美国不同年龄段人群中臭氧和细颗粒物与呼吸科急诊就诊的关系。

Age-Specific Associations of Ozone and Fine Particulate Matter with Respiratory Emergency Department Visits in the United States.

机构信息

1 Environmental Health Tracking Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.

2 Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.

出版信息

Am J Respir Crit Care Med. 2019 Apr 1;199(7):882-890. doi: 10.1164/rccm.201806-1147OC.

DOI:10.1164/rccm.201806-1147OC

PMID:30277796

Abstract

RATIONALE

Whereas associations between air pollution and respiratory morbidity for adults 65 years and older are well documented in the United States, the evidence for people under 65 is less extensive. To address this gap, the Centers for Disease Control and Prevention's National Environmental Public Health Tracking Program collected respiratory emergency department (ED) data from 17 states.

OBJECTIVES

To estimate age-specific acute effects of ozone and fine particulate matter (particulate matter ≤2.5 mm in aerodynamic diameter [PM]) on respiratory ED visits.

METHODS

We conducted time-series analyses in 894 counties by linking daily respiratory ED visits with estimated ozone and PM concentrations during the week before the date of the visit. Overall effect estimates were obtained with a Bayesian hierarchical model to combine county estimates for each pollutant by age group (children, 0-18; adults, 19-64; adults ≥ 65, and all ages) and by outcome group (acute respiratory infection, asthma, chronic obstructive pulmonary disease, pneumonia, and all respiratory ED visits).

MEASUREMENTS AND MAIN RESULTS

Rate ratios (95% credible interval) per 10-μg/m increase in PM and all respiratory ED visits were 1.024 (1.018-1.029) among children, 1.008 (1.004-1.012) among adults younger than 65 years, and 1.002 (0.996-1.007) among adults 65 and older. Per 20-ppb increase in ozone, rate ratios were 1.017 (1.011-1.023) among children, 1.051 (1.046-1.056) among adults younger than 65, and 1.033 (1.026-1.040) among adults 65 and older. Associations varied in magnitude by age group for each outcome group.

CONCLUSIONS

These results address a gap in the evidence used to ensure adequate public health protection under national air pollution policies.

摘要

背景

在美国，老年人（65 岁及以上）与空气污染和呼吸道疾病发病率之间的相关性已得到充分证实，而 65 岁以下人群的证据则相对较少。为了解决这一差距，疾病控制与预防中心的国家环境公共卫生跟踪计划从 17 个州收集了呼吸道急诊（ED）数据。

目的

估计臭氧和细颗粒物（空气动力学直径≤2.5μm 的颗粒物[PM]）对呼吸道 ED 就诊的特定年龄的急性影响。

方法

我们通过将每日呼吸道 ED 就诊与就诊前一周估计的臭氧和 PM 浓度相关联，对 894 个县进行了时间序列分析。使用贝叶斯层次模型对每个污染物的县估计值进行合并，按年龄组（儿童，0-18 岁；成年人，19-64 岁；成年人≥65 岁，以及所有年龄组）和结局组（急性呼吸道感染、哮喘、慢性阻塞性肺疾病、肺炎和所有呼吸道 ED 就诊）进行总体效应估计。

测量和主要结果

每增加 10μg/m³ PM，PM 和所有呼吸道 ED 就诊的比率比（95%可信区间）分别为儿童为 1.024（1.018-1.029），65 岁以下成年人为 1.008（1.004-1.012），65 岁及以上成年人为 1.002（0.996-1.007）。每增加 20-ppb 臭氧，儿童的比率比为 1.017（1.011-1.023），65 岁以下成年人为 1.051（1.046-1.056），65 岁及以上成年人为 1.033（1.026-1.040）。对于每个结局组，各年龄组的关联程度存在差异。