Schouten J P, Vonk J M, de Graaf A
Department of Epidemiology and Statistics, University of Groningen, Netherlands.
J Epidemiol Community Health. 1996 Apr;50 Suppl 1(Suppl 1):s22-9. doi: 10.1136/jech.50.suppl_1.s22.
To assess the short term relationship between air pollution and the daily number of emergency hospital admissions for respiratory disease.
Data were analysed using autoregressive Poisson regression allowing for overdispersion and controlling for possible confounding factors such as seasonal and other chronological variables, meteorological factors, and influenza epidemics.
The two major cities in The Netherlands-Amsterdam (694,700 inhabitants) and Rotterdam (576,200 inhabitants).
Emergency hospital admissions for respiratory diseases, registered on a daily basis by the National Medical Registration, for the period 1977-89 were used. ICD-9 codes included were: respiratory (460-519), chronic obstructive pulmonary disease (490-492, 494, 496), and asthma (493). The mean (range) of the total daily number of admissions for these three classifications were as follows: 6.70 (0-23), 1.74 (0-9) and 1.13 (0-7) respectively in Amsterdam and 4.79 (0-19), 1.57 (0-9), and 0.53 (0-5) in Rotterdam. Air pollution measurements were provided by the National Institute of Public Health and Environmental Protection. In The Netherlands, air pollution is at a low to moderate ("summer type") or a low ("winter type") level. The levels in Amsterdam and Rotterdam did not differ much for the "summer type". For 1977-89 the mean (range) values of ozone (O3), the "summer type" pollutant (O3-8 h), were 86 (0-252) micrograms/m3 in Amsterdam and 82 (0-286) micrograms/m3 in Rotterdam. The mean (range) of the values "winter type", pollutant, sulphur dioxide (SO2-24 h), were 38 (0-381) micrograms/m3 in Amsterdam and 50 (1-379) micrograms/m3 in Rotterdam. For black smoke (BS-24 h), values were 14 (1-84) micrograms/m3 and 28 (1-144) micrograms/m3 respectively (1986-89).
Ozone had a non-significant positive effect on the number of respiratory emergency admissions in summer in people aged > or = 65 years (relative risk for a 100 micrograms/m3 increase in O3-8 h of 1.127 (0.983, 1.292) in Amsterdam and a significant positive effect of 1.344 (1.097, 1.647) in 1977-81 in Rotterdam). Sulphur dioxide did not show any clear effects; in Amsterdam a significant negative effect was even found. The same was true for nitrogen dioxide in Amsterdam; in Rotterdam, however, nitrogen dioxide showed non-significant positive effects (RR 0.965, 1.342). Black smoke did not show any clear effects in Amsterdam; in Rotterdam it was positively but not significantly related to the number of admissions.
The results show that the relation between short term air pollution and emergency hospital admissions is not always consistent at these rather low levels of daily hospital admissions and of air pollution.
评估空气污染与呼吸系统疾病每日急诊入院人数之间的短期关系。
采用自回归泊松回归分析数据，该方法考虑了过度离散情况，并控制了可能的混杂因素，如季节和其他时间变量、气象因素以及流感流行情况。
荷兰的两个主要城市——阿姆斯特丹（694,700居民）和鹿特丹（576,200居民）。
使用1977 - 1989年期间由国家医疗登记处每日登记的呼吸系统疾病急诊入院数据。纳入的国际疾病分类第九版（ICD - 9）编码包括：呼吸系统疾病（460 - 519）、慢性阻塞性肺疾病（490 - 492、494、496）和哮喘（493）。这三种分类的每日入院总数的均值（范围）如下：阿姆斯特丹分别为6.70（0 - 23）、1.74（0 - 9）和1.13（0 - 7）；鹿特丹分别为4.79（0 - 19）、1.57（0 - 9）和0.53（0 - 5）。空气污染测量数据由国家公共卫生和环境保护研究所提供。在荷兰，空气污染处于低至中度（“夏季型”）或低水平（“冬季型”）。阿姆斯特丹和鹿特丹的“夏季型”污染水平差异不大。1977 - 1989年，“夏季型”污染物臭氧（O3）的均值（范围），在阿姆斯特丹为86（0 - 252）微克/立方米，在鹿特丹为82（0 - 286）微克/立方米。“冬季型”污染物二氧化硫（SO2 - 24小时）的均值（范围），在阿姆斯特丹为38（0 - 381）微克/立方米，在鹿特丹为50（1 - 379）微克/立方米。黑烟（BS - 24小时）的值，在阿姆斯特丹和鹿特丹分别为14（1 - 84）微克/立方米和28（1 - 144）微克/立方米（1986 - 1989年）。
臭氧对65岁及以上人群夏季呼吸系统急诊入院人数有不显著的正向影响（在阿姆斯特丹，O3 - 8小时浓度每增加100微克/立方米，相对风险为1.127（0.983，1.292）；在鹿特丹，1977 - 1981年有显著的正向影响，相对风险为1.344（1.097，1.647））。二氧化硫未显示出任何明显影响；在阿姆斯特丹甚至发现有显著的负向影响。阿姆斯特丹的二氧化氮情况相同；然而，在鹿特丹，二氧化氮显示出不显著的正向影响（相对风险0.965，1.342）。黑烟在阿姆斯特丹未显示出任何明显影响；在鹿特丹，它与入院人数呈正相关，但不显著。
结果表明，在每日入院人数和空气污染水平相对较低的情况下，短期空气污染与急诊入院人数之间的关系并不总是一致的。
