School of Public Health, Guangzhou Medical University, Guangzhou, China.
Institute for Environmental and Climate Research, Jinan University, Guangzhou, China.
JMIR Public Health Surveill. 2023 Oct 9;9:e41862. doi: 10.2196/41862.
There is limited evidence regarding the adverse impact of particulate matters (PMs) on multiple body systems from both epidemiological and mechanistic studies. The association between size-fractionated PMs and mortality risk, as well as the burden of a whole spectrum of causes of death, remains poorly characterized.
We aimed to examine the wide range of susceptible diseases affected by different sizes of PMs. We also assessed the association between PMs with an aerodynamic diameter less than 1 µm (PM), 2.5 µm (PM), and 10 µm (PM) and deaths from 36 causes in Guangzhou, China.
Daily data were obtained on cause-specific mortality, PMs, and meteorology from 2014 to 2016. A time-stratified case-crossover approach was applied to estimate the risk and burden of cause-specific mortality attributable to PMs after adjusting for potential confounding variables, such as long-term trend and seasonality, relative humidity, temperature, air pressure, and public holidays. Stratification analyses were further conducted to explore the potential modification effects of season and demographic characteristics (eg, gender and age). We also assessed the reduction in mortality achieved by meeting the new air quality guidelines set by the World Health Organization (WHO).
Positive and monotonic associations were generally observed between PMs and mortality. For every 10 μg/m increase in 4-day moving average concentrations of PM, PM, and PM, the risk of all-cause mortality increased by 2.00% (95% CI 1.08%-2.92%), 1.54% (95% CI 0.93%-2.16%), and 1.38% (95% CI 0.95%-1.82%), respectively. Significant effects of size-fractionated PMs were observed for deaths attributed to nonaccidental causes, cardiovascular disease, respiratory disease, neoplasms, chronic rheumatic heart diseases, hypertensive diseases, cerebrovascular diseases, stroke, influenza, and pneumonia. If daily concentrations of PM, PM, and PM reached the WHO target levels of 10, 15, and 45 μg/m, 7921 (95% empirical CI [eCI] 4454-11,206), 8303 (95% eCI 5063-11,248), and 8326 (95% eCI 5980-10690) deaths could be prevented, respectively. The effect estimates of PMs were relatively higher during hot months, among female individuals, and among those aged 85 years and older, although the differences between subgroups were not statistically significant.
We observed positive and monotonical exposure-response curves between PMs and deaths from several diseases. The effect of PM was stronger on mortality than that of PM and PM. A substantial number of premature deaths could be preventable by adhering to the WHO's new guidelines for PMs. Our findings highlight the importance of a size-based strategy in controlling PMs and managing their health impact.
来自流行病学和机制研究的有限证据表明，颗粒物 (PM) 对多个身体系统有不良影响。目前，关于不同粒径的 PM 与死亡率风险之间的关联，以及全死因负担的特征仍知之甚少。
我们旨在研究不同大小的 PM 影响的广泛易感疾病。我们还评估了直径小于 1 µm（PM）、2.5 µm（PM）和 10 µm（PM）的 PM 与中国广州 36 种死因死亡之间的关联。
从 2014 年至 2016 年，我们获得了特定病因死亡率、PM 和气象数据的日常数据。采用时间分层病例交叉方法，在调整潜在混杂变量（如长期趋势和季节性、相对湿度、温度、气压和节假日）后，估计 PM 对特定病因死亡率的风险和负担。进一步进行分层分析，以探讨季节和人口统计学特征（如性别和年龄）的潜在修饰效应。我们还评估了通过达到世界卫生组织 (WHO) 新的空气质量标准来降低死亡率的效果。
通常观察到 PM 与死亡率之间存在正相关和单调关系。对于 4 天移动平均浓度每增加 10 μg/m 的 PM、PM 和 PM，全因死亡率的风险分别增加 2.00%（95%CI 1.08%-2.92%）、1.54%（95%CI 0.93%-2.16%）和 1.38%（95%CI 0.95%-1.82%）。PM 对非意外原因、心血管疾病、呼吸道疾病、肿瘤、慢性风湿性心脏病、高血压疾病、脑血管疾病、中风、流感和肺炎等死因的影响具有显著意义。如果每日 PM、PM 和 PM 浓度达到世卫组织 10、15 和 45 μg/m 的目标水平，可分别预防 7921 例（95%经验置信区间[eCI] 4454-11206）、8303 例（95%eCI 5063-11248）和 8326 例（95%eCI 5980-10690）死亡。尽管亚组之间的差异没有统计学意义，但在炎热月份、女性和 85 岁及以上人群中，PM 的效应估计值相对较高。
我们观察到 PM 与几种疾病死亡之间存在正相关和单调的暴露-反应关系。PM 对死亡率的影响强于 PM 和 PM。通过遵守世卫组织新的 PM 标准，可以预防大量的过早死亡。我们的研究结果强调了基于粒径的策略在控制 PM 和管理其健康影响方面的重要性。
