Lu Xiaofeng, Zhang Xu, Zhang Tao, Ni Jianping, Peng Yongzhen, Chen Xuyang, Wu Hanqing, Wang Guosheng, Fan Xiaoyun, Pan Faming
Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.
The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, Hefei, China.
J Glob Health. 2025 Jun 27;15:04196. doi: 10.7189/jogh.15.04196.
Although short-term exposure to air pollutants has been linked to heightened hospital admissions for respiratory diseases (RDs), evidence regarding its association with the risk of mortality from such diseases remains scarce. We aimed to examine the impact of short-term exposure to air pollutants on RD-related mortality.
We employed a time-stratified case-crossover design to explore the impact of short-term exposure to various air pollutants (fine particulate matter (PM), coarse particulate matter (PM), nitrogen dioxide (NO2), sulfur dioxide (SO), carbon monoxide (CO), and ozone (O)) on mortality due to RDs. Our sample comprised 15 878 RD-related deaths that occurred between 2017 and 2020 in Hefei, Anhui province. We delineated daily exposure to air pollutants using raster data corresponding to the residential addresses of the study subjects. We used conditional logistic regression to assess the relationship between pollutant exposure and the risk of mortality. To improve precision in identifying vulnerable populations, we stratified individuals by gender and age. Lastly, we used interrupted time series (ITS) analysis to explore COVID-19's impact on RD mortality.
We found that every 10 μg/m3 increase in PM, PM, and CO at a lag of zero days was associated with the largest significant effect on increased mortality from RDs (excess mortality risks of 0.735%, 1.349%, and 0.160%, respectively). We observed the highest positive associations between NO and O with delays of one and two days, resulting in excess mortality risks of 1.965% and 0.861%, respectively. We obtained consistent findings through moving average concentration analysis, while our stratified analysis showed that females and the elderly exhibited a heightened susceptibility to mortality from RDs attributable to short-term exposure to pollutants. Additionally, the ITS analysis confirmed that the COVID-19 outbreak did not significantly alter the level and trend of RD deaths.
Our findings indicate that short-term exposure to air pollutants, excluding SO, increases mortality rates from RDs, particularly among women and the elderly. In the context of Hefei, our findings highlight the public health imperative for reducing local residents' exposure to air pollutants, particularly through targeted protection of vulnerable populations, to minimise preventable RD mortality.
尽管短期接触空气污染物与呼吸道疾病（RDs）住院人数增加有关，但其与此类疾病死亡风险之间关联的证据仍然稀少。我们旨在研究短期接触空气污染物对RD相关死亡率的影响。
我们采用时间分层病例交叉设计，以探究短期接触各种空气污染物（细颗粒物（PM）、粗颗粒物（PM）、二氧化氮（NO₂）、二氧化硫（SO₂）、一氧化碳（CO）和臭氧（O₃））对RD导致的死亡率的影响。我们的样本包括2017年至2020年期间在安徽省合肥市发生的15878例与RD相关的死亡病例。我们使用与研究对象居住地址对应的栅格数据来描绘每日空气污染物暴露情况。我们使用条件逻辑回归来评估污染物暴露与死亡风险之间的关系。为提高识别脆弱人群的准确性，我们按性别和年龄对个体进行分层。最后，我们使用中断时间序列（ITS）分析来探究新冠疫情对RD死亡率的影响。
我们发现，在滞后0天的情况下，PM、PM和CO每增加10μg/m³，与RD死亡率增加的最大显著效应相关（超额死亡风险分别为0.735%、1.349%和0.160%）。我们观察到NO₂和O₃在滞后1天和2天时有最高的正相关，导致超额死亡风险分别为1.965%和0.861%。通过移动平均浓度分析我们得到了一致的结果，而我们的分层分析表明，女性和老年人对短期接触污染物导致的RD死亡率表现出更高的易感性。此外，ITS分析证实，新冠疫情爆发并未显著改变RD死亡的水平和趋势。
我们的研究结果表明，短期接触除SO₂之外的空气污染物会增加RD死亡率，尤其是在女性和老年人中。在合肥的背景下，我们的研究结果凸显了减少当地居民接触空气污染物的公共卫生紧迫性，特别是通过有针对性地保护脆弱人群，以尽量减少可预防的RD死亡率。
