Szyszkowicz Mieczysław, Willey Jeff B, Grafstein Eric, Rowe Brian H, Colman Ian
Population Studies Division, Health Canada, Ottawa, ON, Canada.
Environ Health Insights. 2010 Oct 15;4:79-86. doi: 10.4137/EHI.S5662.
Comorbidity of depression, heart disease, and migraine has been observed in clinical practice, while ambient air pollution has been identified among different risk factors for these health conditions. Suicide attempts and ideations as the result of depression may be linked to air pollution exposure. Therefore the effects of ambient air pollution on emergency department (ED) visits for suicide attempts were investigated.
Emergency visit data were collected in a hospital in Vancouver, Canada. The generalized linear mixed models technique was applied in the analysis of these data. A natural hierarchical structure of the data was used to define the clusters, with days nested in a 3-level structure (day of week, month, year). Poisson models were fitted to the clustered counts of ED visits with a single air pollutant, temperature and relative humidity. In addition, the case-crossover methodology was used with the same data for comparison. The analysis was performed by gender (all, males, females) and month (all: January-December, warm: April-September, cold: October-March).
Both hierarchical and case-crossover methods confirmed positive and statistically significant associations among carbon monoxide (CO), nitrogen dioxide (NO(2)), sulphur dioxide (SO(2)), and particulate matter (PM(10)) for all suicide attempts in the cold period. The largest increase was observed for males in the cold period for a 1-day lagged exposure to NO(2), with an excess risk of 23.9% (95% CI: 7.8, 42.4) and odds ratio of 1.21 (95% CI: 1.03, 1.41). In warm months the associations were not statistically significant, and the highest positive value was obtained for ozone lagged by 1 day.
The results indicate a potential association between air pollution and emergency department visits for suicide attempts.
在临床实践中已观察到抑郁症、心脏病和偏头痛的合并症，而在这些健康状况的不同风险因素中已确定了环境空气污染。抑郁症导致的自杀未遂和自杀意念可能与接触空气污染有关。因此，研究了环境空气污染对因自杀未遂而到急诊科就诊的影响。
在加拿大温哥华的一家医院收集急诊就诊数据。在这些数据的分析中应用了广义线性混合模型技术。数据的自然层次结构用于定义聚类，天数嵌套在三级结构（星期几、月份、年份）中。泊松模型用于拟合单一空气污染物、温度和相对湿度的急诊科就诊聚类计数。此外，使用病例交叉方法对相同数据进行比较。分析按性别（所有、男性、女性）和月份（所有：1月至12月、温暖：4月至9月、寒冷：10月至3月）进行。
分层和病例交叉方法均证实，在寒冷时期，一氧化碳（CO）、二氧化氮（NO₂）、二氧化硫（SO₂）和颗粒物（PM₁₀）与所有自杀未遂之间存在正向且具有统计学意义的关联。在寒冷时期，男性在滞后1天接触NO₂时观察到最大增幅，超额风险为23.9%（95%CI：7.8，42.4），优势比为1.21（95%CI：1.03，1.41）。在温暖月份，这些关联无统计学意义，臭氧滞后1天获得的正值最高。
结果表明空气污染与因自杀未遂而到急诊科就诊之间可能存在关联。
