Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
Department of Preventive Medicine, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, The Third Clinical Medical Institute Affiliated to Guangzhou University of Chinese Medicine, Guangzhou, China.
Sci Total Environ. 2022 Apr 15;817:152789. doi: 10.1016/j.scitotenv.2021.152789. Epub 2022 Jan 4.
Although low temperature and air pollution exposures have been associated with the risk of anxiety, their combined effects remain unclear.
To investigate the independent and interactive effects of low temperature and air pollution exposures on anxiety.
Using a case-crossover study design, the authors collected data from 101,636 outpatient visits due to anxiety in three subtropical Chinese cities during the cold season (November to April in 2013 through 2018), and then built conditional logistic regression models based on individual exposure assessments [temperature, relative humidity, particulate matter (PM, PM), sulfur dioxide (SO), and nitrogen dioxide (NO)] and twelve cold spell definitions. Additive-scale interactions were assessed using the relative excess risk due to interaction (RERI).
Both cold spell and air pollution were significantly associated with outpatients for anxiety. The effects of cold spell increased with its intensity, ranging from 8.98% (95% CI: 2.02%, 16.41%) to 15.24% (95% CI: 6.75%, 24.39%) in Huizhou. Additionally, each 10 μg/m increase of PM, PM, NO and SO was associated with a 1.51% (95% CI: 0.61%, 2.43%), 1.58% (95% CI: 0.89%, 2.28%), 13.95% (9.98%, 18.05%) and 11.84% (95% CI: 8.25%, 15.55%) increase in outpatient visits for anxiety. Synergistic interactions (RERI >0) of cold spell with all four air pollutants on anxiety were observed, especially for more intense cold spells. For particulate matters, these interactions were found even under mild cold spell definitions [RERI: 0.11 (95% CI: 0.02, 0.21) for PM, and 0.24 (95% CI: 0.14, 0.33) for PM]. Stratified analyses yielded a pronounced results in people aged 18-65 years.
These findings indicate that both cold spell and air pollution are important drivers of the occurrence of anxiety, and simultaneous exposure to these two factors might have synergistic effects on anxiety. These findings highlight the importance of controlling air pollution and improving cold-warning systems.
尽管低温和空气污染暴露与焦虑风险相关，但它们的综合影响尚不清楚。
研究低温和空气污染暴露对焦虑的独立和交互作用。
采用病例交叉研究设计，作者收集了 2013 年至 2018 年寒冷季节（11 月至 4 月）期间中国三个亚热带城市因焦虑而就诊的 101636 例门诊数据，并基于个体暴露评估（温度、相对湿度、颗粒物（PM）、二氧化硫（SO）和二氧化氮（NO））和 12 个寒冷天气定义构建条件逻辑回归模型。使用相对超额交互作用风险（RERI）评估加性尺度交互作用。
寒冷天气和空气污染均与焦虑症门诊就诊显著相关。寒冷天气的影响随其强度增加而增加，在惠州，范围从 8.98%（95%置信区间：2.02%，16.41%）到 15.24%（95%置信区间：6.75%，24.39%）。此外，PM、PM、NO 和 SO 每增加 10μg/m，焦虑症门诊就诊的风险分别增加 1.51%（95%置信区间：0.61%，2.43%）、1.58%（95%置信区间：0.89%，2.28%）、13.95%（9.98%，18.05%）和 11.84%（95%置信区间：8.25%，15.55%）。在焦虑症方面，寒冷天气与四种空气污染物之间存在协同交互作用（RERI>0），尤其是在更强烈的寒冷天气下。对于颗粒物，即使在轻度寒冷天气定义下也发现了这些相互作用[RERI：0.11（95%置信区间：0.02，0.21），PM；0.24（95%置信区间：0.14，0.33），PM]。分层分析显示，在 18-65 岁人群中，结果更为显著。
这些发现表明，寒冷天气和空气污染都是焦虑发生的重要驱动因素，同时暴露于这两个因素可能对焦虑产生协同作用。这些发现强调了控制空气污染和改善寒冷预警系统的重要性。
