上海市温度和大气污染对居民心血管疾病门急诊人数的影响

目的 探讨上海市日均温度和大气污染物对居民心血管疾病门急诊人数的影响。方法 采用广义相加Possion回归模型,在控制时间的长期趋势、节假日效应、星期效应和医保政策等混杂因素后,分析上海市2013年1月至2014年12月温度、主要大气污染物与心血管疾病门急诊人数之间的关系。结果 上海市2013年1月至2014年12月,上海市主要大气污染物PM2.5、PM10、SO2、NO2的日均浓度分别为56.3、76、20.6、46.7μg/m3。当平均温度低于18℃时,心血管疾病的就诊风险是平均温度高于18℃时的1.016倍(95% CI:1.013～1.018)。春夏季,PM2.5、PM10、SO2、NO2浓度每升高10μg/m3,居民心血管疾病门急诊人数分别增加0.502%(95% CI:0.464%～0.545%)、0.251%(95% CI:0.221%～0.282%)、2.716%(95% CI:2.558%～2.874%)、1.496%(95% CI:1.421%～1.571%)；秋冬季,PM2.5、PM10、SO2、NO2浓度每升高10μg/m3,居民心血管疾病门急诊人数分别增加0.543%(95% CI:0.521%～0.570%)、0.568%(95% CI:0.548%～0.587%)、1.607%(95% CI:1.528%～1.685%)、1.923%(95% CI:1.868%～1.978%)。结论 上海市居民心血管内科门急诊人数与日平均温度呈非线性负相关,在控制温度等混杂因素后,与大气污染物浓度呈正相关。
Objective To explore the effects of temperature and air pollution on the number of daily outpatient and emergency department visits for cardiovascular diseases in shanghai. Methods The data of air pollution and temperature, and number of visits to outpatient and emergency departments for cardiovascular diseases in Shanghai were collected between January 2013 and December 2014. Poisson regression models incorporating natural spline smooth functions (generalized linear models, GLM) were used to adjust for long-term, seasonal trends and weekend effect, public holiday, as wells as other confounding factors. Results A total of 9,6,835 hospital visits of cardiovascular diseases were identified during study period. The primary pollutants were PM2.5, PM10, SO2 and NO2, and their average daily concentrations were 56.3,6, 20.6 and 46.7μg/m3, respectively. The relative risks (RR) of average temperature lower than 18℃ versus above 18℃for cardiovascular incidence was 1.016(95% CI:1.013-1.018). In warm season, with a 10μg/m3 increase in concentrations of PM2.5, PM10, SO2 or NO2, the numbers of hospital visits for cardiovascular diseases increased by 0.502% (95% CI:0.464%-0.545%), 0.251% (95% CI:0.221%-0.282%), 2.716% (95% CI:2.558%-2.874%)and 1.496% (95% CI:1.421%-1.571%), respectively. In cold season, the corresponding values were 0.543% (95% CI:0.521%-0.570%), 568% (95% CI:0.548%-0.587%), 1.607% (95% CI:1.528%-1.685%), 1.923% (95% CI:1.868%-1.978%), respectively. Furthermore, each primary pollutant had different lag effect on hospital visits. Conclusion Low temperature increases daily numbers of hospital visits of cardiovascular diseases; which also increase with the increasing concentrations of primary air pollutants after adjusting confounding factors