Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051 China.
Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, No.361 Zhongshan Road, Shijiazhuang 050017 China.
Injury. 2022 Oct;53(10):3139-3148. doi: 10.1016/j.injury.2022.08.021. Epub 2022 Aug 8.
Air pollutants have an impact on the occurrence of spine fractures, hip fractures, proximal humerus fractures and forearm fractures. This study aimed at evaluating the short-term impact of particulate matter with aerodynamic diameters of less than 2.5 µm (PM) on the occurrence of those fractures in Shijiazhuang, Hebei, China.
The daily meteorological, pollution, and fracture data of Shijiazhuang from 2014 to 2019 were collected. Distribution characteristics of fractures were described using descriptive epidemiological methods. The distributed lag nonlinear model (DLNM) was used to reveal the description of those fractures in the exposed and lag dimensions at the same time. Based on gender and age (<18 years old, 18-69 years old and >69 years old), stratified analysis was performed. Sensitivity analysis was performed to ascertain the robustness of the results.
Between 2014 and 2019, fracture incidences in Shijiazhuang exhibited an overall increasing trend, with an obvious seasonality. PM was positively related to daily fracture cases and the effects were more obvious in women, adolescents and people of working age. When PM concentrations increased by one interquartile range (IQR) (70 μg/m), RR exhibited a unimodal distribution. Its peak appeared on the 16th day of lag (RR=1.005987, 95% CI:1.002472,1.009652), and the RRs were also statistically significant from the 10th to 22nd day of lag. Similarly, cumulative effects of each increase in the concentration of PM IQR also showed a unimodal distribution. The largest cumulative effect occurred on the 28th day of lag (RR=1.084457, 95% CI:1.012207,1.161864), and the cumulative RRs were also statistically significant from the 19th day to 30nd days. In the dose-response relationship, as PM concentrations increased, RR increased.
Year by year, fractures in Shijiazhuang City exhibited an increasing trend. PM can affect the occurrence of those fractures. The impact on women, adolescents and people of working age is even greater. The supervision of PM should be strengthened while large-scale emissions should be limited.
空气污染物会影响脊柱骨折、髋部骨折、肱骨近端骨折和前臂骨折的发生。本研究旨在评估中国河北省石家庄市小于 2.5μm 空气动力学直径的颗粒物（PM）对这些骨折发生的短期影响。
收集了 2014 年至 2019 年石家庄市的每日气象、污染和骨折数据。采用描述性流行病学方法描述骨折的分布特征。使用分布式滞后非线性模型（DLNM）同时揭示暴露和滞后维度的骨折描述。基于性别和年龄（<18 岁、18-69 岁和>69 岁）进行分层分析。进行敏感性分析以确定结果的稳健性。
2014 年至 2019 年间，石家庄市骨折发生率呈总体上升趋势，且具有明显季节性。PM 与每日骨折病例呈正相关，其影响在女性、青少年和劳动年龄段人群中更为明显。当 PM 浓度增加一个四分位距（IQR）（70μg/m）时，RR 呈单峰分布。其峰值出现在滞后第 16 天（RR=1.005987，95%CI：1.002472，1.009652），滞后第 10-22 天的 RR 也具有统计学意义。同样，每个 PM IQR 浓度增加的累积效应也呈单峰分布。最大累积效应发生在滞后第 28 天（RR=1.084457，95%CI：1.012207，1.161864），滞后第 19-30 天的累积 RR 也具有统计学意义。在剂量反应关系中，随着 PM 浓度的增加，RR 增加。
年复一年，石家庄市的骨折呈上升趋势。PM 会影响这些骨折的发生。对女性、青少年和劳动年龄段人群的影响更大。应加强对 PM 的监管，同时限制大规模排放。
