Li Xianzhi, Yu Bin, Li Yajie, Meng Haorong, Shen Meiying, Yang Yan, Zhou Zonglei, Liu Shunjin, Tian Yunyun, Xing Xiangyi, Yin Li
Meteorological Medical Research Center, Panzhihua Central Hospital, Panzhihua, Sichuan Province, China.
Clinical Medical Research Center, Panzhihua Central Hospital, Panzhihua, Sichuan Province, China.
J Glob Health. 2023 Oct 13;13:04118. doi: 10.7189/jogh.13.04118.
There is limited evidence on association between air pollutants and hospital admissions, hospital cost and length of stay (LOS) among patients with diabetes mellitus (DM) and comorbid respiratory diseases (RD), especially in low- and middle-income countries (LMICs) with low levels of air pollution.
Daily data on RD-DM patients were collected in Panzhihua from 2016 to 2020. A generalised additive model (GAM) was used to explore the effect of air pollutants on daily hospital admissions, LOS and hospital cost. Attributable risk was employed to estimate RD-DM's burden due to exceeding air pollution exposure, using both 0 microgrammes per cubic metre (μg/m) and WHO's 2021 air quality guidelines as reference.
For each 10 ug/m increase of particles with an aerodynamic diameter <2.5 micron (μm) (PM), particles with an aerodynamic diameter <10 μm (PM), sulfur dioxide (SO), nitrogen dioxide (NO) and ozone (O), the admissions of RD-DM patients increased by 7.25% (95% CI = 4.26 to 10.33), 5.59% (95% CI = 3.79 to 7.42), 10.10% (95% CI = 7.29 to 12.98), 12.33% (95% CI = 8.82 to 15.95) and -2.99% (95% CI = -4.08 to -1.90); per 1 milligramme per cubic metre (mg/m) increase of carbon monoxide (CO) corresponded to a 25.77% (95% CI = 17.88 to 34.19) increment for admissions of RD-DM patients. For LOS and hospital cost, the six air pollutants showed similar effect. Given 0 μg/m as the reference, NO showed the maximum attributable fraction of 32.68% (95% CI = 25.12 to 39.42%), corresponding to an avoidable burden of 5661 (95% CI = 3611 to 5860) patients with RD-DM.
There is an association between PM, PM, SO, NO, and CO with increased hospital admissions, LOS and hospital cost in patients with RD-DM. Disease burden of RD-DM may be improved by formulating policies related to air pollutants exposure reduction, especially in LMICs with low levels of air pollution.
关于空气污染物与糖尿病（DM）合并呼吸系统疾病（RD）患者的住院率、住院费用和住院时长（LOS）之间的关联，证据有限，尤其是在空气污染水平较低的低收入和中等收入国家（LMICs）。
收集了攀枝花市2016年至2020年RD-DM患者的每日数据。采用广义相加模型（GAM）探讨空气污染物对每日住院率、LOS和住院费用的影响。采用归因风险来估计因空气污染暴露超标导致的RD-DM负担，分别以每立方米0微克（μg/m）和世界卫生组织2021年空气质量指南作为参考。
对于空气动力学直径<2.5微米（μm）的颗粒物（PM）、空气动力学直径<10μm的颗粒物（PM）、二氧化硫（SO）、二氧化氮（NO）和臭氧（O）每增加10μg/m，RD-DM患者的住院率分别增加7.25%（95%CI = 4.26至10.33）、5.59%（95%CI = 3.79至7.42）、10.10%（95%CI = 7.29至12.98）、12.33%（95%CI = 8.82至15.95）和-2.99%（95%CI = -4.08至-1.90）；一氧化碳（CO）每增加1毫克/立方米（mg/m），RD-DM患者的住院率相应增加25.77%（95%CI = 17.88至34.19）。对于LOS和住院费用，这六种空气污染物显示出相似的影响。以0μg/m作为参考，NO的最大归因比例为32.68%（95%CI = 25.12至39.42%），对应可避免的RD-DM患者负担为5661例（95%CI = 3611至5860）。
PM、PM、SO、NO和CO与RD-DM患者住院率、LOS和住院费用增加之间存在关联。通过制定与减少空气污染暴露相关的政策，RD-DM的疾病负担可能会得到改善，尤其是在空气污染水平较低的LMICs。
