气候因素和空气质量指数之间的相互作用改善儿童哮喘自我管理
2020/11/17
摘要
背景：每日空气质量指数（AQI）预报可以提供预警信息，目前尚不清楚是否适合儿童哮喘住院治疗（CAHS）。此外，人们对AQI对CAHS的影响以及温度、湿度和AQI之间的相互作用知之甚少。
方法：收集2013-2016年合肥市32238例病例，通过结合Poisson广义线性模型（PGLMs）与分布滞后非线性模型（DLNMs）估计每日CAHS与AQI的相关性。通过对AQI和温度、湿度进行分层，检验AQI与温度的相互作用。
结果：AQI与儿童哮喘住院风险增加相关。不良反应首次出现在第3天，RR为1.011, 95%CI：1.000-1.023），持续至19天（RR=1.010，95%CI：1.001-1.020）。在亚组分析中，男性和学龄前儿童对AQI较为敏感，AQI对CAHS的影响存在季节性差异。此外，在AQI为150的分层分析中，我们发现了温度、湿度和AQI之间的协同作用。温度与AQI交互作用的相对危险度（IRR）和相对超额危险度（RERI）分别为1.157 (95%CI: 1.029-1.306)和0.122 (95%CI: 0.022-0.223)。对于温度，IRR和RERI分别为1.090 (95%CI: 1.056-1.206) 和 0.083 (95%CI: 0.083-0.143)。在交互作用分析中探索不同的亚组，值得注意的是，女性和学龄前儿童对AQI和温度之间的交互作用更敏感，而学龄儿童对AQI与温度的交互作用更为敏感。
结论：研究发现，不仅AQI能显著增加CAHS风险，而且在气候变化的背景下，温度和湿度对AQI具有协同效应，提示仅考虑空气污染的预警信息不足以加强儿童哮喘住院的预后。
Interactions between climate factors and air quality index for improved childhood asthma self-management
Rubing Pan , Xu Wang , Weizhuo Yi , Qiannan Wei , Jiaojiao Gao , Zihan Xu , Jun Duan , Yangyang He , Chao Tang , Xiangguo Liu , Yu Zhou, Shasha Son , Yanhu Ji , Yanfeng Zou , Hong Su.
Abstract
Background: Daily air quality index (AQI) forecast can provide early warning information, and it is not clear whether it is appropriate for childhood asthma hospitalizations (CAHs). Furthermore, little is known about the effects of AQI on CAHs, as well as the interactions between temperature, humidity and AQI.
Methods: We collected 32,238 cases in Hefei from 2013 to 2016 and estimated the association between daily CAHs and AQI by combining the Poisson Generalized Linear Models (PGLMs) with the Distributed Lag Nonlinear Models (DLNMs). The interaction between AQI and temperature was tested by stratifying AQI and temperature, as well as humidity.
Results: AQI was associated with an increased risk of hospitalizations for childhood asthma. The adverse effect first appeared on the 3rd day, with the RR of 1.011 (95%CI: 1.000-1.023) and continued until the 19th day of lag (RR = 1.010, 95%CI: 1.001-1.020). In the subgroup analysis, the male and pre-school children were more sensitive to AQI, and there are seasonal differences in the effects of AQI on CAHs. Besides, in a stratified analysis with an AQI of 150, we found synergies between temperature, humidity and AQI. The interaction relative risk (IRR) and relative excess risk due to interaction (RERI) for the interaction between temperature and AQI were 1.157 (95%CI: 1.029-1.306) and 0.122 (95%CI: 0.022-0.223) respectively. For the humidity, the IRR and RERI were 1.090 (95%CI: 1.056-1.206) and 0.083 (95%CI: 0.083-0.143) respectively. Exploring different subgroups in the interaction analyses, it was worth noting that female and pre-school children were more sensitive to the interaction between AQI and temperature, while school-age children were more sensitive to the interaction between AQI and humidity.
Conclusions: The study found that not only AQI can significantly increase the risk of CAHs, but also that under the context of climate change, temperature and humidity have a synergistic effect on AQI, suggesting that considering only the warning information of air pollution is not enough to strengthen the prevention of childhood asthma hospitalization.
背景：每日空气质量指数（AQI）预报可以提供预警信息，目前尚不清楚是否适合儿童哮喘住院治疗（CAHS）。此外，人们对AQI对CAHS的影响以及温度、湿度和AQI之间的相互作用知之甚少。
方法：收集2013-2016年合肥市32238例病例，通过结合Poisson广义线性模型（PGLMs）与分布滞后非线性模型（DLNMs）估计每日CAHS与AQI的相关性。通过对AQI和温度、湿度进行分层，检验AQI与温度的相互作用。
结果：AQI与儿童哮喘住院风险增加相关。不良反应首次出现在第3天，RR为1.011, 95%CI：1.000-1.023），持续至19天（RR=1.010，95%CI：1.001-1.020）。在亚组分析中，男性和学龄前儿童对AQI较为敏感，AQI对CAHS的影响存在季节性差异。此外，在AQI为150的分层分析中，我们发现了温度、湿度和AQI之间的协同作用。温度与AQI交互作用的相对危险度（IRR）和相对超额危险度（RERI）分别为1.157 (95%CI: 1.029-1.306)和0.122 (95%CI: 0.022-0.223)。对于温度，IRR和RERI分别为1.090 (95%CI: 1.056-1.206) 和 0.083 (95%CI: 0.083-0.143)。在交互作用分析中探索不同的亚组，值得注意的是，女性和学龄前儿童对AQI和温度之间的交互作用更敏感，而学龄儿童对AQI与温度的交互作用更为敏感。
结论：研究发现，不仅AQI能显著增加CAHS风险，而且在气候变化的背景下，温度和湿度对AQI具有协同效应，提示仅考虑空气污染的预警信息不足以加强儿童哮喘住院的预后。
(中日友好医院呼吸与危重症医学科 张清 摘译 林江涛 审校)
(Sci Total Environ. 2020 Jun25;723:137804. doi:10.1016/j.scitotenv.2020.137804.)
(Sci Total Environ. 2020 Jun25;723:137804. doi:10.1016/j.scitotenv.2020.137804.)
Interactions between climate factors and air quality index for improved childhood asthma self-management
Rubing Pan , Xu Wang , Weizhuo Yi , Qiannan Wei , Jiaojiao Gao , Zihan Xu , Jun Duan , Yangyang He , Chao Tang , Xiangguo Liu , Yu Zhou, Shasha Son , Yanhu Ji , Yanfeng Zou , Hong Su.
Abstract
Background: Daily air quality index (AQI) forecast can provide early warning information, and it is not clear whether it is appropriate for childhood asthma hospitalizations (CAHs). Furthermore, little is known about the effects of AQI on CAHs, as well as the interactions between temperature, humidity and AQI.
Methods: We collected 32,238 cases in Hefei from 2013 to 2016 and estimated the association between daily CAHs and AQI by combining the Poisson Generalized Linear Models (PGLMs) with the Distributed Lag Nonlinear Models (DLNMs). The interaction between AQI and temperature was tested by stratifying AQI and temperature, as well as humidity.
Results: AQI was associated with an increased risk of hospitalizations for childhood asthma. The adverse effect first appeared on the 3rd day, with the RR of 1.011 (95%CI: 1.000-1.023) and continued until the 19th day of lag (RR = 1.010, 95%CI: 1.001-1.020). In the subgroup analysis, the male and pre-school children were more sensitive to AQI, and there are seasonal differences in the effects of AQI on CAHs. Besides, in a stratified analysis with an AQI of 150, we found synergies between temperature, humidity and AQI. The interaction relative risk (IRR) and relative excess risk due to interaction (RERI) for the interaction between temperature and AQI were 1.157 (95%CI: 1.029-1.306) and 0.122 (95%CI: 0.022-0.223) respectively. For the humidity, the IRR and RERI were 1.090 (95%CI: 1.056-1.206) and 0.083 (95%CI: 0.083-0.143) respectively. Exploring different subgroups in the interaction analyses, it was worth noting that female and pre-school children were more sensitive to the interaction between AQI and temperature, while school-age children were more sensitive to the interaction between AQI and humidity.
Conclusions: The study found that not only AQI can significantly increase the risk of CAHs, but also that under the context of climate change, temperature and humidity have a synergistic effect on AQI, suggesting that considering only the warning information of air pollution is not enough to strengthen the prevention of childhood asthma hospitalization.
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