{"title":"环境颗粒物与心血管疾病入院人数、住院时间和住院费用的关系：基于2016年至2019年上海医保系统数据的时间序列分析","authors":"Wenyong Zhou, Zexuan Wen, Wenjia Peng, Xinyu Wang, Minyi Yang, Weibing Wang, Jing Wei, Haiyan Xiong","doi":"10.1186/s12302-023-00754-z","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>There is limited evidence supporting a relationship of ambient particulate matter (PM), especially PM<sub>1</sub>, with hospital admissions, hospital costs, and length of hospital stay (LOS) due to cardiovascular disease (CVD). We used a generalized additive model (GAM) to estimate the associations of these indicators due to CVD for each 10 μg/m<sup>3</sup> increase in the level of PM<sub>1</sub>, PM<sub>2.5</sub>, and PM<sub>10</sub>, and the attributable risk caused by PM on CVD was determined using the WHO air quality guidelines from 2005 and 2021.</p><h3>Results</h3><p>For each 10 μg/m<sup>3</sup> increase in the level of each PM and for a 0-day lag time, there were significant increases in daily hospital admissions for CVD (PM<sub>1</sub>: 1.006% [95% CI 0.859, 1.153]; PM<sub>2.5</sub>: 0.454% [95% CI 0.377, 0.530]; PM<sub>10</sub>: 0.263% [95% CI 0.206, 0.320]) and greater daily hospital costs for CVD (PM<sub>1</sub>: 523.135 thousand CNY [95% CI 253.111, 793.158]; PM<sub>2.5</sub>: 247.051 thousand CNY [95% CI 106.766, 387.336]; PM<sub>10</sub>: 141.284 thousand CNY [95% CI 36.195, 246.373]). There were no significant associations between PM and daily LOS. Stratified analyses demonstrated stronger effects in young people and males for daily hospital admissions, and stronger effects in the elderly and males for daily hospital costs. Daily hospital admissions increased linearly with PM concentration up to about 30 µg/m<sup>3</sup> (PM<sub>1</sub>), 60 µg/m<sup>3</sup> (PM<sub>2.5</sub>), and 90 µg/m<sup>3</sup> (PM<sub>10</sub>), with slower increases at higher concentrations. Daily hospital costs had an approximately linear increase with PM concentration at all tested concentrations. In general, hospital admissions, hospital costs, and LOS due to CVD were greater for PM<sub>2.5</sub> than PM<sub>10</sub>, and the more stringent 2021 WHO guidelines indicated greater admissions, costs, and LOS due to CVD.</p><h3>Conclusions</h3><p>Short-term elevation of PM of different sizes was associated with an increased risk of hospital admissions and hospital costs due to CVD. The relationship with hospital admissions was strongest for men and young individuals, and the relationship with hospital costs was strongest for men and the elderly. Smaller PM is associated with greater risk.</p></div>","PeriodicalId":54293,"journal":{"name":"Environmental Sciences Europe","volume":null,"pages":null},"PeriodicalIF":5.9000,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://enveurope.springeropen.com/counter/pdf/10.1186/s12302-023-00754-z","citationCount":"0","resultStr":"{\"title\":\"Association of ambient particulate matter with hospital admissions, length of hospital stay, and hospital costs due to cardiovascular disease: time-series analysis based on data from the Shanghai Medical Insurance System from 2016 to 2019\",\"authors\":\"Wenyong Zhou, Zexuan Wen, Wenjia Peng, Xinyu Wang, Minyi Yang, Weibing Wang, Jing Wei, Haiyan Xiong\",\"doi\":\"10.1186/s12302-023-00754-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>There is limited evidence supporting a relationship of ambient particulate matter (PM), especially PM<sub>1</sub>, with hospital admissions, hospital costs, and length of hospital stay (LOS) due to cardiovascular disease (CVD). We used a generalized additive model (GAM) to estimate the associations of these indicators due to CVD for each 10 μg/m<sup>3</sup> increase in the level of PM<sub>1</sub>, PM<sub>2.5</sub>, and PM<sub>10</sub>, and the attributable risk caused by PM on CVD was determined using the WHO air quality guidelines from 2005 and 2021.</p><h3>Results</h3><p>For each 10 μg/m<sup>3</sup> increase in the level of each PM and for a 0-day lag time, there were significant increases in daily hospital admissions for CVD (PM<sub>1</sub>: 1.006% [95% CI 0.859, 1.153]; PM<sub>2.5</sub>: 0.454% [95% CI 0.377, 0.530]; PM<sub>10</sub>: 0.263% [95% CI 0.206, 0.320]) and greater daily hospital costs for CVD (PM<sub>1</sub>: 523.135 thousand CNY [95% CI 253.111, 793.158]; PM<sub>2.5</sub>: 247.051 thousand CNY [95% CI 106.766, 387.336]; PM<sub>10</sub>: 141.284 thousand CNY [95% CI 36.195, 246.373]). There were no significant associations between PM and daily LOS. Stratified analyses demonstrated stronger effects in young people and males for daily hospital admissions, and stronger effects in the elderly and males for daily hospital costs. Daily hospital admissions increased linearly with PM concentration up to about 30 µg/m<sup>3</sup> (PM<sub>1</sub>), 60 µg/m<sup>3</sup> (PM<sub>2.5</sub>), and 90 µg/m<sup>3</sup> (PM<sub>10</sub>), with slower increases at higher concentrations. Daily hospital costs had an approximately linear increase with PM concentration at all tested concentrations. In general, hospital admissions, hospital costs, and LOS due to CVD were greater for PM<sub>2.5</sub> than PM<sub>10</sub>, and the more stringent 2021 WHO guidelines indicated greater admissions, costs, and LOS due to CVD.</p><h3>Conclusions</h3><p>Short-term elevation of PM of different sizes was associated with an increased risk of hospital admissions and hospital costs due to CVD. The relationship with hospital admissions was strongest for men and young individuals, and the relationship with hospital costs was strongest for men and the elderly. Smaller PM is associated with greater risk.</p></div>\",\"PeriodicalId\":54293,\"journal\":{\"name\":\"Environmental Sciences Europe\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":5.9000,\"publicationDate\":\"2023-06-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://enveurope.springeropen.com/counter/pdf/10.1186/s12302-023-00754-z\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Environmental Sciences Europe\",\"FirstCategoryId\":\"93\",\"ListUrlMain\":\"https://link.springer.com/article/10.1186/s12302-023-00754-z\",\"RegionNum\":3,\"RegionCategory\":\"环境科学与生态学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"Environmental Science\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Environmental Sciences Europe","FirstCategoryId":"93","ListUrlMain":"https://link.springer.com/article/10.1186/s12302-023-00754-z","RegionNum":3,"RegionCategory":"环境科学与生态学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"Environmental Science","Score":null,"Total":0}
引用次数: 0
摘要
背景目前支持环境颗粒物（PM），尤其是 PM1 与心血管疾病（CVD）导致的入院人数、住院费用和住院时间（LOS）之间关系的证据有限。我们使用广义相加模型（GAM）估算了PM1、PM2.5和PM10水平每增加10微克/立方米时，这些指标与心血管疾病的相关性，并使用2005年和2021年世界卫生组织空气质量指南确定了PM对心血管疾病造成的可归因风险。006%[95%CI 0.859, 1.153]；PM2.5：0.454%[95%CI 0.377, 0.530]；PM10：0.263%[95%CI 0.206, 0.320])，每天因心血管疾病住院的费用增加（PM1：523.13.5万元人民币[95% CI 253.111，793.158]；PM2.5：247.051万元人民币[95% CI 106.766，387.336]；PM10：141.284万元人民币[95% CI 36.195，246.373]）。可吸入颗粒物与每日LOS之间无明显关联。分层分析表明，年轻人和男性对每日入院人数的影响更大，而老年人和男性对每日住院费用的影响更大。每日入院人数与 PM 浓度呈线性增长，最高可达约 30 µg/m3（PM1）、60 µg/m3（PM2.5）和 90 µg/m3（PM10），浓度越高，增长越慢。在所有测试浓度下，每日住院费用与 PM 浓度呈近似线性增长。一般来说，PM2.5 比 PM10 导致的心血管疾病入院率、住院费用和住院时间更长，而更严格的 2021 年世界卫生组织指南表明，心血管疾病导致的入院率、住院费用和住院时间更长。男性和年轻人与入院风险的关系最为密切，而男性和老年人与住院费用的关系最为密切。PM 越小，风险越大。
Association of ambient particulate matter with hospital admissions, length of hospital stay, and hospital costs due to cardiovascular disease: time-series analysis based on data from the Shanghai Medical Insurance System from 2016 to 2019
Background
There is limited evidence supporting a relationship of ambient particulate matter (PM), especially PM1, with hospital admissions, hospital costs, and length of hospital stay (LOS) due to cardiovascular disease (CVD). We used a generalized additive model (GAM) to estimate the associations of these indicators due to CVD for each 10 μg/m3 increase in the level of PM1, PM2.5, and PM10, and the attributable risk caused by PM on CVD was determined using the WHO air quality guidelines from 2005 and 2021.
Results
For each 10 μg/m3 increase in the level of each PM and for a 0-day lag time, there were significant increases in daily hospital admissions for CVD (PM1: 1.006% [95% CI 0.859, 1.153]; PM2.5: 0.454% [95% CI 0.377, 0.530]; PM10: 0.263% [95% CI 0.206, 0.320]) and greater daily hospital costs for CVD (PM1: 523.135 thousand CNY [95% CI 253.111, 793.158]; PM2.5: 247.051 thousand CNY [95% CI 106.766, 387.336]; PM10: 141.284 thousand CNY [95% CI 36.195, 246.373]). There were no significant associations between PM and daily LOS. Stratified analyses demonstrated stronger effects in young people and males for daily hospital admissions, and stronger effects in the elderly and males for daily hospital costs. Daily hospital admissions increased linearly with PM concentration up to about 30 µg/m3 (PM1), 60 µg/m3 (PM2.5), and 90 µg/m3 (PM10), with slower increases at higher concentrations. Daily hospital costs had an approximately linear increase with PM concentration at all tested concentrations. In general, hospital admissions, hospital costs, and LOS due to CVD were greater for PM2.5 than PM10, and the more stringent 2021 WHO guidelines indicated greater admissions, costs, and LOS due to CVD.
Conclusions
Short-term elevation of PM of different sizes was associated with an increased risk of hospital admissions and hospital costs due to CVD. The relationship with hospital admissions was strongest for men and young individuals, and the relationship with hospital costs was strongest for men and the elderly. Smaller PM is associated with greater risk.
期刊介绍：
ESEU is an international journal, focusing primarily on Europe, with a broad scope covering all aspects of environmental sciences, including the main topic regulation.
ESEU will discuss the entanglement between environmental sciences and regulation because, in recent years, there have been misunderstandings and even disagreement between stakeholders in these two areas. ESEU will help to improve the comprehension of issues between environmental sciences and regulation.
ESEU will be an outlet from the German-speaking (DACH) countries to Europe and an inlet from Europe to the DACH countries regarding environmental sciences and regulation.
Moreover, ESEU will facilitate the exchange of ideas and interaction between Europe and the DACH countries regarding environmental regulatory issues.
Although Europe is at the center of ESEU, the journal will not exclude the rest of the world, because regulatory issues pertaining to environmental sciences can be fully seen only from a global perspective.
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