17 个中低收入国家中 5 岁以下儿童与 PM 相关的死亡的潜在来源部门。
Source sectors underlying PM-related deaths among children under 5 years of age in 17 low- and middle-income countries.
机构信息
Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing 100191, China; Advanced Institute of Information Technology, Peking University, Hangzhou 311215, China; National Institute of Health Data Science, Peking University, Beijing 100191, China.
Advanced Institute of Information Technology, Peking University, Hangzhou 311215, China.
出版信息
Environ Int. 2023 Feb;172:107756. doi: 10.1016/j.envint.2023.107756. Epub 2023 Jan 16.
BACKGROUND
Fine particulate matter (PM) from different source sectors might differ in toxicity. However, data from large-scale studies on vulnerable children in low- and middle-income countries (LMICs) are insufficient.
OBJECTIVE
To analyze the association of under-five death (U5D) with long-term exposure to PM from different sources.
METHOD
We evaluated demographic and health survey data for 79,995 babies born in 2017 in 16 Asian and African LMICs (AA-LMICs) and a Latin America low-income country (i.e., Haiti). Long-term exposure to PM was assessed by a well-established product that attributed the annual concentration to 20 source sectors in 2017. The associations of survival during < 5-year periods with each source-specific concentration of PM were analyzed by Cox regression with multiple adjustments. We derived a multiple-pollutant ridge regression model to estimate the joint exposure-response function (JERF) between U5D and PM mixtures. To evaluate how sources affected PM toxicity, we evaluated the number of U5Ds attributable to PM based on the source profiles for 88 AA-LMICs.
RESULTS
According to the single-pollutant model, the risk of U5D increased by 7% (95% confidence interval [CI]: 5%, 9%) for each 10 μg/m increment in total PM concentration. The model performance was lower than that of the multiple-pollutant ridge regression model. For each 10 μg/m increment in PM, the excess risk of U5D ranged from 6% (95% CI: 4%, 9%) in Nepal to 10% (95% CI: 6%, 14%) in Mauritania. Based on the JERF, PM contributed to 817,647 (95% CI: 585,729, 1,050,439), i.e., 28.0% (95% CI: 20.1%, 35.8%), of all U5Ds across the 88 AA-LMICs. The PM-related U5Ds were mostly attributable to PM produced by desert dust, followed by solid biofuel combustion and open fires.
CONCLUSION
The average toxicity of PM varied by source profile, which should be taken into consideration when planning public health interventions. For some AA LMICs, natural sources of PM had the most significant health effects, and should not be ignored to ensure the protection of child health.
背景
来自不同源部门的细颗粒物（PM）在毒性上可能存在差异。然而，来自低收入和中等收入国家（LMICs）的脆弱儿童的大型研究数据仍然不足。
目的
分析五岁以下儿童死亡（U5D）与长期暴露于不同来源的 PM 之间的关联。
方法
我们评估了来自亚洲和非洲 16 个低收入国家（AA-LMICs）和拉丁美洲一个低收入国家（海地）的 2017 年出生的 79995 名婴儿的人口和健康调查数据。PM 的长期暴露通过一种成熟的产品进行评估，该产品将每年的浓度归因于 2017 年的 20 个源部门。通过 Cox 回归进行了多调整，分析了每个特定源的 PM 浓度与<5 年期间的生存之间的关联。我们得出了一个多污染物脊回归模型，以估计 U5D 和 PM 混合物之间的联合暴露-反应函数（JERF）。为了评估源如何影响 PM 毒性，我们根据 88 个 AA-LMICs 的源分布，评估了归因于 PM 的 U5D 数量。
结果
根据单污染物模型，总 PM 浓度每增加 10μg/m，U5D 的风险增加 7%（95%置信区间[CI]：5%，9%）。该模型的性能低于多污染物脊回归模型。对于 PM 每增加 10μg/m，U5D 的超额风险范围从尼泊尔的 6%（95% CI：4%，9%）到毛里塔尼亚的 10%（95% CI：6%，14%）。基于 JERF，PM 导致了 817647 名（95% CI：585729，1050439），即所有 88 个 AA-LMICs 中 28.0%（95% CI：20.1%，35.8%）的 U5D。与 PM 相关的 U5D 主要归因于沙尘产生的 PM，其次是固体生物燃料燃烧和露天火灾产生的 PM。
结论
PM 的平均毒性因源分布而异，在规划公共卫生干预措施时应予以考虑。对于一些 AA-LMICs，PM 的自然来源对健康的影响最大，不应忽视，以确保儿童健康得到保护。
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