2013-2017 年北京市每日空气质量与慢性阻塞性肺疾病急性加重住院的关系：一项生态学分析。
Associations between daily air quality and hospitalisations for acute exacerbation of chronic obstructive pulmonary disease in Beijing, 2013-17: an ecological analysis.
机构信息
Clinical Epidemiology and Tobacco Dependence Treatment Research Department, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
MRC-PHE Centre for Environment and Health, Department of Analytical, Environmental and Forensic Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
出版信息
Lancet Planet Health. 2019 Jun;3(6):e270-e279. doi: 10.1016/S2542-5196(19)30085-3.
BACKGROUND
Air pollution in Beijing has been improving through implementation of the Air Pollution Prevention and Control Action Plan (2013-17), but its implications for respiratory morbidity have not been directly investigated. We aimed to assess the potential effects of air-quality improvements on respiratory health by investigating the number of cases of acute exacerbations of chronic obstructive pulmonary disease (COPD) advanced by air pollution each year.
METHODS
Daily city-wide concentrations of PM, PM, PM (particulate matter >2·5-10 μm diameter), nitrogen dioxide (NO), sulphur dioxide (SO), carbon monoxide (CO), and ozone (O) in 2013-17 were averaged from 35 monitoring stations across Beijing. A generalised additive Poisson time-series model was applied to estimate the relative risks (RRs) and 95% CIs for hospitalisation for acute exacerbation of COPD associated with pollutant concentrations.
FINDINGS
From Jan 18, 2013, to Dec 31, 2017, 161 613 hospitalisations for acute exacerbation of COPD were recorded. Mean ambient concentrations of SO decreased by 68% and PM decreased by 33% over this 5-year period. For each IQR increase in pollutant concentration, RRs for same-day hospitalisation for acute exacerbation of COPD were 1·029 (95% CI 1·023-1·035) for PM, 1·028 (1·021-1·034) for PM, 1·018 (1·013-1·022) for PM, 1·036 (1·028-1·044) for NO, 1·019 (1·013-1·024) for SO, 1·024 (1·018-1·029) for CO, and 1·027 (1·010-1·044) for O in the warm season (May to October). Women and patients aged 65 years or older were more susceptible to the effects of these pollutants on hospitalisation risk than were men and patients younger than 65 years. In 2013, there were 12 679 acute exacerbations of COPD cases that were advanced by PM pollution above the expected number of cases if daily PM concentrations had not exceeded the WHO target (25 μg/m), whereas the respective figure in 2017 was 7377 cases.
INTERPRETATION
Despite improvement in overall air quality, increased acute air pollution episodes were significantly associated with increased hospitalisations for acute exacerbations of COPD in Beijing. Stringent air pollution control policies are important and effective for reducing COPD morbidity, and long-term multidimensional policies to safeguard public health are indicated.
FUNDING
UK Medical Research Council.
背景
通过实施《北京市空气重污染应急预案（2013-2017 年）》，北京的空气污染情况有所改善，但空气污染对呼吸发病率的影响尚未得到直接调查。我们旨在通过调查每年因空气污染而提前发生的慢性阻塞性肺疾病（COPD）急性加重的病例数，评估空气质量改善对呼吸健康的潜在影响。
方法
2013-2017 年，我们从北京 35 个监测站平均获得了每日全市 PM、PM、PM（直径>2.5-10μm 的颗粒物）、二氧化氮（NO）、二氧化硫（SO）、一氧化碳（CO）和臭氧（O）浓度。应用广义加性泊松时间序列模型估计与污染物浓度相关的 COPD 急性加重住院相关的相对风险（RR）和 95%置信区间（CI）。
结果
从 2013 年 1 月 18 日至 2017 年 12 月 31 日，记录了 161613 例 COPD 急性加重住院病例。在这 5 年期间，SO 的环境浓度平均下降了 68%，PM 下降了 33%。对于每个污染物浓度的 IQR 增加，同一天 COPD 急性加重住院的 RR 分别为 PM（1.029，95%CI 1.023-1.035）、PM（1.028，1.021-1.034）、PM（1.018，1.013-1.022）、NO（1.036，1.028-1.044）、SO（1.019，1.013-1.024）、CO（1.024，1.018-1.029）和 O（1.027，1.010-1.044）。与男性和 65 岁以下的患者相比，女性和 65 岁以上的患者更容易受到这些污染物对住院风险影响。2013 年，有 12679 例 COPD 急性加重病例是由 PM 污染引起的，如果每日 PM 浓度未超过世界卫生组织（WHO）目标（25μg/m），则超过预期病例数，而 2017 年的相应数字为 7377 例。
解释
尽管空气质量总体有所改善，但急性空气污染事件的增加与北京 COPD 急性加重住院人数的增加显著相关。严格的空气污染控制政策对于降低 COPD 发病率非常重要和有效，并且需要长期的多方面政策来保障公众健康。
资金
英国医学研究理事会。
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