Gnerucci Alessio, Rossetto Andrea, Faraoni Paola, Ranaldi Francesco, Cavallaro Gabriele, Tonietti Barbara, Santosuosso Ugo, Bonaccorsi Lorella, Nazerian Peiman
Department of Physics and Astronomy, University of Florence, Via Sansone, 1, 50019, Florence, FI, Italy.
University of Florence, Florence, Italy.
Intern Emerg Med. 2025 Jun 19. doi: 10.1007/s11739-025-04013-2.
Fluctuations in emergency department (ED) utilization may be related to pollutant concentration variations that can heighten acute pathologies, exacerbate chronic conditions or indicate increased human activity. This study investigates the association between particulate matter (PM2.5-PM10) concentrations in patients' residential areas and ED visits. Retrospective, single-centre, time-series cohort study on a 100km urban area around a level 1 hospital in Florence, Italy, with 307,279 ED visits of patients of age > 14 years between 01/01/2019 and 31/12/2022. PM2.5 and PM10 daily concentrations, recorded by 14 air-quality stations, were interpolated at patients' residences, in a 250m grid, with inverse distance weighting and averaged on various time windows (lag) up to 30 days before ED visit. The association between ED visits and pollutant concentrations as percent excess of incidence rate (%Er) with 95% confidence intervals were investigated with generalized additive models. Significant association was found with short-term PM2.5 and PM10 fluctuations (PM2.5: 1.24%Er, 0.59-1.99 95%CI; PM10: 1.79%Er, 1.08-2.72). Such association was stronger for the subgroups of deceased patients (PM2.5 5.71%Er, 1.44-8.99; PM10 6.38%Er, 2.02-10.83), elderly patients presenting with dyspnoea (PM2.5 4.18%Er, 2.36-6.33; PM10 4.99%Er, 2.77-7.32) and younger patients suffering traumatic events (PM2.5 1.29%Er, 0.32-2.51; PM10 2.14%Er, 0.88-3.50). Exposure-response curves showed that particulate matter is associated with ED visits even at concentrations below the WHO guard levels. A short-term rise in PM2.5 and PM10, even below guard levels, was associated with increased ED utilization, particularly related to elderly patients with dyspnoea and the concomitant lurking occurrence of vehicle accidents in the younger population. Trial registration: NCT06491290; 09/07/2024; retrospectively registered.
急诊科（ED）利用率的波动可能与污染物浓度变化有关，这些变化会加剧急性病症、加重慢性病或表明人类活动增加。本研究调查了患者居住地区的颗粒物（PM2.5 - PM10）浓度与急诊科就诊之间的关联。在意大利佛罗伦萨一家一级医院周围100公里的市区进行回顾性、单中心、时间序列队列研究，纳入2019年1月1日至2022年12月31日期间年龄大于14岁的患者的307,279次急诊科就诊病例。由14个空气质量监测站记录的PM2.5和PM10每日浓度，通过反距离加权法在250米网格内插值到患者住所，并在急诊科就诊前长达30天的不同时间窗口（滞后）进行平均。使用广义相加模型研究急诊科就诊与污染物浓度之间的关联，以发病率超额百分比（%Er）及95%置信区间表示。发现短期PM2.5和PM10波动存在显著关联（PM2.5：1.24%Er，95%CI为0.59 - 1.99；PM10：1.79%Er，95%CI为1.08 - 2.72）。这种关联在死亡患者亚组中更强（PM2.5 5.71%Er，1.44 - 8.99；PM10 6.38%Er，2.02 - 10.83），出现呼吸困难的老年患者亚组（PM2.5 4.18%Er，2.36 - 6.33；PM10 4.99%Er，2.77 - 7.32）以及遭受创伤事件的年轻患者亚组（PM（此处原文有误，应为PM2.）5 1.29%Er，0.32 - 2.51；PM（此处原文有误，应为PM10）10 2.14%Er，0.88 - 3.50）中也更强。暴露 - 反应曲线表明，即使颗粒物浓度低于世界卫生组织警戒水平，也与急诊科就诊有关。PM2.5和PM10的短期升高，即使低于警戒水平，也与急诊科利用率增加有关，特别是与出现呼吸困难的老年患者以及年轻人群中同时潜伏发生车辆事故有关。试验注册：NCT06491290；2024年7月9日；回顾性注册。
