河南省极端空气污染物浓度对冠心病住院率的短期影响：一项时间分层病例交叉研究

Short-term effects of extreme air pollutant concentrations on coronary heart disease hospitalization in Henan province: a time-stratified case-crossover study.

作者信息

Liu Shuming, Wang Yongbin, Wang Lujie, Li Xuefang, Fei Menghui, Dong Pingshuan, Yang Kan, Liu Hui, Xie Na, Chen Hengwen, Chen Guang, Li Huan, Zang Xiayan, Li Jun, Chen Zhigang, Lin Fei, Zhao Guoan

机构信息

Department of Cardiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China.

Department of Epidemiology and Health Statistics, Xinxiang Medical University, Xinxiang, China.

出版信息

Front Cardiovasc Med. 2025 Apr 24;12:1538788. doi: 10.3389/fcvm.2025.1538788. eCollection 2025.

DOI:10.3389/fcvm.2025.1538788

PMID:40342980

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12058883/

Abstract

INTRODUCTION

Coronary heart disease (CHD) is a leading cause of cardiovascular mortality, with air pollution serving as a significant risk factor. Henan Province, characterized by both a high incidence of CHD and severe air pollution, faces substantial health and economic challenges. However, limited research has explored the relationship between air pollution and CHD in this region.

METHODS

This study employs a case-crossover design combined with a distributed lag non-linear model (DLNM) to examine the short-term effects of extreme concentrations of air pollutants (PM₂.₅, PM₁₀, NO₂, SO₂, CO, and O₃) on CHD hospitalizations in Henan. Data on 133,294 confirmed CHD patients from seven large hospitals across five cities (2016-2021) were collected, with patients' addresses linked to nearby air quality monitoring stations to assess exposure to air pollutants and meteorological factors. The time-stratified case-crossover design and DLNM were used to calculate relative risks (RRs) for pollutant exposure on CHD hospitalizations, and subgroup analyses were conducted to identify sensitive groups.

RESULTS

Significant increases in CHD hospitalizations were associated with extremely high concentrations of NO₂, SO₂, and PM₁₀, with maximum RRs of 1.768 for NO₂, 2.821 for SO₂, and 1.728 for PM₁₀ on the 7th cumulative day, while high O₃ levels showed a protective effect. Younger individuals (≤64y) and males were more sensitive to these effects, and high CO concentrations only increase the risk of CHD incidence in the younger (≤64y) subgroup. Synergistic interactions were observed between certain pollutants, such as CO and NO₂/SO₂/PM₁₀, suggesting that the negative impact of CO on CHD is amplified in a multi-pollutant environment due to interactions with other pollutants.

DISCUSSION

These findings highlight the significant public health impact of air pollution on CHD in Henan Province.

摘要

引言

冠心病（CHD）是心血管疾病死亡的主要原因，空气污染是一个重要的风险因素。河南省冠心病发病率高且空气污染严重，面临着重大的健康和经济挑战。然而，该地区关于空气污染与冠心病之间关系的研究有限。

方法

本研究采用病例交叉设计结合分布滞后非线性模型（DLNM），以检验空气污染物（PM₂.₅、PM₁₀、NO₂、SO₂、CO和O₃）极端浓度对河南冠心病住院的短期影响。收集了来自五个城市七家大型医院的133294例确诊冠心病患者的数据（2016 - 2021年），将患者地址与附近空气质量监测站相关联，以评估空气污染物暴露和气象因素。采用时间分层病例交叉设计和DLNM计算污染物暴露对冠心病住院的相对风险（RRs），并进行亚组分析以确定敏感人群。

结果

冠心病住院显著增加与NO₂、SO₂和PM₁₀的极高浓度相关，在第7个累积日，NO₂的最大RRs为1.768，SO₂为2.821，PM₁₀为1.728，而高O₃水平显示出保护作用。较年轻个体（≤64岁）和男性对这些影响更敏感，高CO浓度仅增加较年轻（≤64岁）亚组冠心病发病风险。在某些污染物之间观察到协同相互作用，如CO与NO₂/SO₂/PM₁₀之间，这表明在多污染物环境中，由于与其他污染物的相互作用，CO对冠心病的负面影响会被放大。