Tewari Pranav, Xu Baihui, Pei Ma, Tan Kelvin Bryan, Abisheganaden John, Yim Steve Hung-Lam, Lee Dickens Borame, Lim Jue Tao
Lee Kong Chian School of Medicine Nanyang Technological University Singapore Singapore.
Saw Swee Hock School of Public Health National University of Singapore Singapore Singapore.
Geohealth. 2024 Sep 4;8(9):e2024GH001061. doi: 10.1029/2024GH001061. eCollection 2024 Sep.
Unpredictable emergency department (ED) admissions challenge healthcare systems, causing resource allocation inefficiencies. This study analyses associations between air pollutants, meteorological factors, and 2,655,861 cause-specific ED admissions from 2014 to 2018 across 12 categories. Generalized additive models were used to assess non-linear associations for each exposure, yielding Incidence Rate Ratios (IRR), while the population attributable fraction (PAF) calculated each exposure's contribution to cause-specific ED admissions. IRRs revealed increased risks of ED admissions for respiratory infections (IRR: 1.06, 95% CI: 1.01-1.11) and infectious and parasitic diseases (IRR: 1.09, 95% CI: 1.03-1.15) during increased rainfall (13.21-16.97 mm). Wind speeds >12.73 km/hr corresponded to increased risks of ED admissions for respiratory infections (IRR: 1.12, 95% CI: 1.03-1.21) and oral diseases (IRR: 1.58, 95% CI: 1.31-1.91). Higher concentrations of air pollutants were associated with elevated risks of cardiovascular disease (IRR: 1.16, 95% CI: 1.05-1.27 for PM) and respiratory infection-related ED admissions (IRR: 2.78, 95% CI: 1.69-4.56 for CO). Wind speeds >12.5 km/hr were predicted to contribute toward 10% of respiratory infection ED admissions, while mean temperatures >28°C corresponded to increases in the PAF up to 5% for genitourinary disorders and digestive diseases. PM concentrations >60 μg/m were highly attributable toward cardiovascular disease (PAF: 10%), digestive disease (PAF: 15%) and musculoskeletal disease (PAF: 10%) ED admissions. CO concentrations >0.6 ppm were highly attributable to respiratory infections (PAF: 20%) and diabetes mellitus (PAF: 20%) ED admissions. This study underscores protective effects of meteorological variables and deleterious impacts of air pollutant exposures across the ED admission categories considered.
急诊科不可预测的入院情况给医疗系统带来了挑战,导致资源分配效率低下。本研究分析了空气污染物、气象因素与2014年至2018年期间12类2655861例特定病因急诊科入院病例之间的关联。使用广义相加模型评估每种暴露的非线性关联,得出发病率比(IRR),而人群归因分数(PAF)计算每种暴露对特定病因急诊科入院病例的贡献。IRR显示,降雨增加(13.21 - 16.97毫米)期间,呼吸道感染(IRR:1.06,95%置信区间:1.01 - 1.11)以及传染病和寄生虫病(IRR:1.09,95%置信区间:1.03 - 1.15)的急诊科入院风险增加。风速>12.73千米/小时对应呼吸道感染(IRR:1.12,95%置信区间:1.03 - 1.21)和口腔疾病(IRR:1.58,95%置信区间:1.31 - 1.91)的急诊科入院风险增加。较高浓度的空气污染物与心血管疾病风险升高相关(PM的IRR:1.16,95%置信区间:1.05 - 1.27)以及与呼吸道感染相关的急诊科入院风险升高相关(CO的IRR:2.78,95%置信区间:1.69 - 4.56)。预计风速>12.5千米/小时导致10%的呼吸道感染急诊科入院病例,而平均温度>28°C对应泌尿生殖系统疾病和消化系统疾病的PAF增加高达5%。PM浓度>60微克/立方米对心血管疾病(PAF:10%)、消化系统疾病(PAF:15%)和肌肉骨骼疾病(PAF:10%)的急诊科入院病例有很高的归因度。CO浓度>0.6 ppm对呼吸道感染(PAF:20%)和糖尿病(PAF:20%)的急诊科入院病例有很高的归因度。本研究强调了气象变量的保护作用以及所考虑的急诊科入院类别中空气污染物暴露的有害影响。