大气污染与心血管疾病合并糖尿病患者住院人数、住院时间和住院费用的关系：基于中国北京 2014-2019 年 1969755 例病例。

Association between ambient air pollution and hospital admissions, length of hospital stay and hospital cost for patients with cardiovascular diseases and comorbid diabetes mellitus: Base on 1,969,755 cases in Beijing, China, 2014-2019.

机构信息

Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China; Department of Nutrition and Food Hygiene, School of Public Health, Hebei Medical University, Shijiazhuang, China.

出版信息

Environ Int. 2022 Jul;165:107301. doi: 10.1016/j.envint.2022.107301. Epub 2022 May 16.

DOI:10.1016/j.envint.2022.107301

PMID:35598418

Abstract

BACKGROUND

Evidence on the effects of the air pollutants on the hospital admissions, hospital cost and length of stay (LOS) among patients with comorbidities remains limited in China, particularly for patients with cardiovascular diseases and comorbid diabetes mellitus (CVD-DM).

METHODS

We collected daily data on CVD-DM patients from 242 hospitals in Beijing between 2014 and 2019. Generalized additive model was employed to quantify the associations between admissions, LOS, and hospital cost for CVD-DM patients and air pollutants. We further evaluated the attributable risk posed by air pollutants to CVD-DM patients, using both Chinese and WHO air quality guidelines as reference.

RESULTS

Per 10 ug/m increase of particles with an aerodynamic diameter < 2.5 μm (PM), particles with an aerodynamic diameter < 10 μm (PM), sulfur dioxide (SO), nitrogen dioxide (NO), carbonic oxide (CO) and ozone (O) corresponded to a 0.64% (95% CI: 0.57 to 0.71), 0.52% (95% CI: 0.46 to 0.57), 0.93% (95% CI: 0.67 to 1.20), 0.98% (95% CI: 0.81 to 1.16), 1.66% (95% CI: 1.18 to 2.14) and 0.53% (95% CI: 0.45 to 0.61) increment for CVD-DM patients' admissions. Among the six pollutants, particulate pollutants (PM and PM) in most lag days exhibited adverse effects on LOS and hospital cost. For every 10 ug/m increase in PM and PM, the absolute increase with LOS will increase 62.08 days (95% CI: 28.93 to 95.23) and 51.77 days (95% CI:22.88 to 80.66), respectively. The absolute increase with hospital cost will increase 105.04 Chinese Yuan (CNY) (95% CI: 49.27 to 160.81) and 81.76 CNY (95% CI: 42.01 to 121.51) in PM and PM, respectively. Given WHO 2021 air quality guideline as the reference, PM had the maximum attributable fraction of 3.34% (95% CI: 2.94% to 3.75%), corresponding to an avoidable of 65,845 (95% CI: 57,953 to 73,812) patients with CVD-DM.

CONCLUSION

PM and PM are positively associated with hospital admissions, hospital cost and LOS for patients with CVD-DM. Policy changes to reduce air pollutants exposure may reduce CVD-DM admissions and substantial savings in health care spending and LOS.

摘要

背景

在中国，有关空气污染物对合并症患者（尤其是合并心血管疾病和糖尿病的患者）住院、住院费用和住院时间（LOS）影响的证据仍然有限。

方法

我们在北京的 242 家医院收集了 2014 年至 2019 年期间合并症患者的每日数据。使用广义加性模型来量化空气污染物与合并症患者的住院、 LOS 和住院费用之间的关联。我们还使用中国和世界卫生组织（WHO）空气质量指南作为参考，评估了空气污染物对合并症患者的归因风险。

结果

PM_2.5、PM₁₀、二氧化硫（SO₂）、二氧化氮（NO₂）、一氧化碳（CO）和臭氧（O₃）每增加 10μg/m³，分别对应合并症患者住院的 0.64%（95%CI：0.57 至 0.71）、0.52%（95%CI：0.46 至 0.57）、0.93%（95%CI：0.67 至 1.20）、0.98%（95%CI：0.81 至 1.16）、1.66%（95%CI：1.18 至 2.14）和 0.53%（95%CI：0.45 至 0.61）的增幅。在这六种污染物中，大部分滞后天数的颗粒物污染物（PM_2.5和 PM₁₀）对 LOS 和住院费用有不利影响。PM_2.5和 PM₁₀每增加 10μg/m³，LOS 的绝对增加量将分别增加 62.08 天（95%CI：28.93 至 95.23）和 51.77 天（95%CI：22.88 至 80.66）。PM_2.5和 PM₁₀的绝对住院费用增加分别为 105.04 元人民币（95%CI：49.27 至 160.81）和 81.76 元人民币（95%CI：42.01 至 121.51）。以 2021 年世界卫生组织空气质量指南为参考，PM_2.5的归因分数最高，为 3.34%（95%CI：2.94% 至 3.75%），对应可避免的合并症患者 65845 人（95%CI：57953 至 73812）。