天津市2001-2009年空气污染物二氧化硫、二氧化氮和可吸入颗粒物对冠心病死亡影响的时间序列分析

摘要

Objective To quantitatively explore the effect of air pollution on coronary heart disease mortality in Tianjin.Methods Mortality data in 2001-2009 were from Tianjin mortality surveillance system operated by the Tianjin Centers for Disease Control and Prevention while data related to meteorology and air pollution were from the Tianjin Meteorological Bureau and Tianjin Environmental Monitoring Station,respectively.Generalized Additive Model (GAM) extended Poisson regression was used to examine the relationship between air pollution and mortality in Tianjin,under the controlling of time trends,weather,the day of week and population etc.Results The crude coronary heart disease mortality in Tianjin increased from year 2001 to 2009,from 105.12/100 000 to 167.03/100 000.The standardized mortality rate of 96.07/100 000 to 105.11/100 000.Air pollutants was more strongly associated with coronary heart disease mortality.By single GAM analysis,a 10 tg/m3 increase in SO2,PM10 and NO2,which accounted for 1.25％(95％CI:0.75％-1.75％),0.65％ (95％CI:0.51％-0.79％) and 1.04％ (95％CI:0.52％-1.55％) increased in daily mortality.By multiple GAM analysis,a 10 μ g/m3 increase in SO2 and PM10 which accounted for 0.86％ (95％ CI:0.60％-1.12％) and 0.40％ (95％ CI:0.06％-0.75％) increased the daily mortality.NO2 was not significantly associated with coronary heart disease mortality rates,but factors as low temperature,low wind speed and population size were (P＜0.05).Conclusion Results from this study showed that air pollution was a risk factor for coronary heart disease mortality in Tianjin.%目的 了解天津市大气污染对居民冠心病死亡的影响.方法 采用2001-2009年天津市疾病预防控制中心收集的居民全死因监测数据,同期气象和大气污染资料源自天津市气象局和环境监测中心.采用时间序列的泊松回归广义可加模型分析天津市每日大气污染与居民冠心病死亡危险度,同时控制气象因素、长期趋势、星期几效应以及人口数等混杂因素的影响.结果 2001-2009年天津市冠心病粗死亡率为105.12/10万至167.03/10万,世界标化死亡率为96.07/10万至105.11/10万,呈逐年上升趋势(P=0.000).单因素分析显示大气中二氧化硫(SO2)、可吸入颗粒物(PM10)、二氧化氮(NO2)日均浓度每升高10 μg/m3,冠心病死亡风险的RR值分别增加1.25％ (95％CI:0.75％～1.75％)、0.65％(95％CI:0.51％～ 0.79％)和1.04％(95％ CI:0.52％ ～1.55％)倍；SO2、PM10效应在当日达到最高,NO2效应在3日后达到最高；多因素分析显示,NO2日均浓度对冠心病死亡的风险无统计学意义(P=0.1313),SO2、PM10日均浓度每增加10 μg/m3,冠心病死亡风险的RR值分别增加0.86％(95％CI:0.60％ ～ 1.12％)倍和0.40％(95％CI:0.06％ ～ 0.75％)倍.低温、低风速、年均人口数增加也是冠心病死亡的危险因素(P＜0.05).结论 天津市大气污染可增加人群冠心病死亡风险.