Chang Jer-Hwa, Hsu Shih-Chang, Bai Kuan-Jen, Huang Shau-Ku, Hsu Chin-Wang
Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.
PLoS One. 2017 Jul 21;12(7):e0181106. doi: 10.1371/journal.pone.0181106. eCollection 2017.
Ambient air pollution poses a significant risk for a group of common and often debilitating respiratory diseases, but its direct impact on cause-specific respiratory diseases using emergency room visit (ERV) as an indicator remains to be fully explored. In this study, we conducted a time-series study of ambient PM2.5, NO2, SO2 and their association with ERV for asthma, COPD and pneumonia in a four-year time span. Relative risks for ERV as per log increase in the level of ambient pollutants with time lags of up to 10 days were calculated, using a generalized additive model of Poisson regression. Daily 24-h average concentrations of PM2.5 and pollutant gases were obtained from a local Gutting air quality monitoring station. Results showed that the ERVs for pneumonia and asthma were associated with the level of PM2.5. The effects of PM2.5 on the risk of ERV for asthma were found to be significant at lag days 1 and 2 with increasing risk of 4.34% [RR: 1.091; CI: 1.020-1.166 (95%)] and 3.58% [RR: 1.074; CI: 1.007-1.146 (95%)], respectively. The ERV for pneumonia was associated with the level of PM2.5 at lag days 5, 6 and 7, with increasing risk of 1.92% [RR: 1.039; CI: 1.009-1.070 (95%)], 2.03% [RR: 1.041; CI: 1.009-1.075 (95%)], and 1.82% [RR: 1.037; CI: 1.001-1.075 (95%)], respectively. Further, PM2.5, but not NO2 and SO2, posed a significant risk of ERV for asthma during spring at lag days 0, 1 and 2 (17.12%, RR: 1.408, CI: 1.075-1.238; 15.30%, RR: 1.358 CI: 1.158-1.166; 11.94%, RR: 1.165, CI: 1.004-1.121), which was particularly evident for those who were younger than 75 years of age. In contrast, only PM2.5 was a significant risk of ERV for COPD, which was primarily for those who were younger than 75 years of age during summer season at lag days 3, 4 and 5. (26.66%, RR: 1.704, CI: 1.104-2.632; 26.99%; RR: 1.716, CI: 1.151-2.557; 24.09%; RR: 1.619, CI: 1.111-2.360). Collectively, these results suggested significant seasonal variation and differential time lag effects of PM2.5 on ERV for asthma, COPD and pneumonia.
环境空气污染对一组常见且往往使人衰弱的呼吸道疾病构成重大风险，但其使用急诊就诊（ERV）作为指标对特定病因呼吸道疾病的直接影响仍有待充分探索。在本研究中，我们在四年时间跨度内对环境细颗粒物（PM2.5）、二氧化氮（NO2）、二氧化硫（SO2）及其与哮喘、慢性阻塞性肺疾病（COPD）和肺炎的急诊就诊关联进行了时间序列研究。使用泊松回归的广义相加模型计算了环境污染物水平每对数增加以及长达10天的时间滞后情况下急诊就诊的相对风险。从当地一个空气质量监测站获取了PM2.5和污染气体的每日24小时平均浓度。结果表明，肺炎和哮喘的急诊就诊与PM2.5水平相关。发现PM2.5对哮喘急诊就诊风险的影响在滞后第1天和第2天显著，风险分别增加4.34% [相对风险（RR）：1.091；置信区间（CI）：1.020 - 1.166（95%）]和3.58% [RR：1.074；CI：1.007 - 1.146（95%）]。肺炎的急诊就诊在滞后第5天、第6天和第7天与PM2.5水平相关，风险分别增加1.92% [RR：1.039；CI：1.009 - 1.070（95%）]、2.03% [RR：1.041；CI：1.009 - 1.075（95%）]和1.82% [RR：1.037；CI：1.001 - 1.075（95%）]。此外，在春季，PM2.5而非NO2和SO2在滞后第0天、第1天和第2天对哮喘急诊就诊构成显著风险（17.12%，RR：1.408，CI：1.075 - 1.238；15.30%，RR：1.358，CI：1.158 - 1.166；11.94%，RR：1.165，CI：1.004 - 1.121），这在75岁以下人群中尤为明显。相比之下，仅PM2.5是COPD急诊就诊的显著风险因素，主要是在夏季，针对75岁以下人群，在滞后第3天、第4天和第5天（26.66%，RR：1.704，CI：1.104 - 2.632；26.99%；RR：1.716，CI：1.151 - 2.557；24.09%；RR：1.619，CI：1.111 - 2.360）。总体而言，这些结果表明PM2.5对哮喘、COPD和肺炎急诊就诊存在显著的季节变化和不同的时间滞后效应。
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