School of Tropical Medicine and Global Health, Nagasaki University, Japan.
Environmental Health Division, Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Japan; Environmental Health Sciences, Department of Global Ecology, Graduate School of Global Environmental Studies, Kyoto University, Japan.
Sci Total Environ. 2020 Aug 10;729:138934. doi: 10.1016/j.scitotenv.2020.138934. Epub 2020 Apr 25.
Several studies have noted that the existence of comorbidities lead to an increase in the risk of premature mortality and morbidity. Most of the studies examining the effects of air pollution on comorbidity visits were from Northern American countries, with scarce literature from Asia. This study contributes to existing, yet limited understanding of air pollution-comorbidity by examining the effects of daily air pollutants on outpatient single morbidity and comorbid cardiorespiratory visits in Japan. A total of 1,452,505 outpatient cardiorespiratory visits were recorded among the 21 Japanese cities from 2013 to 2016. Daily outpatient cardiorespiratory visit data were obtained from a health insurance claims database managed by the Japan Medical Data Center Co., Ltd. (JMDC). A time-stratified case crossover analysis coupled with Generalized Additive Mixed Model was used to analyze the association of daily air pollutants (particulate matter 2.5 μm or less in diameter, ozone and nitrogen dioxide) on daily single (respiratory and cardiovascular) and comorbidity health outcomes. We further examined single and cumulative effects for 0-3 and 0-14 lag periods. Ozone, NO, and PM were positively associated with cardiorespiratory visits in either shorter or longer lags, with more apparent comorbidity associations with NO exposure. A 10-unit increase in NO, after adjusting for ozone, was associated with a 2.24% (95% CI: 1.34-3.15) and 6.49% (95% CI: 5.00-8.01) increase in comorbidity visit at Lag 0 (of Lag 0-3) and cumulative lag 0-3, respectively. Our results contribute to existing evidence suggesting that short-term and extended exposure to air pollution elicit health risks on cardiovascular, respiratory and comorbid clinic visits. Exposure to NO, in particular, was associated with increase in the risk of single and comorbidity cardiorespiratory visits. Results can be potentially utilized for both individual health (e.g. risk population health management) and health facility management (e.g. health visit influx determination).
已有多项研究指出，合并症的存在会增加早逝和发病的风险。大多数研究考察了空气污染对合并症就诊的影响，这些研究都来自北美国家，而来自亚洲的相关文献却很少。本研究通过考察日本每日空气污染物对门诊单一疾病和合并症心肺就诊的影响，对现有但有限的空气污染-合并症认识做出了贡献。2013 年至 2016 年，在日本的 21 个城市共记录了 1452505 例门诊心肺就诊。每日门诊心肺就诊数据来自由日本医疗数据中心有限公司（JMDC）管理的医疗保险索赔数据库。采用时间分层病例交叉分析结合广义加性混合模型，分析了每日空气污染物（直径 2.5μm 以下的颗粒物、臭氧和二氧化氮）与每日单一（呼吸和心血管）和合并症健康结果的关系。我们进一步检查了 0-3 天和 0-14 天的滞后期的单一和累积效应。臭氧、NO 和 PM 与心肺就诊均呈正相关，无论滞后时间较短或较长，与 NO 暴露的合并症关联更为明显。调整臭氧后，NO 每增加 10 个单位，滞后 0 天（滞后 0-3 天）和累积滞后 0-3 天，合并症就诊的风险分别增加 2.24%（95%CI：1.34-3.15）和 6.49%（95%CI：5.00-8.01）。我们的研究结果有助于现有证据表明，短期和长期暴露于空气污染会对心血管、呼吸和合并症门诊就诊产生健康风险。特别是接触 NO 与单一和合并症心肺就诊的风险增加有关。研究结果可能会被用于个体健康（例如风险人群的健康管理）和医疗机构管理（例如就诊人数的确定）。
