| Objectives:Air pollution has many adverse effects on health,which is one of the main factors of global disease burden.Cardio-cerebrovascular disease is one of the leading causes of death worldwide.To evaluate the lagged effects and seasonal,age and sex differences in effects of air pollution on cardio-cerebrovascular disease,we analyzed the relationship between air pollution and daily morbidity and mortality of cardio-cerebrovascular disease in Suzhou city,which will provide a scientific basis for further taking corresponding prevention measures.Methods:Daily morbidity and mortality of cardio-cerebrovascular disease,the daily average concentration of atmospheric pollutants(including PM2.5,PM10,SO2,NO2,CO,O3)and the daily average meteorological data(temperature,relative humidity,air pressure and wind speed)from January 1,2016 to December 31,2017 in Suzhou were collected.The general additive Poisson regression model and distributed lag non-linear models were used to analyze the health effects of air pollution on cardio-cerebrovascular disease,with the relative risk(RR)and 95%confidence intervals(95%CI)calculated for an interquartile range(IQR)increase in air pollutants.We divided full year into four season,they were spring(February to April),summer(May to July),autumn(August to October),and winter(November to January of the next year)respectively.Statistical analysis was conducted using R3.5.1 software.All P values were based on a 2-sided test and a significance level of 0.05.Results:1、The total mortality number of cardio-cerebrovascular disease was 30200,the daily median mortality number of cardio-cerebrovascular disease was 40(interquartile range:33-48).Of the total mortality,14589 were male and 15611 were female,and 27823 were older than 65 years old,2377 were younger than 65.The total morbidity number of cardio-cerebrovascular disease was 101019,the daily median morbidity number of cardio-cerebrovascular disease was 138(interquartile range:122-154).Of the total morbidity,152834 were male and 48185 were female,and 74040 were older than 65,26979 were younger than 65.2、There were 731 days during 2016-2017.According to Ambient Air Quality Standard in China(GB 3095—2012),only daily concentration of PM2.5 and PM10 exceeded the level-1 standard,daily concentration of SO2、NO2、CO、O3 reached the level-1 standard.Daily concentration of all pollutants reached the level-2 standard.3、Stratified by season,fine particulate matter(PM2.5)only increased the mortality risk of cardio-cerebrovascular disease in winter,the mortality risk of cardio-cerebrovascular disease in lag 5 day was statistically significance,with the RR valve of 1.029 and 95%CI of 1.004-1.055.Inhalable particles(PM10)increased the mortality risk of cardio-cerebrovascular disease in autumn and winter.The mortality risk with lag 1 day in autumn was highest(RR=1.077,95%CI:1.001-1.159).Sulfur dioxide(SO2)increased the mortality risk of cardio-cerebrovascular disease in all seasons except summer.Nitrogen dioxide(NO2)increased the mortality risk of cardio-cerebrovascular disease in spring and winter.Ozone(O3)increased the mortality risk of cardio-cerebrovascular disease in summer and autumn.No statistical significance of carbonic oxide(CO)was observed in all seasons.4、In single-day lag models,with an interquartile range increase of PM2.5 and PM10 concentration,the highest risk was found in lag 3 day(Lag3,PM2.5:RR=1.017,95%CI:1.001-1.034;PM10:RR=1.020,95%CI:1.004-1.037).In the average-lag model,with an interquartile range increase of PM2.5 and PM10 moving average concentration from lagO to lag5(lag05),the RR values of death of cardio-cerebrovascular disease were 1.055(95%CI:1.019-1.093),1.062(95%CI:1.027-1.098).In single-day lag models,with an interquartile range increase of SO2 and O3 concentration,the highest risk was found in lag 3 day(Lag3,SO2:RR=1.026,95%CI:1.007-1.044;03:RR=1.032,95%CI:1.008-1.057).With an interquartile range increase of NO2concentration5 the highest risk was found in lag 1 day(Lag1,RR=1.037,95%CI:1.017-1.058).In average-lag models,effects of SO2 and O3 were the largest in the past 5 days,that is,the moving average concentrations of SO2 and O3 from lagO to lag5 increased by one quartile interval,and the RR values of death from cardio-cerebrovascular disease were 1.062(95%CI:1.024-1.101)and 1.078(95%CI:1.028-1.132).The risk of death from cardio-cerebrovascular disease was highest for each increase in the quartile interval of the moving average of NO2 concentration from lagO to lag1(Lag01,RR=1.058,95%CI:1.030-1.087).The mortality risk of cardio-cerebrovascular disease was analyzed within 20 days lagged by using distributed lag nonlinear model,PM2.5 was observed to be statistically significant within 5-12 days lag,with the maximum lagged effect reached on the 8th day.PM10 was observed to be statistically significant within 4-11 days lag,and the maximum lagged effect was reached on the 7th day.Statistically significant lagged effects of SO2 were observed within 2-4 days lag,and the maximum effect was reached on the 2th day.NO2 was observed to be statistically significant within 3-11 days lag,in which the maximum effect was reached on the 6th day.No statistical significance of CO and O3 were observed during 20 lag days.5、In multi-pollutant models of PM2.5 and PM10,PM2.5 was statistically significance after adjusting for NO2,CO,O3 except SO2.After adjustment of NO2,CO,O3,with an interquartile range increase of PM2.5 concentration,the mortality risk of cardio-cerebrovascular disease increased,the risk was highest after introducing CO(RR=1.093,95%CI:1.037-1.151).With an interquartile range increase of PM10concentration,the RR value of cardio-cerebrovascular disease was 1.044(95%CI:0.999-1.090)after introducing SO2.After adjusting for NO2,CO,O3,the mortality risk of cardio-cerebrovascular disease increased with an interquartile range increase of PM10 concentration,and the risk was highest after introducing NO2(RR=1.081,95%CI:1.034-1.130).6、The morbidity risk of cardio-cerebrovascular disease was statistically significant in all seasons with an interquartile range increase of NO2 and CO concentration,the highest risk was found on lag 0 day(NO2:RR=1.040;95%CI:1.025-1.055;CO:RR=1.022,95%CI:1.010-1.034).Stratified by season,PM2.5,PM10,SO2,CO increased the morbidity risk of cardio-cerebrovascular disease in spring and winter.Further,in single-day lag models,statistically significant associations between PM2.5,PM10,SO2,CO and the morbidity risk of cardio-cerebrovascular disease were observed on lag 0 day in winter(PM2.5:RR=1.018,95%CI:1.002-1.034;PM10:RR=1.021,95%CI:1.001-1.042;SO2:RR=1.027,95%CI:1.002-1.052;CO:RR=1.027,95%CI:1.007-1.047).In spring,the morbidity risks of cardio-cerebrovascular disease statistically increased with the increase of PM2.5,PM10,SO2,CO on the lag 4 day(PM2.5:RR=1.042,95%CI:1.022-1.063;PM10:RR=1.051,95%CI:1.028-1.074;SO2:RR=1.036,95%CI:1.014-1.059;CO:RR=1.036,95%CI:1.012-1.061).In the average-lag model,the highest morbidity risk of cardio-cerebrovascular disease was observed for the moving average concentration of PM2.5,PM10,SO2 from lag 0 to lag5 days in spring(PM2.5:RR=1.060,95%CI:1.004-1.119;PM10:RR=1.107,95%CI:1.027-1.192;SO2:RR=1.063,1.007-1.123).And the moving average concentration of CO from lagO to lag3 in spring has the greatest risk of cardio-cerebrovascular disease(RR=1.101,95%CI:1.035-1.172).7、Stratified by gender(male/female),the results showed that the mortality risk of the cardio-cerebrovascular disease increased in female population with the increase of air pollution concentration,while it was not observed in male population.With an interquartile range increase of PM2.5,PM10,SO2 and O3 concentration,the morbidity risk of the cardio-cerebrovascular disease hadn’t found statistically significant in both male and female.However,the morbidity risk of the cardio-cerebrovascular disease increased in male and female with increasement of NO2 and CO.8、Stratified by age(people aged≥65 and<65),the results showed that with the increase of air pollutant concentration,the mortality risk of the cardio-cerebrovascular disease increased in people who aged>65,no statistical significance was found in people who aged<65.With an interquartile range increase of PM2.5,PM10,SO2,O3 concentrations,the morbidity risks of the cardio-cerebrovascular disease were not found statistically significant among people aged>65 and<65.The morbidity risk of the cardio-cerebrovascular disease increased in people aged>65 and people aged<65 with increase of NO2 and CO.Conclusions:1、With the increase of air pollutant concentration in Suzhou,the risks of mortality and morbidity of cardio-cerebrovascular disease have been increased,and the lag effects have been observed.2、The seasonal differences have been observed between air pollutants and risk of death and occurrence of cardio-cerebrovascular disease.The risk of death from cardio-cerebrovascular disease in winter was higher than that in other seasons.And the risks of death from cardio-cerebrovascular disease in spring and winter were higher than that in summer and autumn.3、Exposure to air pollution,female and the elderly aged over 65 had higher risks of death from the cardio-cerebrovascular disease.However,people who≥65 and<65 years old had a similar risk to have cardio-cerebrovascular disease. |
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