Objective: To explore the acute effect of fine particulate matters (PM(2.5)), O(3), NO(2) on daily non-accidental mortality, cardiovascular disease mortality and respiratory mortality data in thirteen cities of Jiangsu province. Methods: Daily average concentrations of non-accidental mortality, cardiovascular disease mortality, respiratory mortality data and environmental data were collected from January 1, 2015 to December 31, 2017 in thirteen cities of Jiangsu Province. Daily air quality, mortality and meteorology data were collected from the Information System of Air Pollution and Health Impact Monitoring of Chinese Center for Disease Control and Prevention. We used generalized additive model to evaluate the association between daily concentrations of air pollutants and mortality at single-city level and multi-city level, after adjusting the long-term and seasonal trend, as well as meteorological factors and the effect of "days and weeks" . A multivariate Meta-analysis with random effects was applied to estimate dose-response relationship between air pollutants and mortality. Results: At multi-city level, per interquartile range increase of PM(2.5), O(3), NO(2) was associated with an increase of 1.10% (95%CI: 0.66%, 1.54%), 0.59% (95%CI: 0.18%, 1.00%), 2.00% (95%CI: 1.29%, 2.72%) of daily non-accidental mortality respectively; 1.01% (95%CI: 0.63%, 1.38%), 0.66% (95%CI: 0.02%, 1.30%), 1.62% (95%CI: 1.00%, 2.23%) of daily cardiovascular mortality respectively; 1.09% (95%CI: 0.35%, 1.82%), 0.44% (95%CI: -0.29%, 1.16%), 2.75% (95%CI: 1.42%, 4.08%) of daily respiratory mortality respectively. The air pollutants effect varied across different cities. The strongest effect of PM(2.5) was current day (excess risk (ER)=1.10%, 95%CI: 0.66%, 1.54%)), the strongest effect of O(3) was 2-day lag (ER=1.82%, 95%CI: 0.69%, 2.97%) and the strongest effect of NO(2) was 1-day lag (ER=2.09%, 95%CI: 1.34%, 2.83%) of daily non-accidental mortality respectively. Conclusion: The increases of PM(2.5) and NO(2) concentration could result in the increases of daily non-accidental mortality, cardiovascular disease mortality and respiratory mortality. O(3) could result in the increases of daily non-accidental mortality and cardiovascular disease mortality. The acute effects for non-accidental mortality from high to low were NO(2), PM(2.5) and O(3,) and the strongest effect of PM(2.5) was current day. O(3) and NO(2) had lagged effects.
目的： 探讨江苏省大气PM(2.5)、O(3)、NO(2)污染对居民每日非意外、心血管疾病、呼吸系统疾病死亡的急性效应。 方法： 收集江苏省13个设区市2015年1月1日至2017年12月31日的PM(2.5)、O(3)、NO(2)日平均浓度，同期每日非意外、心血管疾病、呼吸系统死亡例数，以及气象资料，以上资料均来源于中国疾病预防控制中心空气污染人群健康影响监测信息系统。采用基于自然样条平滑函数的广义相加模型，分析不同城市大气污染物与每日死亡的相关性。采用多元Meta分析随机效应模型合并多个城市污染物与死亡风险的暴露-反应关系。 结果： 在13个设区市平均水平，PM(2.5)、O(3)、NO(2)浓度每升高1个四分位距，引起的居民非意外死亡率超额危险度（ER）分别为1.10%（95%CI：0.66%，1.54%）、0.59%（95%CI：0.18%，1.00%）、2.00%（95%CI：1.29%，2.72%）；心血管疾病死亡率ER值分别为1.01%（95%CI：0.63%，1.38%）、0.66%（95%CI：0.02%，1.30%）、1.62%（95%CI：1.00%，2.23%）；呼吸系统疾病死亡率ER值分别为1.09%（95%CI：0.35%，1.82%）、0.44%（95%CI：-0.29%，1.16%）、2.75%（95%CI：1.42%，4.08%）；对于非意外死亡，PM(2.5)在暴露当天效应最强（ER=1.10%，95%CI：0.66%，1.54%），O(3)在滞后第2天最强（ER=1.82%，95%CI：0.69%，2.97%），NO(2)在滞后第1天效应最强（ER=2.09%，95%CI：1.34%，2.83%）。 结论： PM(2.5)和NO(2)增加了非意外、呼吸系统疾病、心血管疾病死亡风险，O(3)污染增加了心血管疾病和非意外死亡风险；对非意外死亡的急性效应由高到低依次为NO(2)、PM(2.5)、O(3)，PM(2.5)在污染当天效应最强，NO(2)和O(3)有滞后效应。.
Keywords: Air pollutants; Mortality; Multicenter study; Time-series.