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    2014—2019年北京市大气NO2对呼吸系统疾病入院人次的影响

    Effect of atmospheric NO2 on the number of hospital admissions for respiratory diseases in Beijing, China, 2014—2019

      摘要
    • 摘要:
      目的 探究NO2对北京市呼吸系统疾病入院人次的影响，进一步探索NO2对是/否合并糖尿病的呼吸系统疾病入院人次的影响。
      方法 收集北京市2014—2019年大气污染物NO2浓度、气象因素数据，结合同时期呼吸系统疾病(慢性阻塞性肺疾病、哮喘、肺炎、上/下呼吸道感染)入院资料，运用广义相加模型(generalized additive model，GAM)，分析研究NO2对呼吸系统疾病的入院人次的相关性，探索性的研究NO2对是/否合并糖尿病的呼吸系统疾病入院人群在不同年龄、性别、季节分层下的差异。
      结果 GAM分析结果表明NO2浓度与总呼吸系统疾病入院人次呈正相关(P < 0.05)，累积效应值大于单日效应值。NO2浓度每升高1个四分位数间距(interquartile range，IQR)(23.55 μg/m3)，在lag0-14 d的效应最强，对总人群的超额危险度(excess risk, ER)为13.78%(95%CI：12.48%~15.09%)，对＞60岁(Z=4.87，P＜0.01)和女性(Z=-2.81，P＜0.01)呼吸系统疾病入院人次的影响更大。合并糖尿病人群和未合并糖尿病人群的ER值在lag0-14 d均为最大值，分别为15.44%(95%CI：12.22%~18.75%)、13.55%(95%CI：12.17%~14.95%)。大部分滞后期的糖尿病人群效应值均高于非糖尿病人群效应值，但仅在lag0-5 d~lag0-9 d差异有统计学意义(P＜0.05)。其中，未合并糖尿病人群在不同年龄(Z=-4.58，P＜0.01)和性别(Z=-2.43，P＜0.05)的差异有统计学意义，与总呼吸系统的分层结果一致。未发现NO2对合并糖尿病人群影响存在性别和年龄差异。
      结论 2014—2019年北京市呼吸系统疾病的入院人次增加与NO2浓度升高相关，对老年人和女性的影响更大；探索发现，NO2对合并糖尿病的呼吸系统疾病入院人群的效应大于未合并糖尿病人群，>60岁人群对影响更为敏感。

       

      Abstract:
      Objective To investigate the impact of nitrogen dioxide (NO2) on the number of hospital admissions for respiratory diseases in Beijing, China, and explore its effect on the number of admissions for respiratory diseases among subpopulations with or without diabetes.
      Methods The data on the concentration of the air pollutant NO2, meteorological factors, and hospital admission records for respiratory diseases (chronic obstructive pulmonary disease, asthma, pneumonia, and upper/lower respiratory tract infection) in Beijing from 2014 to 2019 were collected. A generalized additive model (GAM) was constructed to analyze the relationship between NO2 and the number of admissions for respiratory diseases. Furthermore, exploratory analyses were conducted by age, sex, and season to investigate the relationship between NO2 and the number of admissions for respiratory diseases among patients with diabetes and those without diabetes.
      Results The GAM result showed a positive association of NO2 concentrations with the total number of admissions for respiratory diseases (P < 0.05), with the cumulative effects greater than the single-day effects. For every increase of one interquartile range (23.55 μg/m3) in daily NO2 concentrations, the strongest effect was observed at a cumulative lag of 0 to 14 days (lag0-14 d), with the excess risk (ER) of 13.78% (95% confidence interval CI: 12.48%-15.09%) for the total population and significantly greater impact on the total number of admissions for respiratory diseases among those over 60 years old (Z=4.87, P < 0.01) and females (Z=-2.81, P < 0.01). For both patients with diabetes and those without diabetes, the ER values were the highest at lag0-14 d, being 15.44% (95%CI: 12.22%-18.75%, P < 0.01) and 13.55% (95%CI: 12.17%-14.95%, P < 0.01), respectively. Mostly, the lagged effect for the people with diabetes were higher than those for people without diabetes, but only showing significant differences from lag0-5 d to lag0-9 d (P < 0.05). There were significant differences in the stratified result by age (Z=-4.58, P < 0.01) and sex (Z=-2.43, P < 0.05) among the subpopulation without diabetes, which was consistent with the stratified results for the total admissions. No gender or age difference was found in the impact of NO2 on diabetic patients.
      Conclusion There is an association of an increased NO2 concentration with an increased number of hospital admissions for respiratory diseases in Beijing from 2014 to 2019, with greater impact for the elderly and females. The effect of NO2 on admissions for respiratory diseases is greater among patient with diabetes than among patients without diabetes, and people over 60 years old are more sensitive to its impact.

       

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