综合空气污染和非适宜温度相关死亡风险构建空气健康指数
张庆丽 , 陈仁杰 , 印冠锦 , 杜喜浩 , 孟夏 , 邱杨 , 阚海东 , 周脉耕
工程(英文) ›› 2022, Vol. 14 ›› Issue (7) : 156 -162.
综合空气污染和非适宜温度相关死亡风险构建空气健康指数
The Establishment of a New Air Health Index Integrating the Mortality Risks Due to Ambient Air Pollution and Non-Optimum Temperature
综合的空气健康指数有助于强调多种大气危险因素的健康风险,有利于向公众传达不良大气环境的总体风险。本文试图通过整合我国大气污染和非适宜温度相关的每日死亡风险,建立一种新的空气健康指数(Air Health Index, AHI)。本研究从时间序列模型中获得了暴露-反应系数,通过将 2013—2015 年我国 272个城市大气污染物与非适宜温度相关的超额死亡风险求和,构建了新的AHI。估计了基于总死亡率构建的AHI('总AHI')与全死因死亡率的关系,并进一步比较了'总AHI'与'特异性AHI'(基于疾病别死 亡率构建)在预测心肺系统疾病死亡率方面的能力。研究发现,空气污染和非适宜温度与28.23%的每日超额死亡率有关,其中23.47%与非适宜温度有关,其余的与PM2.5(1.12%)、NO2(2.29%)和O3( 2.29%)有关。新的AHI采用了10分制的评分标准,272座城市的平均AHI为6分。AHI与死亡率关系的暴露-反应曲线呈线性,不存在阈值。'总AHI'每增加一个单位,全死因死亡率增加0.84%,心血管疾病、冠心病、中风、呼吸系统疾病和慢性阻塞性肺疾病的死亡率分别增加1.01%、0.98%、1.02%、1.66%和1.71%。使用'总AHI'估计疾病别死亡率风险与使用'特异性AHI'预测的疾病别死亡率风险相似。综上所述,本研究提出的'总AHI'可能是一种有前途的风险交流工具,有利于向公众传达与大气环境有关的健康风险。
A composite Air Health Index (AHI) is helpful for separately emphasizing the health risks of multiple stimuli and communicating the overall risks of an adverse atmospheric environment to the public. We aimed to establish a new AHI by integrating daily mortality risks due to air pollution with those due to non-optimum temperature in China. Based on the exposure-response (E-R) coefficients obtained from time-series models, the new AHI was constructed as the sum of excess mortality risk associated with air pollutants and non-optimum temperature in 272 Chinese cities from 2013 to 2015. We examined the association between the ″total AHI″ (based on total mortality) and total mortality, and further compared the ability of the ″total AHI″ to predict specific cardiopulmonary mortality with that of ″specific AHIs″ (based on specific mortalities). On average, air pollution and non-optimum temperature were associated with 28.23% of daily excess mortality, of which 23.47% was associated with non-optimum temperature while the remainder was associated with fine particulate matter (PM2.5) (1.12%), NO2 (2.29%,), and O3 (2.29%). The new AHI uses a 10-point scale and shows an average across all 272 cities of 6 points. The E-R curve for AHI and mortality is approximately linear, without any thresholds. Each one unit increase in ″total AHI″ is associated with a 0.84% increase in all-cause mortality and 1.01%, 0.98%, 1.02%, 1.66%, and 1.71% increases in cardiovascular disease, coronary heart disease, stroke, respiratory diseases, and chronic obstructive pulmonary disease mortality, respectively. Cause-specific mortality risk estimates using the ″total AHI″ are similar to those predicted by ″specific AHIs.″ In conclusion, the ″total AHI″ proposed herein could be a promising tool for communicating health risks related to exposure to the ambient environment to the public.
大气污染 / 温度 / 空气健康指数 / 死亡 / 时间序列 / 风险交流
Air pollution / Temperature / Air Health Index / Mortality / Time-series / Risk communication
| Variables | Mean | SD | Minimum | P25 | Median | P75 | Maximum |
|---|---|---|---|---|---|---|---|
| Number of daily non-accidental deaths | |||||||
| Total | 16 | 16 | 3 | 7 | 12 | 20 | 165 |
| CVD | 8 | 7 | 1 | 3 | 6 | 10 | 65 |
| CHD | 3 | 3 | 0 | 1 | 2 | 3 | 28 |
| Stroke | 4 | 4 | 0 | 2 | 3 | 5 | 33 |
| Respiratory disease | 2 | 3 | 0 | 1 | 1 | 3 | 34 |
| COPD | 2 | 2 | 0 | 0 | 1 | 2 | 29 |
| Air pollutants | |||||||
| PM2.5 (μg·m‒3) | 56 | 20 | 18 | 41 | 54 | 67 | 127 |
| NO2 (μg·m‒3) | 31 | 11 | 10 | 22 | 30 | 38 | 66 |
| O3 (μg·m‒3) | 77 | 14 | 36 | 68 | 77 | 87 | 113 |
| Weather | |||||||
| Mean temperature (°C) | 15 | 5 | -0.5 | 12 | 16 | 18 | 25 |
| Relative humidity (%) | 68 | 10 | 35 | 61 | 71 | 77 | 91 |
| Diseases | c value | Coefficients for each pollutant and temperature | ||||
|---|---|---|---|---|---|---|
| PM2.5 | NO2 | O3 | Temperature | |||
| Warm period | ||||||
| CVD | 24.30 | 0.000175 | 0.000511 | 0.000206 | 0.0321 | |
| CHD | 21.60 | 0.000138 | 0.000705 | 0.000205 | 0.0295 | |
| Stroke | 25.60 | 0.000258 | 0.000362 | 0.000172 | 0.0336 | |
| Respiratory disease | 38.80 | 0.000264 | 0.000834 | 0.000110 | 0.0416 | |
| COPD | 32.00 | 0.000397 | 0.001110 | 0.000140 | 0.0317 | |
| Total | 18.00 | 0.000171 | 0.000498 | 0.000090 | 0.0239 | |
| Cold period | ||||||
| CVD | 91.10 | 0.000248 | 0.000858 | 0.000240 | 0.0270 | |
| CHD | 100.00 | 0.000277 | 0.000779 | 0.000217 | 0.0275 | |
| Stroke | 82.10 | 0.000178 | 0.000743 | 0.000194 | 0.0256 | |
| Respiratory disease | 53.50 | 0.000368 | 0.000953 | 0.000440 | 0.0185 | |
| COPD | 57.30 | 0.000480 | 0.001170 | 0.000539 | 0.0187 | |
| Total | 66.10 | 0.000212 | 0.000724 | 0.000214 | 0.0214 | |
| Parameters | Mean | SD | Minimum | P25 | Median | P75 | Maximum |
|---|---|---|---|---|---|---|---|
| AHI | 6 | 4 | 0 | 3 | 5 | 8 | 26 |
| ER | |||||||
| Total (%) | 28.23 | 24.81 | 1.03 | 10.48 | 18.57 | 39.87 | 172.80 |
| PM2.5 (%) | 1.12 | 0.79 | 0.09 | 0.56 | 0.90 | 1.43 | 9.01 |
| O3 (%) | 1.35 | 0.75 | 0.08 | 0.79 | 1.19 | 1.77 | 5.36 |
| NO2 (%) | 2.29 | 1.33 | 0.15 | 1.30 | 1.99 | 3.01 | 10.47 |
| Temperature (%) | 23.47 | 24.15 | 0 | 6.25 | 14.46 | 34.41 | 167.59 |
| Diseases | Total AHI (%) | Specific AHI (%) | |||||
|---|---|---|---|---|---|---|---|
| Estimates (95% CI) | R2 | AIC | Estimates (95% CI) | R2 | AIC | ||
| CVD | 1.01 (0.72, 1.30) | 0.1405 | 1.4019 | 0.96 (0.67, 1.25) | 0.1405 | 1.4019 | |
| CHD | 0.98 (0.57, 1.40) | 0.0847 | 1.2665 | 0.86 (0.44, 1.28) | 0.0849 | 1.2661 | |
| Stroke | 1.02 (0.65, 1.39) | 0.0867 | 1.2978 | 0.92 (0.57, 1.28) | 0.0865 | 1.2980 | |
| Respiratory disease | 1.66 (1.18, 2.15) | 0.0960 | 1.2135 | 1.66 (1.19, 2.13) | 0.0959 | 1.2136 | |
| COPD | 1.71 (1.15, 2.27) | 0.0833 | 1.1508 | 1.75 (1.19, 2.31) | 0.0832 | 1.1511 | |
| Total | 0.84 (0.62, 1.07) | 0.1646 | 1.5648 | ||||
| AHI | Colors | Levels | Health implications | Cautionary statements |
|---|---|---|---|---|
| 0‒1 | Green | Good | Air quality and temperature are satisfactory, and air pollution and temperature pose little or no risk | None |
| 2‒3 | Yellow | Moderate | Air quality and temperature are acceptable; however, for some pollutants or temperature, there may be a moderate health concern for a very small number of people who are unusually sensitive to air pollution or temperature | People with severe diseases should limit prolonged outdoor exertion |
| 4‒5 | Orange | Unhealthy for sensitive groups | Members of sensitive groups may experience health effects. The general public is not likely to be affected | Active children and adults, and people with respiratory or CVDs, should limit prolonged outdoor exertion |
| 6‒7 | Red | Unhealthy | Some members of the general public may experience health effects; members of sensitive groups may experience more serious health effects | Common protective measures: Active children and adults, and people with respiratory or CVDs, should avoid prolonged outdoor exertion and stay indoors with the doors and windows closed; everyone else, especially children, should limit prolonged outdoor exertion Specific adaptive measures: If air pollutants are the dominant risk factors, the above sensitive groups may take personalized protective measures (e.g., wearing a mask or respirator, using a home air purifier, and taking fish oil); if temperature is the dominant risk factor, the above sensitive groups may take precautions to maintain suitable temperature conditions (e.g., using an air conditioner and dressing appropriately according to the weather conditions) |
| 8‒9 | Purple | Very unhealthy | Health warnings of emergency conditions. The entire population is likely to be affected | Common protective measures: Active children and adults, and people with respiratory or CVDs, should avoid all outdoor exertion and stay indoors with the doors and windows closed; everyone else, especially children, should limit outdoor exertion Specific adaptive measures: If air pollutants are the dominant risk factors, everyone may take personalized protective measures (e.g., wearing a mask or respirator, using a home air purifier, and taking fish oil); if temperature is the dominant risk factor, everyone may take precautions to maintain suitable temperature conditions (e.g., using an air conditioner and dressing appropriately according to the weather conditions) |
| 10+ | Maroon | Hazardous | Health alert: Everyone may experience more serious health effects | Common protective measures: Everyone should avoid all outdoor exertion and stay indoors with the doors and windows closed Specific adaptive measures: If air pollutants are the dominant risk factors, everyone should take personalized protective measures (e.g., wearing a mask or respirator, using a home air purifier, and taking fish oil); if temperature is the dominant risk factor, everyone should take precautions to maintain suitable temperature conditions (e.g., using an air conditioner and dressing appropriately according to the weather conditions) |
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