Impact of Urban Air Pollution on Incidence of Respiratory Disease in Children: A Case Study of Zhengzhou City
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摘要: 随着城市化进程的加快，空气质量对人体健康的影响日益受到关注. 该研究以空气污染较严重的郑州市为例，针对2019年6月1日—2022年6月30日郑州大学第三附属医院(三甲医院)儿童呼吸道疾病日门诊人数、空气污染物(PM2.5、PM10、NO2、CO、SO2和O3)浓度和气象要素(气温和相对湿度)进行相关性分析，并进一步利用广义相加模型分析空气污染物对儿童呼吸道疾病就诊人数的当日及滞后效应，及其受性别、年龄和季节的影响. 结果表明：①儿童呼吸道疾病就诊人数与PM2.5、PM10、NO2、CO和SO2的浓度均呈正相关，与气温和相对湿度均呈负相关. ②6种空气污染物对儿童呼吸道疾病就诊人数的影响均存在滞后效应，且在空气污染物对儿童呼吸道疾病就诊人数影响最大的滞后日，PM2.5、PM10、NO2和O3的浓度每增加10 μg/m3，儿童呼吸道疾病就诊人数分别增加0.66%、0.37%、4.63%和0.82%；SO2浓度每增加1 μg/m3，就诊人数增加1.72%；CO浓度每增加1 mg/m3，就诊人数增加4.25%. ③PM2.5、PM10和NO2对女童的影响大于男童，污染物浓度每增加10 μg/m3，女童就诊人数增长率比男童分别高出0.06%、0.04%和2.36%. ④空气污染物对儿童呼吸道疾病影响显著的种类数大致随着儿童年龄的增加而减小. ⑤秋冬季空气污染物对儿童呼吸道疾病就诊率的影响较大. 研究显示，儿童呼吸道疾病就诊人数与空气质量密切相关，但不同性别、不同年龄儿童受空气污染影响程度不同，且具有明显的季节变化特征，因此降低城市大气污染物浓度可有效降低儿童呼吸道疾病就诊率.
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关键词:
- 儿童呼吸道疾病 /
- 空气质量 /
- 空气污染物 /
- 气象因素 /
- 广义相加模型(GAM)
Abstract: With the acceleration of urbanization, the impact of air quality on human health has received increasing attention. This study takes Zhengzhou City, a city with serious air pollution, as an example. The correlation analysis was performed on the daily number of visits for child respiratory disease at the Third Affiliated Hospital of Zhengzhou University (a Grade-A tertiary hospital), air pollutants (PM2.5, PM10, NO2, CO, SO2 and O3) and meteorological factors (temperature and relative humidity) from June 1st, 2019 to June 30th, 2022. A further Generalized Additive Model (GAM) was used to analyze the effect of air pollutants on the number of outpatients on daily and lagged bases, and the effects of gender, age, and season were also taken into consideration. The results showed that: (1) The number of visits was positive correlated with the concentrations of PM2.5, PM10, NO2, CO and SO2, and negatively correlated with temperature and relative humidity. (2) All six air pollutants showed lagged effects on the number of visits. On the lagged days with the strongest effects, the number of visits increased by 0.66%, 0.37%, 4.63% and 0.82% for each 10 μg/m3 increase in PM2.5, PM10, NO2 and O3, respectively, 1.72% for 1 μg/m3 increase in SO2 and 4.25% for CO. (3) The PM2.5, PM10, and NO2 had greater effects on the number of doctor visits for girls′ visits than boys by 0.06%, 0.04% and 2.36% with an increasing concentration of 10 μg/m3, respectively. (4) With the increasing of children′s age, the number of air pollutants with significant effects decreased. (5) In autumn and winter, the impacts of air pollutants became stronger. Overall, the research shows that the number of hospital visits for child respiratory disease was closely related to the air pollution. Children of different genders and ages were affected differently by the air pollution, with significant seasonal characteristics. Thus, the hospital visit rate can be effectively reduced by improving air quality. -
图 1 郑州市儿童呼吸道疾病就诊人数与空气质量指数时间序列
注：“疫情期”是指新型冠状病毒感染疫情期间，郑州市大部分区域封控期+管控期≥10天的时段.
Figure 1. Time series plot of the number of visits for child respiratory disease and the Air Quality Index in Zhengzhou City
图 2 单一滞后0~7 d空气污染物对儿童呼吸道疾病就诊人数的影响
Figure 2. Effect of air pollutants on the number of visits for child respiratory disease with a single lag of 0 d to 7 d
图 3 累积滞后1~7 d空气污染物对儿童呼吸道疾病就诊人数的影响
注：灰色区域为超额危险度的95%可信区间.
Figure 3. Effect of air pollutants on the number of visits for child respiratory disease with a cumulative lag of 1 d to 7 d
表 1 样本总量及样本性别和年龄分布
Table 1. Sample size and the distribution based on gender and age
人 样本总量 男童 女童 0~<1岁 1~<3岁 3~<7岁 7~<14岁 14~16岁 65 586 38 422 27 164 18 660 20 990 20 511 5 099 326 
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表 2 郑州市空气污染物浓度统计分析
Table 2. Statistical analysis of air pollutants concentrations in Zhengzhou City
项目 单位 GB 3095—2012
二级标准限值平均值±标准差 最大值 超标率 PM2.5浓度 μg/m3 75 47.6±37.4 284 16.6% PM10浓度 μg/m3 150 91.0±62.1 928 9.5% SO2浓度 μg/m3 150 8.3±3.8 26 0 NO2浓度 μg/m3 80 35.2±16.0 98 0.7% O3-8 h浓度 μg/m3 160 110.9±55.2 286 21.3% CO浓度 mg/m3 4 0.8±0.3 2.5 0
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表 3 儿童呼吸道疾病就诊人数与气象要素、空气污染物的相关性
Table 3. Correlation between the number of visits for child respiratory disease and meteorological factors and air pollutants
变量 PM2.5浓度 PM10浓度 SO2浓度 NO2浓度 O3-8 h浓度 CO浓度 气温 相对湿度 儿童呼吸道疾病就诊人数 0.24 0.22 0.26 0.47 −0.26 0.27 −0.28 −0.17 PM2.5浓度 0.81 0.52 0.63 −0.34 0.70 −0.55 0.09 PM10浓度 0.60 0.57 -0.17 0.42 −0.36 -0.24 SO2浓度 0.57 −0.28 0.24 −0.49 −0.50 NO2浓度 −0.37 0.54 −0.43 −0.02 O3-8 h浓度 −0.34 0.83 −0.15 CO浓度 −0.42 0.44 气温 0.00 注：加粗部分表示具有统计学意义，P<0.05.
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表 4 不同城市空气污染物在最强作用日对儿童呼吸道疾病就诊人数的影响
Table 4. Effects of air pollutants on the number of visits for child respiratory disease on the strongest effect days in different cities
城市 PM2.51) PM101) O31) SO21) NO21) CO2),3) 最强作用日 ER 最强作用日 ER 最强作用日 ER 最强作用日 ER 最强作用日 ER 最强作用日 ER 郑州市 lag0 0.66% lag0 0.37% lag02 0.82% lag07 18.62% lag07 4.63% lag7 0.42%2) 兰州市 lag01 0.25% — — — — lag07 1.66% lag01 0.57% lag01 2.25%3) 临沂市 lag05 0.60% lag0 0.36% lag3 1.07% lag0 1.77% lag0 1.29% lag0 0.69%2) 注：1)PM2.5、PM10、O3、SO2和NO2增长的单位浓度为10 μg/m3；2)郑州市和临沂市CO增长的单位浓度为0.1 mg/m3；3)兰州市CO增长的单位浓度为1 mg/m3. 数据均有统计学意义，P<0.05. —表示无统计学意义.
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表 5 污染物每升高单位浓度导致的不同性别儿童呼吸道疾病就诊人数的超额危险度及95%置信区
Table 5. ER and 95% CI for the number of respiratory disease visits for children of different genders per unit increase in pollutant concentration
污染物 最强作用日 超额危险度及95%置信区间 男童 女童 PM2.51) lag0 0.65%(0.22%，1.09%) 0.71%(0.20%，1.21%) PM101) lag0 0.36%(0.08%，0.65%) 0.40%(0.06%，0.73%) O3-8 h1) lag02 0.90%(0.28%，1.52%) 0.66%(−0.08%，1.41%) SO22) lag07 1.98%(0.92%，3.05%) 0.98%(−0.20%，2.16%) NO21) lag07 3.49%(0.86%，3.18%) 5.85%(2.72%，9.09%) CO3) lag7 3.98%(−0.41%，8.55%) 5.38%(0.17%，10.87%) 注：1)PM2.5、PM10、O3-8 h和NO2增长的单位浓度为10 μg/m3；2)SO2增长的单位浓度为1 μg/m3；3)CO增长的单位浓度为1 mg/m3. 加粗部分表示具有统计学意义，P<0.05.
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表 6 污染物每升高单位浓度导致的不同年龄儿童呼吸道疾病就诊人数的超额危险度及95%置信区间
Table 6. ER and 95% CI of the number of respiratory disease visits for children of different ages per unit increase in pollutant concentration
污染物 最强作用日 超额危险度及95%置信区间 0~<1岁 1~<3岁 3~<7岁 7~<14岁 14~16岁 PM2.51) lag0 0.71%(0.08%，1.36%) 0.52%(−0.03%，1.08%) 0.41%(−0.13%，0.95%) 1.01%(−0.26%，2.31%) 2.93%(−1.55%，7.62%) PM101) lag0 0.48%(0.05%，0.90%) 0.28%(−0.11%，0.66%) 0.27%(−0.11%，0.66%) 0.51%(−0.33%，1.36%) 3.44%(0.55%，6.42%) O3-8 h1) lag02 0.20%(−0.70%，1.10%) 1.01%(0.19%，1.85%) 1.23%(0.36%，2.10%) 2.48%(0.72%，4.27%) −2.07%(−8.49%，4.80%) SO22) lag07 2.64%(1.12%，4.18%) 2.52%(1.11%，3.96%) −0.15%(−1.50%，1.21%) 4.78%(1.71%，7.93%) −7.42%(−16.21%，2.30%) NO21) lag07 8.68%(4.92%，12.58%) 3.31%(−0.12%，6.87%) 0.63%(−2.80%，4.19%) 10.91%(3.18%，19.21%) −8.51%(−27.85%，16.00%) CO3) lag7 5.40%(−1.09%，12.31%) −2.12%(−7.67%，3.76%) 11.45%(5.25%，18.01%) −0.87%(−13.32%，13.37%) −5.12%(−40.16%，50.43%) 注：1)PM2.5、PM10、O3-8 h和NO2增长的单位浓度为10 μg/m3；2)SO2增长的单位浓度为1 μg/m3；3)CO增长的单位浓度为1 mg/m3. 加粗部分表示具有统计学意义，P<0.05.
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表 7 不同季节污染物每升高单位浓度导致的儿童呼吸道疾病就诊人数的超额危险度及95%置信区间
Table 7. ER and 95%CI of the number of respiratory disease visits for children per unit increase in pollutant concentration in different seasons
污染物 最强作用日 超额危险度及95%置信区间 春季 夏季 秋季 冬季 PM2.51) lag0 −0.28%(−1.61%，1.06%) 0.93%(−1.42%，3.34%) −0.22%(−1.68%，1.26%) 0.32%(−0.17%，0.81%) PM101) lag0 0.02%(−0.21%，0.26%) 0.17%(−0.63%，0.98%) −0.02%(−0.68%，0.64%) 0.24%(−0.11%，0.59%) O3-8 h1) lag02 −3.72%(−6.75%，−0.60%) 0.60%(−0.47%，1.69%) 0.84%(0.03%，1.65%) 0.38%(−1.20%，1.99%) SO22) lag07 −2.31%(−4.15%，0.44%) 1.64%(−0.82%，4.16%) 2.71%(0.04%，5.44%) −1.80%(−4.01%，0.46%) NO21) lag07 −8.38%(−13.89%，−2.52%) 2.75%(−2.03%，7.76%) 0.77%(−4.61%，6.45%) 4.94%(2.22%，7.73%) CO3) lag7 1.28%(−17.78%，24.77%) 15.51%(−0.69%，34.35%) 5.30%(−5.92%，17.85%) 4.43%(−0.42%，9.51%) 注：1)PM2.5、PM10、O3-8 h和NO2增长的单位浓度为10 μg/m3；2)SO2增长的单位浓度为1 μg/m3；3)CO增长的单位浓度为1 mg/m3. 加粗部分表示具有统计学意义，P<0.05.
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表 8 单污染物和双污染物对儿童呼吸道疾病就诊人数的影响分析结果
Table 8. The analysis results of the impact of single and dual pollutants on the number of visits for child respiratory disease
污染物 最强作用日 超额危险度及95%置信区间 双污染物影响 单污染物影响 PM2.51) lag0 0.55%(0.06%，1.05%) 0.66%(0.34%，1.00%) PM101) lag0 0.10%(−0.22%，0.43%) 0.37%(0.16%，0.59%) SO22) lag07 1.05%(0.10%，2.01%) 1.72%(0.91%，2.54%) NO21) lag07 3.25%(0.87%，5.68%) 4.63%(2.57%，6.72%) 注：1)PM2.5、PM10和NO2增长的单位浓度为10 μg/m3；2)SO2增长的单位浓度为1 μg/m3. 加粗部分表示具有统计学意义，P<0.05.
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表 9 不同时间自由度下污染物对儿童呼吸道疾病就诊人数的影响
Table 9. Effect of pollutants on the number of visits for child respiratory disease at different degrees of temporal freedom
自由度(df) 超额危险度及95%置信区间 PM2.51) (lag0) PM101)(lag0) O3-8 h1)(lag02) SO22)(lag07) NO21)(lag07) CO3)(lag7) 15 0.83%(0.50%，1.16%) 0.49%(0.27%，0.71%) 0.79%(0.32%，1.28%) 2.60%(1.81%，3.39%) 4.62%(2.56%，6.71%) 3.38%(0%，6.88%) 16 0.66%(0.34%，1.00%) 0.37%(0.16%，0.59%) 0.82%(0.34%，1.30%) 1.72%(0.91%，2.54%) 4.63%(2.57%，6.72%) 4.25%(0.85%，7.77%) 17 0.62%(0.28%，0.95%) 0.34%(0.12%，0.56%) 0.84%(0.36%，1.32%) 1.50%(0.67%，2.35%) 4.35%(2.29%，6.45%) 4.70%(1.31%，8.21%) 18 0.63%(0.29%，0.96%) 0.35%(0.13%，0.57%) 0.84%(0.36%，1.32%) 1.46%(0.62%，2.31%) 4.28%(2.16%，6.45%) 4.68%(1.29%，8.19%) 注：1)PM2.5、PM10、O3-8 h和NO2增长的单位浓度为10 μg/m3；2)SO2增长的单位浓度为1 μg/m3；3)CO增长的单位浓度为1 mg/m3. 数据均具有统计学意义，P<0.05.
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