Health Big Data Research Institute, Big Data Research Center, University of Electronic Science and Technology of China, Chengdu 611731, China.
Health and Family Planning Information Center of Sichuan Province, Chengdu 610041, China.
Int J Environ Res Public Health. 2018 Mar 11;15(3):492. doi: 10.3390/ijerph15030492.
Evidence on the burden of chronic obstructive pulmonary disease (COPD) morbidity attributable to the interaction between ambient air pollution and temperature has been limited. This study aimed to examine the modification effect of temperature on the association of ambient air pollutants (including particulate matter (PM) with aerodynamic diameter <10 μm (PM) and <2.5 μm (PM), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), carbon monoxide (CO) and ozone (O₃)) with risk of hospital admissions (HAs) for COPD, as well as the associated morbidity burden in urban areas of Chengdu, China, from 2015 to 2016. Based on the generalized additive model (GAM) with quasi-Poisson link, bivariate response surface model and stratification parametric model were developed to investigate the potential interactions between ambient air pollution and temperature on COPD HAs. We found consistent interactions between ambient air pollutants (PM, PM and SO₂) and low temperature on COPD HAs, demonstrated by the stronger associations between ambient air pollutants and COPD HAs at low temperatures than at moderate temperatures. Subgroup analyses showed that the elderly (≥80 years) and males were more vulnerable to this interaction. The joint effect of PM and low temperature had the greatest impact on COPD morbidity burden. Using WHO air quality guidelines as reference concentration, about 17.30% (95% CI: 12.39%, 22.19%) and 14.72% (95% CI: 10.38%, 19.06%) of COPD HAs were attributable to PM and PM exposures on low temperature days, respectively. Our findings suggested that low temperature significantly enhanced the effects of PM and SO₂ on COPD HAs in urban Chengdu, resulting in increased morbidity burden. This evidence has important implications for developing interventions to reduce the risk effect of COPD morbidity.
有关环境空气污染和温度相互作用对慢性阻塞性肺疾病（COPD）发病率负担的证据有限。本研究旨在研究温度对环境空气污染物（包括空气动力学直径<10μm（PM₁₀）和<2.5μm（PM₂.₅）、二氧化氮（NO₂）、二氧化硫（SO₂）、一氧化碳（CO）和臭氧（O₃））与 COPD 住院风险（HA）之间关联的修饰作用，以及 2015 年至 2016 年中国成都市城区相关发病率负担。基于广义加性模型（GAM）与拟泊松链接、双变量响应面模型和分层参数模型，研究了环境空气污染与温度对 COPDHA 的潜在相互作用。我们发现环境空气污染物（PM、PM 和 SO₂）与低温之间存在一致的相互作用，表现为在低温下环境空气污染物与 COPDHA 之间的关联比在中温下更强。亚组分析表明，老年人（≥80 岁）和男性更容易受到这种相互作用的影响。PM 和低温的联合作用对 COPD 发病率负担的影响最大。以世界卫生组织空气质量指南为参考浓度，约 17.30%（95%CI：12.39%，22.19%）和 14.72%（95%CI：10.38%，19.06%）的 COPDHA 归因于低温天的 PM 和 PM 暴露。我们的研究结果表明，低温显著增强了 PM 和 SO₂对成都市城区 COPDHA 的影响，导致发病率负担增加。这一证据对于制定减少 COPD 发病率风险效应的干预措施具有重要意义。
