Jiang Yixuan, Yan Fanshu, Kan Haidong, Zhou Maigeng, Yin Peng, Chen Renjie
School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China.
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
Chin Med J (Engl). 2024 Dec 20;137(24):3126-3135. doi: 10.1097/CM9.0000000000003415. Epub 2024 Dec 10.
Epidemiological studies have demonstrated a causal relationship between ambient ozone (O 3 ) and mortality from chronic obstructive pulmonary disease (COPD), which is the only outcome considered in the Global Burden of Disease Study 2021 for O 3 . This study aims to evaluate the temporal trend and spatial distribution of the COPD burden attributable to O 3 across China from 1990 to 2021.
The ambient O 3 concentrations in China were estimated. Based on the methodology framework and standard analytical methods applied in the Global Burden of Disease Study 2021, we estimated the annual number, age-standardized rate, and percentage of deaths and disability-adjusted life-years (DALYs) from COPD attributable to O 3 pollution during 1990-2021 at the national and provincial levels in China.
In 2021, a total of 125.7 (95% uncertainty interval [UI], 26.4-228.3) thousand deaths and 1917.5 (95% UI, 398.7-3504.6) thousand DALYs from COPD were attributable to ambient O 3 pollution in China, accounting for 9.8% (95% UI, 2.1-17.0%) and 8.1% (95% UI, 1.8-14.1%) of the total COPD deaths and DALYs, respectively. Generally, a higher burden was observed among males, the elderly, and the population residing in regions with worse health conditions. The age-standardized rates of COPD deaths and DALYs per 100,000 populations ranged from 0.5 (95% UI, 0-1.4) and 8.1 (95% UI, 0.7-20.9) in Hong Kong to 22.8 (95% UI, 3.9-43.5) and 396.6 (95% UI, 68.9-763.7) in Xizang. From 1990 to 2021, there was a notable decrease in the age-standardized rates of COPD-related deaths (68.2%, 95% UI, 60.1-74.9%) and DALYs (71.5%, 95% UI, 63.7-77.6%), especially in regions with poor health conditions. However, the attributable numbers and percentages changed relatively marginally.
Ambient O 3 pollution is a major contributor to the COPD burden in China. Our findings highlight the significant spatial heterogeneity across different provinces and underscore the implementation of geographically tailored policies to effectively reduce O 3 pollution and alleviate the associated disease burden.
流行病学研究已证实环境臭氧（O₃）与慢性阻塞性肺疾病（COPD）死亡率之间存在因果关系，这是《2021年全球疾病负担研究》中针对O₃所考虑的唯一结果。本研究旨在评估1990年至2021年期间中国各地因O₃导致的慢性阻塞性肺疾病负担的时间趋势和空间分布。
估算了中国的环境O₃浓度。基于《2021年全球疾病负担研究》应用的方法框架和标准分析方法，我们估算了1990 - 2021年期间中国全国和省级层面因O₃污染导致的慢性阻塞性肺疾病死亡人数、年龄标准化率、死亡百分比以及伤残调整生命年（DALYs）。
2021年，中国因环境O₃污染导致的慢性阻塞性肺疾病死亡人数总计12.57（95%不确定区间[UI]，2.64 - 22.83）万例，伤残调整生命年为191.75（95% UI，39.87 - 350.46）万例，分别占慢性阻塞性肺疾病总死亡人数和伤残调整生命年的9.8%（95% UI，2.1 - 17.0%）和8.1%（95% UI，1.8 - 14.1%）。总体而言，男性、老年人以及健康状况较差地区的人群负担更高。每10万人口中慢性阻塞性肺疾病死亡和伤残调整生命年的年龄标准化率在香港分别为0.5（95% UI，0 - 1.4）和8.1（95% UI，0.7 - 20.9），在西藏则为22.8（95% UI，3.9 - 43.5）和396.6（95% UI，68.9 - 763.7）。1990年至2021年期间，慢性阻塞性肺疾病相关死亡的年龄标准化率（68.2%，95% UI，60.1 - 74.9%）和伤残调整生命年（71.5%，95% UI，63.7 - 77.6%）显著下降，尤其是在健康状况较差的地区。然而，归因数量和百分比变化相对较小。
环境O₃污染是中国慢性阻塞性肺疾病负担的主要促成因素。我们的研究结果凸显了不同省份之间显著的空间异质性，并强调实施因地制宜的政策以有效减少O₃污染并减轻相关疾病负担。
