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    臭氧对无锡市0~18岁人群上呼吸道感染日门诊量影响的时间序列分析

    Time-series analysis of the effect of ozone exposure on daily outpatient visits of upper respiratory infections among the population aged 0-18 years in Wuxi, China

      摘要
    • 摘要:
      目的 探讨2018-2023年无锡市臭氧暴露对0~18岁人群急性上呼吸道感染(acute upper respiratory tract infection, AURTI)日门诊量的影响。
      方法 收集无锡市两家公立医院2018-2023年AURTI日门诊量数据以及同期臭氧日最大8小时平均浓度(O3-8 h)等大气污染物浓度和相关气象资料, 并根据针对新型冠状病毒感染的非药物干预措施实施情况将研究时间划分为A1期(非药物干预措施实施期: 2020年1月1日-2022年12月20日)和A2期(非干预期: 2018年1月1日-2019年12月31日、2023年1月1日-2023年12月31日), 采用时间序列泊松(Poisson)分布的广义线性模型(generalized linear model, GLM), 分别建立单污染物与双污染物模型, 定量评估O3-8 h暴露对0~18岁人群AURTI日门诊量的影响, 并根据年龄、性别、季节等进行分层分析。
      结果 A1期O3-8 h暴露与0~18岁人群AURTI日门诊量的关联在lag0 d有统计学意义(P < 0.05);O3-8 h浓度每升高10 μg/m3, AURTI日门诊量减少1.20%(95%CI: -2.17%~-0.22%)。A2期O3-8 h暴露与0~18岁人群AURTI日门诊量增加相关, 在lag03 d效应值最大, O3-8 h浓度每升高10 μg/m3, AURTI日门诊量增加1.79%(95%CI: 0.78%~2.66%)。分层分析发现, O3-8 h暴露与0~18岁人群AURTI日门诊量的关联在暖季表现为正相关、冷季表现为负相关; A1期O3-8 h暴露与婴幼儿组(0~3岁) AURTI日门诊量减少相关, A2期O3-8 h暴露与学龄前儿童组(4~6岁)、学龄儿童组(7~12岁)、青少年组(13~18岁) AURTI日门诊量增加相关; 未观察到性别差异。引入其他污染物构建双污染物模型后, 分析结果显示, O3-8 h对0~18岁人群AURTI日门诊量的影响仍然显著(P < 0.05)。
      结论 无锡市A2期O3-8 h暴露增加0~18岁人群AURTI日门诊量, 暖季O3-8 h水平升高对学龄期儿童患AURTI的影响效应更明显, 应加强对该人群的防护。

       

      Abstract:
      Objective To explore the effect of ozone exposure on the daily outpatient volume of acute upper respiratory tract infection (AURTI) in the population aged 0-18 years in Wuxi, China, from 2018 to 2023.
      Methods Data on the daily outpatient volume of AURTI from two public hospitals in Wuxi (2018-2023), along with concentrations of air pollutants (including 8-hour mean ozone, O3-8 h) and relevant meteorological data during the same period, were collected.Based on the implementation of non-pharmaceutical interventions (NPIs) for severe acute respiratory syndrome coronavirus 2, the study period was divided into two phases: phase A1(NPI implementation period: January 1, 2020 to December 20, 2022) and phase A2(non-intervention period: January 1, 2018 to December 31, 2019;January 1, 2023 to December 31, 2023).A generalized linear model (GLM) with Poisson distribution for time-series data was used to construct single-pollutant and two-pollutant models.These models were applied to quantitatively evaluate the effect of O3-8 h exposure on the daily outpatient volume of AURTI in the population aged 0-18 years, with stratified analyses conducted by age, sex, and season.
      Results In phase A1, a significant association was observed between O3-8 h exposure and the daily outpatient volume of AURTI in the population aged 0-18 years at lag0d (P < 0.05);for every 10 μg/m3 increase in O3-8 h concentration, the daily outpatient volume of AURTI decreased by 1.20%(95% confidence intervalCI: -2.17% to-0.22%).In phase A2, O3-8 h exposure was associated with increased daily outpatient volume of AURTI in the population aged 0-18 years, with the strongest effect observed at lag03 d; for every 10 μg/m3 increase in O3-8 h concentration, the daily outpatient volume of AURTI increased by 1.79%(95%CI: 0.78%-2.66%).Stratified analysis revealed that the association between O3-8 h exposure and daily outpatient volume of AURTI was positive in warm seasons and negative in cold seasons.In phase A1, O3-8 h exposure was associated with decreased daily outpatient volume of AURTI in the infants and young children group (0-3 years); in phase A2, O3-8 h exposure was associated with increased daily outpatient volume of AURTI in the preschool children group (4-6 years), school-age children group (7-12 years), and adolescent group (13-18 years).No sex difference was observed.After incorporating other pollutants to construct a two-pollutant model, the analysis results showed that the effect of O3-8 h on the daily outpatient volume of AURTI in the population aged 0-18 years remained significant (P < 0.05).
      Conclusion In Wuxi, O3-8 h exposure in phase A2 increases the daily outpatient volume of AURTI in the population aged 0-18 years.The effect of elevated O3-8 h levels in warm seasons on AURTI in school-age children is more significant, and targeted protection for this population should be strengthened.

       

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