Ge Yihui, Lin Yan, Tsogtbayar Oyu, Khuyagaa Ser-Od, Khurelbaatar Eelin, Galsuren Jargalsaikhan, Prox Lauren, Zhang Shiyu, Tighe Robert M, Gray Gregory C, Zhang Junfeng, Ulziimaa Daramragchaa, Boldbaatar Damdindorj, Nyamdavaa Khurelbaatar, Dambadarjaa Davaalkham
Duke Nicholas School of the Environment, Durham, NC, 27705, USA.
Duke Nicholas School of the Environment, Durham, NC, 27705, USA; Duke Global Health Institute, Durham, NC, 27705, USA.
Environ Res. 2025 Mar 1;268:120743. doi: 10.1016/j.envres.2024.120743. Epub 2024 Dec 31.
Air pollution is a well-documented public health hazard linked to various adverse health outcomes. While studies have shown associations between elevated levels of air pollutants and increased influenza incidence, there is a notable knowledge gap concerning the interactive effects of air pollution and viral exposure on respiratory viral infections.
This study sought to examine the interactive effects of air pollution and viral exposure on influenza hospital visits in Ulaanbaatar, Mongolia.
We conducted a time-series analysis linking daily hospital visits for influenza disease (defined as ICD10 diagnosis codes J11) with ambient concentrations of air pollutants (PM, PM, PM, NO, SO, and O) over a period of 7 years. Viral exposure for a specific geographical region was estimated based on influenza hospital visits within acute (previous day) and sub-acute (preceding 7 days) exposure windows. Covariates included long-term time trend, temperature, temperature variation, relative humidity, holiday, and raw coal ban policy. An over-dispersed generalized linear model (GLM) with a quasi-Poisson distribution was used to assess associations, exploring interactions and lag effects up to 3 days. Season-specific models and stratified analyses by sex and age were performed, with sensitivity analyses using multi-pollutant models.
A total of 16,364 influenza hospital visits were recorded, with significantly higher rates of visits during the winter season. All six pollutants amplified the effects of viral exposure on hospital visits in cold months, while only PM, PM, and O showed synergistic effects in warm months. Stronger synergistic effects were observed among children under 5 years old, particularly for O.
Air pollution significantly amplified the adverse effects of viral exposure on influenza-hospital visits, particularly among young children and during high viral exposure periods. These findings underscore the need for employing protective measures against both air pollution and viral infections.
空气污染是一个有充分文献记载的公共卫生危害，与各种不良健康后果相关。虽然研究表明空气污染物水平升高与流感发病率增加之间存在关联，但关于空气污染和病毒暴露对呼吸道病毒感染的交互作用，存在显著的知识空白。
本研究旨在探讨空气污染和病毒暴露对蒙古乌兰巴托流感住院就诊的交互作用。
我们进行了一项时间序列分析，将7年期间流感疾病的每日住院就诊情况（定义为国际疾病分类第10版诊断代码J11）与空气污染物（PM、PM、PM、NO、SO和O）的环境浓度联系起来。根据急性（前一天）和亚急性（前7天）暴露窗口内的流感住院就诊情况，估算特定地理区域的病毒暴露情况。协变量包括长期时间趋势、温度、温度变化、相对湿度、节假日和原煤禁令政策。使用具有准泊松分布的过度分散广义线性模型（GLM）来评估关联，探索长达3天的交互作用和滞后效应。进行了特定季节模型以及按性别和年龄分层的分析，并使用多污染物模型进行了敏感性分析。
共记录了16364例流感住院就诊病例，冬季就诊率显著更高。在寒冷月份，所有六种污染物都增强了病毒暴露对住院就诊的影响，而在温暖月份，只有PM、PM和O显示出协同效应。在5岁以下儿童中观察到更强的协同效应，尤其是对于O。
空气污染显著增强了病毒暴露对流感住院就诊的不利影响，特别是在幼儿中以及病毒暴露高峰期。这些发现强调了针对空气污染和病毒感染采取保护措施的必要性。
