本文由小咖机器人翻译整理

期刊来源：BMJ

原文链接：https://doi.org/10.1136/bmj-2023-076322

摘要内容如下：

客观

本研究旨在评估美国本土有健康保险的成年人每日暴露于细可吸入颗粒物（PM2.5）浓度低于新的世界卫生组织空气质量指南限值时，因自然原因住院和急诊就诊、心血管疾病和呼吸系统疾病的超额相对和绝对风险。

设计

病例时间序列研究。

设置

美国国家行政医疗保健索赔数据库。

参与者

2010年1月1日至2016年12月31日期间，5010万商业和医疗保险优势受益人年龄≥18岁。

主要结果指标

根据主要诊断代码，因自然原因、心血管疾病和呼吸系统疾病而入院和急诊的每日计数。

结果

在研究期间，在美国2939个县的5010万名成年参与者中，有1030万人因自然原因住院，2410万人因自然原因急诊。每日PM2.5水平在92.6%的县日（7360725/7949713）低于世卫组织新的指导限值15μg/m3。在每日PM2.5水平低于世卫组织新的空气质量指南限值15μg/m3的日子里，当天和前一天PM2.5增加10μg/m3与因自然原因住院的风险较高相关，超额相对风险为0.91%（95%置信区间0.55%-1.26%）。或1.87（95%置信区间1.14至2.59）每天每百万参保者的额外住院人数。仅在年龄≥65岁的成年人中观察到因自然原因住院的风险增加，而在较年轻的成年人中并不明显。PM2.5水平也与心血管和呼吸系统疾病的住院相对风险显著相关。对于急诊就诊，当天和前一天PM2.5增加10μg/m3与呼吸系统疾病相关，超额相对风险为1.34%（0.73%至1.94%），或每百万入选者每天超额急诊就诊0.93（0.52至1.35）。在自然原因或心血管疾病中未发现这种关联。在中青年人群中，因呼吸系统疾病急诊就诊的风险最大。

结论

在有医疗保险的美国成年人中，暴露于浓度低于新的世卫组织空气质量指南限值的环境PM2.5中，在统计学上与因自然原因、心血管疾病和呼吸系统疾病的较高入院率以及因呼吸系统疾病的急诊就诊率显著相关。这些发现对关于修订空气质量限值、指南和标准的辩论做出了重要贡献。

英文原文如下：

Abstracts

OBJECTIVE  To estimate the excess relative and absolute risks of hospital admissions and emergency department visits for natural causes, cardiovascular disease, and respiratory disease associated with daily exposure to fine particulate matter (PM2.5) at concentrations below the new World Health Organization air quality guideline limit among adults with health insurance in the contiguous US.

DESIGN  Case time series study.

SETTING  US national administrative healthcare claims database.

PARTICIPANTS  50.1 million commercial and Medicare Advantage beneficiaries aged ≥18 years between 1 January 2010 and 31 December 2016.

MAIN OUTCOME MEASURES  Daily counts of hospital admissions and emergency department visits for natural causes, cardiovascular disease, and respiratory disease based on the primary diagnosis code.

RESULTS  During the study period, 10.3 million hospital admissions and 24.1 million emergency department visits occurred for natural causes among 50.1 million adult enrollees across 2939 US counties. The daily PM2.5 levels were below the new WHO guideline limit of 15 μg/m3 for 92.6% of county days (7 360 725 out of 7 949 713). On days when daily PM2.5 levels were below the new WHO air quality guideline limit of 15 μg/m3, an increase of 10 μg/m3 in PM2.5 during the current and previous day was associated with higher risk of hospital admissions for natural causes, with an excess relative risk of 0.91% (95% confidence interval 0.55% to 1.26%), or 1.87 (95% confidence interval 1.14 to 2.59) excess hospital admissions per million enrollees per day. The increased risk of hospital admissions for natural causes was observed exclusively among adults aged ≥65 years and was not evident in younger adults. PM2.5 levels were also statistically significantly associated with relative risk of hospital admissions for cardiovascular and respiratory diseases. For emergency department visits, a 10 μg/m3 increase in PM2.5 during the current and previous day was associated with respiratory disease, with an excess relative risk of 1.34% (0.73% to 1.94%), or 0.93 (0.52 to 1.35) excess emergency department visits per million enrollees per day. This association was not found for natural causes or cardiovascular disease. The higher risk of emergency department visits for respiratory disease was strongest among middle aged and young adults.

CONCLUSIONS  Among US adults with health insurance, exposure to ambient PM2.5 at concentrations below the new WHO air quality guideline limit is statistically significantly associated with higher rates of hospital admissions for natural causes, cardiovascular disease, and respiratory disease, and with emergency department visits for respiratory diseases. These findings constitute an important contribution to the debate about the revision of air quality limits, guidelines, and standards.

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