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目的研究杭州市大气污染物浓度与儿童呼吸系统疾病门诊人次的关系。方法收集杭州市儿童呼吸系统疾病监测点医院2014年逐日呼吸系统疾病门诊人次数、大气主要污染物及相关气象因素。采用基于时间序列的Poisson广义相加模型(generalized additive model,GAM),在控制了长期趋势、“星期几效应”及气象因子等混杂因素的影响后,分析2014年杭州市大气污染物与儿童呼吸系统疾病门诊量的暴露-反应关系及滞后效应,并分别建立单污染物和多污染物模型。结果2014年,杭州市年平均NO_2、PM_(10)、PM2.5的浓度均高于二级标准浓度限值;Spearman秩相关分析显示,儿童呼吸系统疾病门诊人次与多种污染物(SO_2、NO_2、CO_、O_3、PM10、PM2.5)浓度呈正相关(P<0.05)。基于GAM模型分析,调整气象因素、“星期几效应”、“假期效应”等因素后,杭州市多种大气主要污染物对儿童呼吸系统疾病健康损害效应从大到小顺序:NO_2[RR(95%CI):1.063 9(1.059 1~1.068 7)]、PM_(10)[RR(95%CI):1.047 9(1.046 0~1.049 9)]、CO_[RR(95%CI):1.039 8(1.016 1~1.064 1)]、O_3[RR(95%CI):1.025 1(1.023 1~1.027 1)]、PM_(2.5)[RR(95%CI):1.024 1(1.022 1~1.026 1)]、SO_2[RR(95%CI):1.020 6(1.012 1~1.029 2)]。结论杭州市大气主要污染物浓度增高可能会导致儿童呼吸系统疾病门诊量增加,应加强监测,降低儿童呼吸系统疾病发病率。
Objective To study the relationship between the concentration of air pollutants and the number of outpatient visits of children with respiratory diseases in Hangzhou. Methods The number of daily respiratory disease outpatients, major atmospheric pollutants and related meteorological factors in Hangzhou’s monitoring stations of childhood respiratory diseases in 2014 were collected. Based on the generalized additive model (GAM) based on time series and the control of long-term trend, the effect of the “day of the week” and meteorological factors and other confounders, this paper analyzes the relationship between the air pollutants Child-respiratory disease outpatient exposure dose-response relationship and lag effect, and the establishment of a single pollutant and multi-pollutant model. Results In 2014, the annual average concentrations of NO 2, PM 10 and PM 2.5 in Hangzhou were higher than those of the second standard. Spearman rank correlation analysis showed that the number of outpatients with respiratory disease in children was significantly higher than those of other pollutants (SO 2, NO_2, CO_, O_3, PM10, PM2.5) concentrations were positively correlated (P <0.05). Based on the GAM model analysis, after adjustment for meteorological factors, such as the “day of the week effect” and “holiday effect”, the effect of major air pollutants on the health of children with respiratory diseases in descending order: NO_2 [RR (95% CI): 1.063 9 (1.059 1 ~ 1.068 7)], PM 10 (RR 95% CI 1.047 9 1.046 0-1.049 9) : 1.039 8 (1.0161 ~ 1.064 1)], O_3 [RR (95% CI): 1.025 1 (1.023 1 ~ 1.027 1)], PM 2.5 (RR 1.026 1)], SO 2 [RR (95% CI): 1.020 6 (1.012 1 ~ 1.029 2)]. Conclusion The increase of the concentration of major pollutants in the atmosphere of Hangzhou may lead to an increase in the outpatient amount of respiratory diseases in children. Monitoring should be strengthened to reduce the incidence of respiratory diseases in children.