Song Wan-Mei, Liu Yi, Liu Jin-Yue, Tao Ning-Ning, Li Yi-Fan, Liu Yao, Wang Liu-Xin, Li Huai-Chen
Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University.
Department of Biostatistics, School of Public Health, Shandong University.
Medicine (Baltimore). 2019 Mar;98(10):e14694. doi: 10.1097/MD.0000000000014694.
The health effects of short-term exposure to air pollutants on respiratory deaths and its modifiers such as meteorological indexes have been widely investigated. However, most of the previous studies are limited to single pollutants or total respiratory deaths, and their findings are inconsistent.To comprehensively examine the short-term effects of air pollutants on daily respiratory mortality.Our analysis included 16,931 nonaccidental respiratory deaths (except lung cancer and tuberculosis) among older adults (>65 years) from 2011 to 2017 in Jinan, China. We used a generalized additive Poisson models adjusted for meteorology and population dynamics to examine the associations between air pollutants (particulate matter with an aerodynamic diameter of b2.5μm [PM2.5], particulate matter with an aerodynamic diameter of b10μm [PM10], SO2, NO2, O3) and daily mortality for the total patients, males, females, chronic airway diseases, pneumonia patients, and rest patients in Jinan.Outdoor air pollution was significantly related to mortality from all respiratory diseases especially from chronic airway disease in Jinan, China. The effects of air pollutants had lag effects and harvesting effects, and the effects estimates usually reached a peak at lag 1 or 2 day. An increase of 10 μg/m or 10 ppb of PM2.5, PM10, SO2, NO2, and O3 corresponds to increments in mortality caused by chronic airway disease of 0.243% (95% confidence interval [CI]: -0.172-0.659) at lag 1 day, 0.127% (95% CI: -0.161-0.415) at lag 1 day, 0.603% (95% CI: 0.069-1.139) at lag 3 day, 0.649% (95% CI: -0.808-2.128) at lag 0 day and 0.944% (95% CI: 0.156-0.1598) at lag 1 day, respectively. The effects of air pollutants were usually greater in females and varied by respiratory subgroups. Spearman correlation analysis suggested that there was a significant association between meteorological indexes and air pollutants.Sex, age, temperature, humidity, pressure, and wind speed may modify the short-term effects of outdoor air pollution on mortality in Jinan. Compared with the other pollutants, O3 had a stronger effect on respiratory deaths among the elderly. Moreover, chronic airway diseases were more susceptible to air pollution. Our findings provided new evidence for new local environmental and health policies making.
短期暴露于空气污染物对呼吸道死亡及其修正因素（如气象指标）的健康影响已得到广泛研究。然而，以往的大多数研究仅限于单一污染物或总呼吸道死亡情况，且研究结果并不一致。为全面研究空气污染物对每日呼吸道死亡率的短期影响。我们的分析纳入了2011年至2017年中国济南65岁以上老年人中16931例非意外呼吸道死亡（肺癌和肺结核除外）。我们使用了经气象学和人口动态调整的广义相加泊松模型，来研究空气污染物（空气动力学直径≤2.5μm的颗粒物[PM2.5]、空气动力学直径≤10μm的颗粒物[PM10]、二氧化硫、二氧化氮、臭氧）与济南所有患者、男性、女性、慢性气道疾病患者、肺炎患者及其他患者的每日死亡率之间的关联。中国济南的室外空气污染与所有呼吸道疾病尤其是慢性气道疾病的死亡率显著相关。空气污染物的影响具有滞后效应和累积效应，效应估计值通常在滞后1天或2天达到峰值。PM2.5、PM10、二氧化硫、二氧化氮和臭氧每增加10μg/m³或10ppb，分别对应慢性气道疾病死亡率在滞后1天增加0.243%（95%置信区间[CI]：-0.172 - 0.659）、滞后1天增加0.127%（95%CI：-0.161 - 0.415）、滞后3天增加0.603%（95%CI：0.069 - 1.139）、滞后0天增加0.649%（95%CI：-0.808 - 2.128）以及滞后1天增加0.944%（9�%CI：0.156 - 1.598）。空气污染物对女性的影响通常更大，且因呼吸道亚组而异。Spearman相关性分析表明气象指标与空气污染物之间存在显著关联。性别、年龄、温度、湿度、气压和风速可能会改变济南室外空气污染对死亡率的短期影响。与其他污染物相比，臭氧对老年人呼吸道死亡的影响更强。此外，慢性气道疾病更容易受到空气污染的影响。我们的研究结果为制定新的地方环境与健康政策提供了新的证据。
