Department of Public Health, Qinghai University Medical College, Xining, Qinghai 810016, China.
Qinghai Institute of Health Sciences, Xining, Qinghai 810016, China.
Ecotoxicol Environ Saf. 2024 Oct 15;285:117046. doi: 10.1016/j.ecoenv.2024.117046. Epub 2024 Sep 13.
Today, air pollution remains a significant issue, particularly in high-altitude areas where its impact on respiratory disease remains incompletely explored. This study aims to investigate the association between various air pollutants and outpatient visits for respiratory disease in such regions, specifically focussing on Xining from 2016 to 2021. By analysing over 570,000 outpatient visits using a time-stratified case-crossover design and conditional logistic regression, we assessed the independent effects of pollutants like PM, PM, SO, NO, and CO, as well as their interactions. The evaluation of interactions employed measures such as relative excess odds due to interaction (REOI), attributable proportion due to interaction (AP), and synergy index (S). We also conducted a stratified analysis to identify potentially vulnerable populations. Our findings indicated that exposure to PM, PM, SO, NO, and CO significantly increased outpatient visits for respiratory disease, with odds ratios (ORs) of 2.40 % (95 % CI: 2.05 %, 2.74 %), 1.07 % (0.98 %, 1.16 %), 3.86 % (3.23 %, 4.49 %), 4.45 % (4.14 %, 4.77 %), and 6.37 % (5.70 %, 7.04 %), respectively. However, exposure to O did not show a significant association. We found significant interactions among PM, SO, NO, and CO, where combined exposure further exacerbated the risk of respiratory diseases. For example, in the combination of PM and SO, the REOI, AP, and S were 0.07 (95 % CI: 0.06, 0.09), 0.07 (0.06, 0.07), and 1.07 (1.05, 1.09), respectively. Additionally, elderly individuals and females were more sensitive to these pollutants, but no statistically significant interaction effects were observed between different age and gender groups. In conclusion, our study highlights the strong link between air pollution and respiratory disease in high-altitude areas, with combined pollutant exposure posing an even greater risk. It underscores the need for enhanced air quality monitoring and public awareness campaigns, particularly to protect vulnerable populations like the elderly and females.
如今，空气污染仍是一个重大问题，尤其是在高海拔地区，其对呼吸疾病的影响尚未被充分研究。本研究旨在调查高海拔地区（以西宁为例，2016 年至 2021 年）内各种空气污染物与呼吸疾病门诊就诊之间的关联，我们采用时间分层病例交叉设计和条件逻辑回归分析了超过 57 万次门诊就诊，评估了 PM、PM、SO、NO 和 CO 等污染物的独立影响，以及它们的相互作用。我们使用相对超额odds 归因于交互作用（REOI）、交互归因比例（AP）和协同指数（S）等指标来评估相互作用。我们还进行了分层分析，以确定潜在的易感人群。研究结果表明，暴露于 PM、PM、SO、NO 和 CO 会显著增加呼吸疾病的门诊就诊，比值比（OR）分别为 2.40%（95%CI：2.05%，2.74%）、1.07%（0.98%，1.16%）、3.86%（3.23%，4.49%）、4.45%（4.14%，4.77%）和 6.37%（5.70%，7.04%）。然而，暴露于 O 与呼吸疾病之间并未显示出显著关联。我们发现 PM、SO、NO 和 CO 之间存在显著的相互作用，联合暴露进一步加剧了呼吸疾病的风险。例如，在 PM 和 SO 的联合暴露中，REOI、AP 和 S 分别为 0.07（95%CI：0.06，0.09）、0.07（0.06，0.07）和 1.07（1.05，1.09）。此外，老年人和女性对这些污染物更为敏感，但在不同年龄和性别组之间未观察到统计学意义上的显著相互作用效应。总之，本研究强调了高海拔地区空气污染与呼吸疾病之间的紧密联系，联合污染物暴露带来更大的风险。这突显了加强空气质量监测和公众意识宣传的必要性，特别是需要保护老年人和女性等脆弱人群。
