北京市空气质量指数与结核病发病关系的时间序列研究

摘要

Objective To analyze the effect of air quality index (AQI) on the incidence of tuberculosis (TB) in Beijing,and to provide evidence for setting up a better program regarding prevention and control of tuberculosis.Methods Generalized additive model (GAM) was used to analyze the association between AQI and the incidence of tuberculosis in Beijing,from January 1,2014 to November 9,2016.Confounding factors as meteorological conditions and time trends were under control.Results In Beijing,a total of 14 533 TB cases with definite dates of onset were collected during the study period,with 36 children excluded from the study.Finally,14 497 cases were included in the study,including 9 513 men and 4 984 women,with 11 290 adults (15-59 years old) and 3 207 elderly (≥60 years old).Data from the optimal single-day lag effect of GAM showed that,with every 1 0 increase of AQI,the percent of increase on the onsets of overall,male,female and adutuberculosis cases were 0.85％ (95％CI:0.26％-1.44％),0.83％ (95％CI:0.24％-1.42％),0.93％ (95％CI:0.24％-1.62％) and 0.88％ (95％CI:0.29％-1.46％),respectively.The optimal lag time of the single-day effects were 15 days (lagl5),but 16 days (lag16) for male.The optimal cumulative lag effect showed that with every 10 AQI increase,the percent of increase on the onsets of overall,male,female and adult tuberculosis cases were 1.92％ (95％CI:0.23％-3.16％),1.94％ (95％CI:0.15％-3.72％),2.04％ (95％CI:0.10％-3.97％) and 2.00％ (95％CI:0.30％-3.69％),respectively,with the optimal lag time of cumulative delayed effects as 17 days (lag0_17),18 days (lag0_18),16 days (lag0_16) and 17 days (lag0_17),respectively.However,there were no statistical significances noticed in the elderly cases.Conclusion There was a positive correlation between AQI and the number of TB cases in Beijing,and the effects of AQI on the number of TB cases in different genders and age groups were different.%目的 分析北京市空气质量指数(AQI)对结核病发病的影响效应,为结核病的防控提供理论依据.方法 采用广义可加模型(GAM)对北京市2014年1月1日至2016年1 1月9日的AQI与结核病发病例数进行回归分析,同时控制气象因素、时间趋势等混杂因素的影响.结果 研究期间共收集北京市具有明确发病日期的结核病病例14 533例,排除儿童36例,共14497例纳入研究.其中,男性9 513例,女性4984例,成年人(15～59岁)11 290例,老年人(≥60岁)3 207例.GAM最佳单日滞后效应结果显示,AQI每增加10,总体、男性、女性及成年人结核病发病例数增加百分比分别为0.85％(95％CI:0.26％～1.44％)、0.83％(95％CI:0.24％～ 1.42％)、0.93％ (95％CI:0.24％～1.62％)及0.88％(95％CI:0.29％～1.46％).单日效应的最佳滞后期除男性为16 d(lag16)以外其余均为15 d(lag15).最佳累积滞后效应结果显示:AQI每增加10,总体、男性、女性及成年人结核病发病例数增加百分比分别为1.92％ (95％ CI:0.23％～3.16％)、1.94％(95％CI:0.15％～3.72％)、2.04％(95％CI:0.10％～ 3.97％)及2.00％(95％CI:0.30％～ 3.69％),累积效应的最佳滞后期分别为累积滞后17 d(lag0_17)、18 d(lag0_18)、16 d(lag0_16)和17 d(lag0_ 17).AQI增加对老年人结核病发病例数影响无统计学意义.结论 北京市AQI对结核病发病例数的影响存在正相关关系,AQI对不同性别和不同年龄组的结核病发病例数的影响存在一定差别.