Kan Haidong, London Stephanie J, Chen Guohai, Zhang Yunhui, Song Guixiang, Zhao Naiqing, Jiang Lili, Chen Bingheng
Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China.
Environ Health Perspect. 2008 Sep;116(9):1183-8. doi: 10.1289/ehp.10851.
Various factors can modify the health effects of outdoor air pollution. Prior findings about modifiers are inconsistent, and most of these studies were conducted in developed countries.
We conducted a time-series analysis to examine the modifying effect of season, sex, age, and education on the association between outdoor air pollutants [particulate matter < 10 microm in aerodynamic diameter (PM(10)), sulfur dioxide, nitrogen dioxide, and ozone] and daily mortality in Shanghai, China, using 4 years of daily data (2001-2004).
Using a natural spline model to analyze the data, we examined effects of air pollution for the warm season (April-September) and cool season (October-March) separately. For total mortality, we examined the association stratified by sex and age. Stratified analysis by educational attainment was conducted for total, cardiovascular, and respiratory mortality.
Outdoor air pollution was associated with mortality from all causes and from cardiorespiratory diseases in Shanghai. An increase of 10 mug/m(3) in a 2-day average concentration of PM(10), SO(2), NO(2), and O(3) corresponds to increases in all-cause mortality of 0.25% [95% confidence interval (CI), 0.14-0.37), 0.95% (95% CI, 0.62-1.28), 0.97% (95% CI, 0.66-1.27), and 0.31% (95% CI, 0.04-0.58), respectively. The effects of air pollutants were more evident in the cool season than in the warm season, and females and the elderly were more vulnerable to outdoor air pollution. Effects of air pollution were generally greater in residents with low educational attainment (illiterate or primary school) compared with those with high educational attainment (middle school or above).
Season, sex, age, and education may modify the health effects of outdoor air pollution in Shanghai. These findings provide new information about the effects of modifiers on the relationship between daily mortality and air pollution in developing countries and may have implications for local environmental and social policies.
多种因素可改变室外空气污染对健康的影响。先前关于影响因素的研究结果并不一致，且大多数此类研究是在发达国家开展的。
我们进行了一项时间序列分析，利用中国上海4年的每日数据（2001 - 2004年），研究季节、性别、年龄和教育程度对室外空气污染物[空气动力学直径小于10微米的颗粒物（PM₁₀）、二氧化硫、二氧化氮和臭氧]与每日死亡率之间关联的修饰作用。
我们使用自然样条模型分析数据，分别考察了暖季（4月至9月）和冷季（10月至3月）空气污染的影响。对于总死亡率，我们按性别和年龄分层考察了这种关联。对总死亡率、心血管疾病死亡率和呼吸系统疾病死亡率进行了按教育程度分层的分析。
在上海，室外空气污染与全因死亡率以及心肺疾病死亡率相关。PM₁₀、SO₂、NO₂和O₃的2天平均浓度每增加10微克/立方米，分别对应全因死亡率增加0.25% [95%置信区间（CI），0.14 - 0.37]、0.95%（95% CI，0.62 - 1.28）、0.97%（95% CI，0.66 - 1.27）和0.31%（95% CI，0.04 - 0.58）。空气污染物的影响在冷季比暖季更明显，女性和老年人更容易受到室外空气污染的影响。与高教育程度（中学及以上）的居民相比，低教育程度（文盲或小学）的居民空气污染的影响通常更大。
季节、性别、年龄和教育程度可能会改变上海室外空气污染对健康的影响。这些发现为发展中国家影响因素对每日死亡率与空气污染之间关系的作用提供了新信息，可能对当地环境和社会政策具有启示意义。
