年1月1日至1998年12月31日所有医院入院病例数据库中选取了古晋地区七家医院的入院病例。对于几种心肺疾病分类，我们使用霍尔特 - 温特斯时间序列分析来确定森林火灾期间（1997年8月1日至10月31日）或火灾后时期（1997年11月1日至12月31日）每月住院总人数是否超过根据1995年1月1日至1997年7月31日历史基线期确定的预测估计值。我们还确定了每年（1995 - 1997年）1月1日至7月31日因特定心肺问题入院的特定年龄组人群。我们比较了1997年队列（暴露于森林火灾烟雾）首次再入院时间的卡普兰 - 迈耶生存曲线与1995年和1996年队列（未暴露，火灾前队列）的生存曲线。时间序列分析表明，在呼吸道住院病例中观察到与火灾相关的统计学显著增加，特别是慢性阻塞性肺疾病（COPD）和哮喘的住院病例。生存分析表明，65岁以上因任何原因（卡方检验（1自由度）= 5.98，p = 0.015）、任何心肺疾病（卡方检验（1自由度）= 5.3，p = 0.02）、任何呼吸道疾病（卡方检验（1自由度）= 7.8，p = 0.005）或COPD（卡方检验（1自由度）= 3.9，p = 0.047）此前已住院的患者，在1997年随访期间比1995年或1996年火灾前随访期间再次住院的可能性显著更高。在1997年11月1日至1998年12月31日的火灾后时期，暴露队列的生存函数恢复到与未暴露队列相似的轨迹。1997年东南亚森林火灾期间暴露于森林火灾烟雾的社区心肺住院病例出现短期增加。当预计会出现空气质量紧急情况时，应从现有住院记录中预先识别出有呼吸道住院史的65岁以上人群，并优先为其提供干预措施。
