| Gaseous pollutants have become an urgent problem in our society,nitrogen dioxide,sulfur dioxide,carbon monoxide,ozone are important parts of it.It is of great significance for the treatment of gaseous pollutants and the prevention of diseases to clarify whether there is a correlation between gaseous pollutants and cardiovascular and cerebrovascular diseases,and whether the concentration of gaseous pollutants has different effects on different populations.ObjectivesBy analyzing the influence of gaseous pollutants SO2,NO2,CO and O3 on the number of hospitalized patients with acute cardiovascular and cerebrovascular diseases in Tianjin,this study explored the harm of gaseous pollutants to cardiovascular and cerebrovascular diseases in Tianjin.Methods1.Experimental data:data of patients with cardiovascular and cerebrovascular diseases admitted to general hospital of Tianjin medical university from 2013 to 2016 were collected(including patient name,gender,age,home address,unit address,discharge diagnosis,etc.).Collect the meteorological data of Tianjin area in the same time period on China meteorological data network(http://data.cma.cn/),including daily average temperature,relative humidity,etc.Collect data related to air pollutants in the same period,including concentration monitoring values of NO2,SO2,CO,O3,PM2.5 and PM10(data from Tianjin environmental monitoring center).2.Data processing and analysis:(1)Qualified patients were screened according to the diagnosis at the time of discharge.The number of daily admissions for cerebral infarction and acute coronary syndrome during the study period was counted and divided into different groups according to gender and age.To describe and analyze the change trend of the number of patients admitted for cerebral infarction and acute coronary syndrome;(2)Calculate the 24-hour average concentration of NO2,SO2,CO,PM2.5,PM10 and the daily maximum 8h average of O3 respectively,and calculate the annual average concentration of the corresponding pollutants,To describe the change of concentration of each pollutant during the study period;(3)The Poisson distribution of the generalized additive model was used to analyze the correlation between the number of hospital admissions and the pollutants studied,and to adjust the effect of holidays,day of the week,time trend,daily average temperature,related humidity and other conditions to reduce the influence of interference factors on the results.The outliers and missing values in the data are processed by substitution method and interpolation method.P<0.05 was considered statistically significant.Results1.The number of patients admitted to the general hospital of Tianjin medical university for cardiovascular and cerebrovascular diseases increased year by year from 2013 to 2016.The total number of patients admitted for cerebral infarction and acute coronary syndrome during the study period was 15,355,including 9081 patients with cerebral infarction and 6,274 patients with acute coronary syndrome.For cerebral infarction and acute coronary syndrome,there are more male patients than female patients and fewer people aged 18-64 than those over 65 years old.2.From 2013 to 2016,the concentrations of CO,SO2,PM2.5 and PM10 in the air pollution in Tianjin gradually decreased,while the concentration of NO2 did not change significantly,and the concentration of O3 increased.During the study period,the average concentration of NO2 was 49.56(±22.83)μg/m3,and the average concentration of SO2 was 39.42(±40.12)μg/m3.The average CO concentration was 1.57(±0.84)mg/m3,the average O3 concentration was 80.37(±49.37)μg/m3,the average PM10 concentration was 125.81(±74.23)μg/m3,and the average PM2.5 concentration was 79.58(±54.74)μg/m3.The annual average concentration of NO2 in these four years exceeded the requirements of Chinese Ambient Air Quality Standard(CAAQS)level 2 standard(40μg/m3).During the study period,the annual average of SO2 always met Chinese Ambient Air Quality Standard level 2 standard(60μg/m3).The concentrations of CO and O3 basically met the corresponding standards of level 2 requirements during the study.The annual average concentration of PM10 was 150.04μg/m3-102.01μg/m3,which was significantly higher than the annual average of 70μg/m3 of the Chinese Ambient Air Quality Standard level 2 standard.The annual concentration range of PM2.5 is 95.66μg/m3-69.05μg/m3,which is significantly higher than the annual average concentration requirement of 35μg/m3.3.Single-pollutant models of the influence of gaseous pollutants on the number of hospital admissions for cerebral infarction:(1)Single-day lag models,RR values of lag3 and lag7 were 0.985(0.973-0.997)and 0.987(0.974-0.999),respectively,with P<0.05.When NO2 concentration increased by 10μg/m3,the number of hospitalized patients with cerebral infarction after 3 days delay decreased by 1.5%,and the number of hospitalized patients with cerebral infarction after 7 days delay decreased by 1.3%.When SO2 concentration increased,the RR value of lag7 was 0.987(0.977-0.998),P<0.05.The concentration of SO2 increased by 10μg/m3,and the number of hospitalized patients with cerebral infarction decreased by 1.3%at lag7.There was no significant correlation between increased CO and O3 concentrations and the risk of cerebral infarction.(2)Multi-day lag models showed that NO2,SO2,CO and O3 had no effect on the number of hospitalized patients with cerebral infarction.4.Multi-pollutant models analysis of the influence of gaseous pollutants on cerebral infarction:after adjusting PM2.5 concentration in the SO2 model,SO2 still reduced the risk of cerebral infarction admission,with RR value of 0.987(0.975-0.999),P<0.05.The effect of NO2 on cerebral infarction disappeared after the introduction of other pollutants.The introduction of other pollutants in CO and O3 still has no obvious effect on cerebral infarction.5.Single-pollutant models of the influence of gaseous pollutants on the number of hospital admissions for acute coronary syndrome:(1)Single-day models,RR value at lag0 was 1.015(1.006-1.023)and RR value at lagl was 1.011(1.002-1.019),P<0.05.An increase in O3 concentration of 10μg/m3 was associated with an increase in the number of patients admitted to hospital with acute coronary syndrome by 1.5%on the day of delay and 1.1%on the lagl.Increased concentrations of NO2,SO2 and CO had no effect on the number of hospital admissions for acute coronary syndrome.(2)Multi-day lag models,the RR values from lag01-lag06 in the O3 model of moving average lag are all greater than 1,and are statistically significant.There was a positive correlation between O3 and the number of hospital admissions for acute coronary syndrome,and there was a lag accumulative effect.6.Multi-pollutant models analysis of the influence of gaseous pollutants on acute coronary syndrome:the introduction of O3 in NO2 caused an increase in patients with acute coronary syndrome,with RR of 1.017(1.003-1.032),and the introduction of O3 in CO also increased the number of hospital admissions for acute coronary syndrome,with RR of 1.582(1.079-2.319),P<0.05.After adjusting the concentration of other pollutants in O3,RR ranged from 0.992(1.009-0.914)to 1.000(0.992-1.008),which were not statistically significant.O3 had no effect on the number of hospital admissions with acute coronary syndrome.The introduction of other contaminants in SO2 had no effect on the number of hospital admissions for acute coronary syndrome.7.Age stratified analysis(lagl):(1)The influence of gaseous pollutants on the number of people admitted to the hospital with cerebral infarction.The influence of CO and O3 on people aged over 65 is more obvious than that of people aged 18-64,and the influence of NO2 and SO2 on people aged 18-64 is more obvious than that of people aged over 65,but there is no statistical significance.(2)the influence of gaseous pollutants on the number of hospitalized patients with acute coronary syndrome,CO,NO2 and SO2 had a significant influence on the population aged over 65 years compared with the population aged 18-64 years,while O3 had a significant influence on the population aged 18-64 years compared with the population aged over 65 years,but there was no statistical significance.8.Gender stratified analysis(lag5):(1)the analysis of gaseous pollutants on the number of people admitted to the hospital for cerebral infarction shows that CO,O3,NO2 and SO2 have more obvious influences on male population than female population,but have no statistical significance.(2)the analysis of gaseous pollutants on the number of hospital admissions for acute coronary syndrome showed that NO2 and SO2 had a significant impact on the male population,while CO and O3 had a significant impact on the female population.Conclusion1.From 2013 to 2016,the number of patients admitted to the general hospital of Tianjin medical university with cerebral infarction and Acute coronary syndrome increased year by year,with the peaks of 6.708 and 5.325 per day,respectively.There were more males than females,and more people older then 65 years old than those between 18 and 64 years old.2.From 2013 to 2016,the concentrations of PM2.5,PM10 and NO2 in the air in Tianjin failed to reach the national limits for second-level ambient air pollutants.The concentrations of PM2.5,PM10,CO and SO2 are decreasing year by year.NO2 concentration did not change significantly,and O3 concentration showed an upward trend.3.Short-term exposure to air pollutants NO2 and SO2 reduces the number of people admitted to hospital for cerebral infarction,while exposure to CO and O3 has no significant effect on the number of people admitted to hospital for cerebral infarction.After the introduction of PM2.5,the influence of NO2 on the number of people admitted to hospital for cerebral infarction disappeared,while the effect of SO2 on reducing the number of people admitted to hospital for cerebral infarction still existed.4.Short-term exposure to air pollutant O3 increases the number of hospital admissions for ACS,and O3 has a lagged cumulative effect on the adverse effects of ACS.Exposure to SO2,NO2 and CO had no significant effect on the number of hospital admissions for ACS,but NO2 and CO could increase the number of hospital admissions for ACS when O3 was introduced.5.The effects of air pollutants NO2,SO2,CO and O3 on cerebral infarction and Acute coronary syndrome were not affected by gender and age. |
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