大气SO<sub>2</sub>暴露与医院每日急诊和门诊人次关系的多中心时间序列研究

周璐; 阚海东; 陈仁杰

doi:10.16462/j.cnki.zhjbkz.2021.10.008

大气SO₂暴露与医院每日急诊和门诊人次关系的多中心时间序列研究

doi: 10.16462/j.cnki.zhjbkz.2021.10.008

200032 上海，复旦大学公共卫生学院环境卫生教研室

基金项目:

国家自然科学基金 92043301

详细信息

通讯作者:
陈仁杰，E-mail: chenrenjie@fudan.edu.cn

中图分类号: R122.7;R195.1
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- 被引次数: 0
出版历程
- 收稿日期: 2021-06-01
- 修回日期: 2021-08-31
- 网络出版日期: 2021-11-17
- 刊出日期: 2021-10-10

Association between sulfur dioxide air pollution and daily hospital emergency and outpatient visits: a multi-city time-series study

Department of Environmental Health, School of Public Health, Fudan University, Shanghai 200032, China

Funds:

National Natural Science Foundation of China 92043301

More Information

Corresponding author: CHEN Ren-jie, E-mail: chenrenjie@fudan.edu.cn

摘要

摘要: 目的分析大气二氧化硫(sulfur dioxide, SO₂)暴露对北京、西安、武汉和广州市等地医院每日急诊和门诊人次的影响。方法收集2013年1月1日至2015年12月31日上述城市5家医院的急诊和门诊资料、大气污染物资料和气象资料。采用广义相加模型分析SO₂浓度与医院每日急诊和门诊人次的关系，采用Meta随机效应模型分析得到合并效应值。结果纳入总急诊和门诊人次分别为411 277和4 935 282人次。北京、西安、武汉和广州市等地的SO₂年平均浓度分别为16.5、30.1、30.5和15.0 μg/m³。SO₂对急诊和门诊的影响存在滞后效应，单日滞后效应逐日递减，且在滞后3 d失去统计学意义。滞后0~2 d影响最大，SO₂平均浓度每升高10 μg/m³，每日急诊和门诊分别增加3.44%(95% CI：1.65%~5.26%)和1.32%(95% CI：0.45%~2.20%)。SO₂对每日急诊和门诊影响的暴露-反应关系曲线均呈近似线性，但在高浓度段有变平缓的趋势。此外，SO₂引起的急诊和门诊人群归因分值分别为6.80%(95% CI：2.20%~11.10%)和2.84%(95% CI：0.98%~4.64%)。结论中国城市SO₂短期暴露可增加医院急诊和门诊的就诊风险，应加强SO₂污染防治并修订相应标准。
- 二氧化硫 /
- 时间序列研究 /
- 急诊 /
- 门诊
Abstract: Objective To assess the effects of sulfur dioxide (SO₂) air pollution on daily hospital emergency and outpatient visits in Beijing, Xian, Wuhan, and Guangzhou. Methods The daily data on emergency and outpatient visits, ambient air pollutants, and weather conditions of 5 hospitals in Beijing, Xian, Wuhan, and Guangzhou were collected from January 1, 2013 to December 31, 2015. Generalized additive models were applied to analyze the effects of SO₂ exposure on daily hospital emergency and outpatient visits. Random-effects meta-analyses were used to obtain the combined effect values. Results The included emergency and outpatient visits of 5 hospitals were 411 277 and 4 935 282, respectively. The average annual SO₂ levels of Beijing, Xian, Wuhan, and Guangzhou were 16.5, 30.1, 30.5, and 15.0 μg/m³, respectively. The lag effects of SO₂ exposure on emergency and outpatient visits were observed in our study. For the single-day lag periods, the estimated effect of the same-day exposure was the largest. Afterward, the effect decreased and lost statistical significance in the lag 3 d. Our results showed that the lag 0-2 d concentrations of SO₂ had the largest effect on emergency and outpatient visits. And a 10 μg/m³ increment in SO₂ concentrations was associated with excess risks of 3.44% (95% CI: 1.65%-5.26%) and 1.32% (95% CI: 0.45%-2.20%) for daily emergency and outpatient visits, respectively. The exposure-response curves between SO₂ exposure and daily emergency and outpatient visits were nearly linear, but the curves turned to level off at higher concentrations. Besides, SO₂-related population attributable fractions were 3.33% (95% CI: 1.63%-4.99%) and 1.31% (95% CI: 0.45%-2.16%) for daily emergency and outpatient visits, respectively. Conclusions Short-term exposure to SO₂ can increase the risk of hospital emergency and outpatient visits in Chinese cities, suggesting that the prevention and control of SO₂ pollution should be further strengthened, and the corresponding air pollution standard should be tightened.
- Sulfur dioxide /
- Time-series study /
- Emergency visits /
- Outpatient visits

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图 1 SO₂浓度每升高10 μg/m³对医院每日急诊与门诊人次在不同滞后时间的影响

注：图中横坐标01、02、03指多日滞后时间，即0~1 d、0~2 d、0~3 d。

Figure 1. Excess risks in the daily count of emergency and outpatient visits per 10 μg/m³ increase in ambient sulfur dioxide concentration over different single-day and multiple-day lag periods

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图 2 滞后0~2 d SO₂暴露浓度与医院每日急诊与门诊人次的暴露-反应关系曲线

Figure 2. Exposure-response curves for the association of daily sulfur dioxide concentrations (lag 0-2 d) with emergency and outpatient visits

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表 1 2013―2015年中国4个城市SO₂与环境因素的Spearman相关分析系数

Table 1. Spearman correlation coefficients between SO₂ and environmental factors in four Chinese cities from 2013 to 2015

城市	PM_2.5	NO₂	O₃	CO	温度	相对湿度
北京	0.55 ^a	0.68 ^a	-0.43 ^a	0.68 ^a	-0.58 ^a	-0.16 ^a
西安	0.67 ^a	0.69 ^a	-0.60 ^a	0.78 ^a	-0.75 ^a	-0.29 ^a
武汉	0.58 ^a	0.65 ^a	-0.23 ^a	0.56 ^a	-0.42 ^a	-0.37 ^a
广州	0.62 ^a	0.59 ^a	0.26 ^a	0.33 ^a	-0.02	-0.15 ^a
注：^a P＜0.05。

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表 2 不同分析模型滞后0~2 d SO₂浓度每升高10 μg/m³对医院每日就诊人次的影响

Table 2. Excess risks in the daily emergency and outpatient visits per 10 μg/m³ increase in sulfur dioxide concentrations (lag 0-2 d) in different analytical models

分析模型	ER(95% CI)值
分析模型	急诊(%)	门诊(%)
单污染物模型
SO₂	3.44(1.65~5.26)	1.32(0.45~2.20)
两污染物模型^a
+PM_2.5	1.85(0.19~3.52)	1.22(0.40~2.04)
+NO₂	1.69(0.05~3.36)	0.40(-0.47~1.28)
+O₃	3.21(1.61~4.83)	1.59(0.45~2.75)
+CO	3.52(1.32~5.76)	0.81(0.04~1.59)
敏感性分析
模型1 ^b	3.58 (1.65~5.54)	1.38 (0.44~2.34)
模型2 ^c	3.26 (1.23~5.33)	1.41 (0.31~2.52)
模型3 ^d	2.96 (0.92~5.03)	1.14 (0.35~1.94)
注：^a模型纳入滞后0~2 d的大气污染物浓度；^b模型取df₁=6；^c模型取df₁=8；^d选取各城市所有环境监测站的平均暴露水平代表就诊人群的暴露水平。

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