Zhang Rong, Lai Ka Yan, Liu Wenhui, Liu Yanhui, Lu Jianyun, Tian Linwei, Webster Chris, Luo Lei, Sarkar Chinmoy
Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong, China.
Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
Sci Total Environ. 2022 Jun 20;826:154135. doi: 10.1016/j.scitotenv.2022.154135. Epub 2022 Feb 25.
Influenza is a major preventable infectious respiratory disease. However, there is little detailed long-term evidence of its associations with PM among children. We examined the community-level associations between exposure to ambient PM and incident influenza in Guangzhou, China.
We used data from the city-wide influenza surveillance system collected by Guangzhou Centre for Disease Control and Prevention (GZCDC) over the period 2013 and 2019. Incident influenza was defined as daily new influenza (both clinically diagnosed and laboratory confirmed) cases as per standard diagnostic criteria. A 200-meter city-wide grid of daily ambient PM exposure was generated using a random forest model. We developed spatiotemporal Bayesian hierarchical models to examine the community-level associations between PM and the influenza adjusting for meteorological and socioeconomic variables and accounting for spatial autocorrelation. We also calculated community-wide influenza cases attributable to PM levels exceeding the China Grade 1 and World Health Organization (WHO) regulatory thresholds.
Our study comprised N = 191,846 children from Guangzhou aged ≤19 years and diagnosed with influenza between January 1, 2013 and December 31, 2019. Each 10 μg/m increment in community-level PM measured on the day of case confirmation (lag 0) and over a 6-day moving average (lag 0-5 days) was associated with higher risks of influenza (RR = 1.05, 95% CI: 1.05-1.06 for lag 0 and RR = 1.15, 95% CI: 1.14-1.16 for lag 05). We estimated that 8.10% (95%CI: 7.23%-8.57%) and 20.11% (95%CI: 17.64%-21.48%) influenza cases respectively were attributable to daily PM exposure exceeding the China Grade I (35 μg/m) and the WHO limits (25 μg/m). The risks associated with PM exposures were more pronounced among children of the age-group 10-14 compared to other age groups.
More targeted non-pharmaceutical interventions aimed at reducing PM exposures at home, school and during commutes among children may constitute additional influenza prevention and control polices.
流感是一种主要的可预防的传染性呼吸道疾病。然而，关于儿童流感与颗粒物（PM）之间关联的详细长期证据较少。我们研究了中国广州地区环境PM暴露与流感发病之间的社区层面关联。
我们使用了广州市疾病预防控制中心（GZCDC）在2013年至2019年期间收集的全市流感监测系统数据。流感发病定义为根据标准诊断标准每日新增的流感病例（包括临床诊断和实验室确诊）。使用随机森林模型生成了一个覆盖全市的200米网格的每日环境PM暴露数据。我们开发了时空贝叶斯分层模型，以研究在调整气象和社会经济变量并考虑空间自相关性的情况下，PM与流感之间的社区层面关联。我们还计算了因PM水平超过中国一级标准和世界卫生组织（WHO）监管阈值而导致的全市范围内的流感病例数。
我们的研究纳入了2013年1月1日至2019年12月31日期间广州市19岁及以下被诊断为流感的191,846名儿童。病例确诊当天（滞后0天）和6天移动平均值（滞后0至5天）测量的社区层面PM每增加10μg/m³，流感风险就会增加（滞后0天时RR = 1. .05，95%CI：1.05 - 1.06；滞后0 - 5天时RR = 1.15，95%CI：1.14 - 1.16）。我们估计，分别有8.10%（95%CI：7.23% - 8.57%）和20.11%（95%CI： 17.64% - 21.48%）的流感病例可归因于每日PM暴露超过中国一级标准（35μg/m³）和WHO限值（25μg/m³）。与其他年龄组相比，10 - 14岁年龄组儿童的PM暴露相关风险更为明显。
针对减少儿童在家、学校和通勤期间PM暴露的更有针对性的非药物干预措施，可能构成额外的流感防控政策。
