背景:细颗粒物(PM2.5)和粗颗粒物(PM2.5-10)与病毒性肺炎和细菌性肺炎的每日死亡率之间的联系尚不清楚。
目的:区分PM2.5和PM2.5-10与病毒性肺炎和细菌性肺炎引起的每日死亡率之间的联系。
方法:使用涵盖中国大陆所有地区的全面国家死亡登记处,我们从2013年至2019年在个人层面进行了病例交叉调查.使用空间分辨率为1公里的基于卫星的模型评估了住宅的每日颗粒浓度。为了分析数据,我们将条件逻辑回归模型与多项式分布滞后模型结合使用。
结果:我们纳入了中国221,507例肺炎死亡病例。PM2.5浓度的每个四分位数间距(IQR)升高(滞后0-2d,37.6μg/m3)与病毒性肺炎(3.03%)的死亡率高于细菌性肺炎(2.14%),而差异不显着(差异的p值=0.38)。PM2.5-10浓度的IQR增加(滞后0-2d,28.4μg/m3)也与病毒性肺炎(3.06%)的死亡率高于细菌性肺炎(2.31%),而差异不显着(差异的p值=0.52)。控制气态污染物后,它们的效果都是稳定的;然而,相互调整,PM2.5的关联仍然存在,PM2.5-10的指标不再具有统计学意义。在75岁及以上的个人中,协会的规模更大,以及在寒冷的季节。
结论:这项全国性研究提供了令人信服的证据,表明PM2.5和PM2.5-10暴露都可能增加病毒和细菌引起的肺炎死亡率,强调PM2.5的影响更强烈,病毒性肺炎的敏感性更高。
BACKGROUND: The connections between fine particulate matter (PM2.5) and coarse particulate matter (PM2.5-10) and daily mortality of viral pneumonia and bacterial pneumonia were unclear.
OBJECTIVE: To distinguish the connections between PM2.5 and PM2.5-10 and daily mortality due to viral pneumonia and bacterial pneumonia.
METHODS: Using a comprehensive national death registry encompassing all areas of mainland China, we conducted a
case-crossover investigation from 2013 to 2019 at an individual level. Residential daily particle concentrations were evaluated using satellite-based models with a spatial resolution of 1 km. To analyze the data, we employed the conditional logistic regression model in conjunction with polynomial distributed lag models.
RESULTS: We included 221,507 pneumonia deaths in China. Every interquartile range (IQR) elevation in concentrations of PM2.5 (lag 0-2 d, 37.6 μg/m3) was associated with higher magnitude of mortality for viral pneumonia (3.03%) than bacterial pneumonia (2.14%), whereas the difference was not significant (p-value for difference = 0.38). An IQR increase in concentrations of PM2.5-10 (lag 0-2 d, 28.4 μg/m3) was also linked to higher magnitude of mortality from viral pneumonia (3.06%) compared to bacterial pneumonia (2.31%), whereas the difference was not significant (p-value for difference = 0.52). After controlling for gaseous pollutants, their effects were all stable; however, with mutual adjustment, the associations of PM2.5 remained, and those of PM2.5-10 were no longer statistically significant. Greater magnitude of associations was noted in individuals aged 75 years and above, as well as during the cold season.
CONCLUSIONS: This nationwide study presents compelling evidence that both PM2.5 and PM2.5-10 exposures could increase pneumonia mortality of viral and bacterial causes, highlighting the more robust effects of PM2.5 and somewhat higher sensitivity of viral pneumonia.