Xia Ruixue, Zhou Guopeng, Zhu Tong, Li Xueying, Wang Guangfa
Department of Respiratory Medicine, First Hospital, Health Sciences Centre, Peking University, 8 Xishiku Rd., Beijing 100034, China.
Department of Hospital Information, First Hospital, Health Sciences Centre, Peking University, 8 Xishiku Rd., Beijing 100034, China.
Int J Environ Res Public Health. 2017 Apr 14;14(4):423. doi: 10.3390/ijerph14040423.
Air pollutants are associated with cardiovascular death; however, there is limited evidence of the effects of different pollutants on out-of-hospital cardiac arrests (OHCAs) in Beijing, China. We aimed to investigate the associations of OHCAs with the air pollutants PM (coarse particulate matter), PM (particles ≤2.5 μm in aerodynamic diameter), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), carbon monoxide (CO), and ozone (O₃) between 2013 and 2015 using a time-stratified case-crossover study design. We obtained health data from the nationwide emergency medical service database; 4720 OHCA cases of cardiac origin were identified. After adjusting for relative humidity and temperature, the highest odds ratios of OHCA for a 10 μg/m³ increase in PM were observed at Lag Day 1 (1.07; 95% confidence interval (CI): 1.04-1.10), with strong associations with advanced age (aged ≥70 years) (1.09; 95% CI: 1.05-1.13) and stroke history (1.11; 95% CI: 1.06-1.16). PM and NO₂ also showed significant associations with OHCAs, whereas SO₂, CO, and O₃ had no effects. After simultaneously adjusting for NO₂ and SO₂ in a multi-pollutant model, PM remained significant. The effects of PM in the single-pollutant models for cases with hypertension, respiratory disorders, diabetes mellitus, and heart disease were higher than those for cases without these complications; however, the differences were not statistically significant. The results support that elevated PM exposure contributes to triggering OHCA, especially in those who are advanced in age and have a history of stroke.
空气污染物与心血管死亡相关；然而，在中国北京，关于不同污染物对院外心脏骤停（OHCA）影响的证据有限。我们旨在采用时间分层病例交叉研究设计，调查2013年至2015年间OHCA与空气污染物PM（粗颗粒物）、PM（空气动力学直径≤2.5μm的颗粒物）、二氧化氮（NO₂）、二氧化硫（SO₂）、一氧化碳（CO）和臭氧（O₃）之间的关联。我们从全国紧急医疗服务数据库获取健康数据；确定了4720例心源型OHCA病例。在调整相对湿度和温度后，在滞后第1天观察到PM每增加10μg/m³时OHCA的最高比值比为1.07（95%置信区间（CI）：1.04 - 1.10），与高龄（≥70岁）（1.09；95%CI：1.05 - 1.13）和中风病史（1.11；95%CI：1.06 - 1.16）有强关联。PM和NO₂也与OHCA显示出显著关联，而SO₂、CO和O₃没有影响。在多污染物模型中同时调整NO₂和SO₂后，PM仍然显著。在单污染物模型中，PM对患有高血压、呼吸系统疾病、糖尿病和心脏病的病例的影响高于无这些并发症的病例；然而，差异无统计学意义。结果支持，PM暴露增加会促使引发OHCA，尤其是在高龄且有中风病史的人群中。
