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652个城市的大气颗粒物污染与每日死亡率的关系
Ambient Particulate Air Pollution and Daily Mortality in 652 Cities


Cong Liu ... 心脑血管疾病 呼吸系统疾病 • 2019.08.22
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中国领衔多国合作登上NEJM:全球视角下的空气污染|附作者视频讲解

 

底骞

清华大学医学院公共健康研究中心

 

中国读者高度关注本国的空气污染问题。虽然近几年北京等城市的空气污染状况有了较大缓解,但时常发生的空气污染总能牵动公众的神经,成为热门话题。

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摘要


背景

模型设定方面的差异和发表偏倚使我们在系统性评价空气污染时间序列研究结果方面面临挑战。

 

方法

我们在多个国家或地区评价了空气动力学直径≤10 μm(PM10)的可吸入颗粒物(PM)和空气动力学直径≤2.5 μm的细颗粒物(PM2.5)与每日全因死亡率、心血管疾病死亡率和呼吸系统疾病死亡率之间的关联。我们从24个国家或地区收集了652个城市的每日死亡率和空气污染数据。并使用过度离散广义可加模型和随机效应荟萃分析方法研究了这些关联。我们拟合了双污染物模型,用于检验关联的稳健性。并且将各城市的浓度-反应曲线汇总,用于计算全球估计值。

 

结果

平均而言,PM10浓度的2天移动均值(代表当天和前一天的平均值)增加10 μg/m3,相关每日全因死亡率、心血管疾病死亡率和呼吸系统疾病死亡率分别增加0.44%(95%置信区间[CI],0.39%~0.50%)、0.36%(95% CI,0.30%~0.43%)和0.47%(95% CI,0.35%~0.58%)。PM2.5浓度发生相同变化时,每日死亡率的相应增幅分别为0.68%(95% CI,0.59%~0.77%)、0.55%(95% CI,0.45%~0.66%)和0.74%(95% CI,0.53%~0.95%)。对气态污染物校正后,上述关联仍然显著。在年平均PM浓度较低和年平均温度较高的地区,上述关联较强。汇总浓度-反应曲线表明,每日死亡率始终随着PM浓度的增加而增加,且PM浓度较低时的斜率较大。

 

结论

我们的数据表明,在全球超过600个城市,PM10和PM2.5的短期暴露与每日全因死亡率、心血管疾病死亡率和呼吸系统疾病死亡率独立相关。这些数据巩固了区域和地方研究中确定的死亡率与PM浓度之间的关联证据(由中国国家自然科学基金等资助)。





作者信息

Cong Liu, M.S., Renjie Chen, Ph.D., Francesco Sera, Ph.D., Ana M. Vicedo-Cabrera, Ph.D., Yuming Guo, Ph.D., Shilu Tong, Ph.D., Micheline S.Z.S. Coelho, Ph.D., Paulo H.N. Saldiva, Ph.D., Eric Lavigne, Ph.D., Patricia Matus, Ph.D., Nicolas Valdes Ortega, M.Sc., Samuel Osorio Garcia, Ph.D., Mathilde Pascal, Ph.D., Massimo Stafoggia, Ph.D., Matteo Scortichini, Ph.D., Masahiro Hashizume, Ph.D., Yasushi Honda, Ph.D., Magali Hurtado-Díaz, Ph.D., Julio Cruz, Ph.D., Baltazar Nunes, Ph.D., João P. Teixeira, Ph.D., Ho Kim, Ph.D., Aurelio Tobias, Ph.D., Carmen Íñiguez, Ph.D., Bertil Forsberg, Ph.D., Christofer Åström, Ph.D., Martina S. Ragettli, Ph.D., Yue-Leon Guo, Ph.D., Bing-Yu Chen, Ph.D., Michelle L. Bell, Ph.D., Caradee Y. Wright, Ph.D., Noah Scovronick, Ph.D., Rebecca M. Garland, Ph.D., Ai Milojevic, Ph.D., Jan Kyselý, Ph.D., Aleš Urban, Ph.D., Hans Orru, Ph.D., Ene Indermitte, Ph.D., Jouni J.K. Jaakkola, Ph.D., Niilo R.I. Ryti, Ph.D., Klea Katsouyanni, Ph.D., Antonis Analitis, Ph.D., Antonella Zanobetti, Ph.D., Joel Schwartz, Ph.D., Jianmin Chen, Ph.D., Tangchun Wu, Ph.D., Aaron Cohen, D.Sc., Antonio Gasparrini, Ph.D., and Haidong Kan, Ph.D.
From the School of Public Health, Key Laboratory of Public Health Safety of the Ministry of Education and National Health Commission Key Laboratory of Health Technology Assessment (C.L., R.C., H. Kan), the Department of Environmental Science and Engineering (J. Chen), Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (R.C., H. Kan), Fudan University, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine (S.T.), and Children’s Hospital of Fudan University, National Center for Children’s Health (H. Kan), Shanghai, the School of Public Health and Management, Binzhou Medical University, Yantai (Y.G.), the School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei (S.T.), and the Key Laboratory of Environment and Health, Ministry of Education, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan (T.W.) — all in China; the Department of Public Health, Environments and Society (F.S., A.M.V.-C., A.M., A.G.) and the Centre for Statistical Methodology (A.G.), London School of Hygiene and Tropical Medicine, and the School of Population Health and Environmental Sciences, King’s College London (K.K.), London; the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (Y.G.), and the School of Public Health and Social Work, Queensland University of Technology, Brisbane (S.T.) — both in Australia; the Institute of Advanced Studies, University of São Paulo, São Paulo (M.S.Z.S.C., P.H.N.S.); the Air Health Science Division, Health Canada, and the School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON (E.L.); the Department of Public Health (P.M.) and the School of Nursing and Obstetrics (N.V.O.), Universidad de los Andes, Santiago, Chile; Hospital Vista Hermosa, Bogota, Colombia (S.O.G.); Santé Publique France, French National Public Health Agency, Saint Maurice, France (M.P.); the Department of Epidemiology, Lazio Regional Health Service–ASL Roma 1, Rome (M. Stafoggia, M. Scortichini); Karolinska Institute, Institute of Environmental Medicine, Stockholm (M. Stafoggia), and the Department of Public Health and Clinical Medicine, Umeå University, Umeå (B.F., C.Å., H.O.) — both in Sweden; the Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki (M.H.), and the Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba (Y.H.) — both in Japan; the Department of Environmental Health, National Institute of Public Health, Cuernavaca, Mexico (M.H.-D., J. Cruz); the Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon (B.N., J.P.T.), and the Epidemiology Research Unit–Instituto de Saúde Pública, Universidade do Porto, Porto (J.P.T.) — both in Portugal; the Department of Public Health Science, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, South Korea (H. Kim); the Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona (A.T.), and the Department of Statistics and Computational Research, University of Valencia Environmental Health Joint Research Unit Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana–Universitat de València–Universitat Jaume I de Castellón Biomedical Research Center Network for Epidemiology and Public Health, Valencia (C.I.) — both in Spain; the Swiss Tropical and Public Health Institute and the University of Basel, Basel, Switzerland (M.S.R.); Environmental and Occupational Medicine, National Taiwan University (Y.-L.G., B.-Y.C.), and the College of Medicine and National Taiwan University Hospital (Y.-L.G.), Taipei City; the School of Forestry and Environmental Studies, Yale University, New Haven, CT (M.L.B.); the Environment and Health Research Unit, South African Medical Research Council (C.Y.W.), the Department of Geography, Geo-informatics, and Meteorology, University of Pretoria (C.Y.W., R.M.G.), and the Natural Resources and the Environment Unit, Council for Scientific and Industrial Research (R.M.G.), Pretoria, and the Unit for Environmental Sciences and Management, North-West University, Potchefstroom (R.M.G.) — all in South Africa; the Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta (N.S.); the Institute of Atmospheric Physics, Czech Academy of Sciences, (J.K., A.U.), and the Faculty of Environmental Sciences (J.K.), Czech University of Life Sciences, Prague, Czech Republic; the Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia (H.O., E.I.); the Center for Environmental and Respiratory Health Research, University of Oulu, Medical Research Center Oulu, and Oulu University Hospital and University of Oulu, Oulu, Finland (J.J.K.J., N.R.I.R.); the Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens (K.K., A.A.); the Department of Environmental Health, Harvard T.H. Chan School of Public Health (A.Z., J.S.), and the Health Effects Institute (A.C.), Boston; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (A.C.). Address reprint requests to Dr. Kan at P.O. Box 249, 130 Dong-An Road, Shanghai 200032, China, or at kanh@fudan.edu.cn.

 

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