Combined effects of multiple air pollutants on number of outpatient visits for respiratory diseases in Chengdu from 2018 to 2019
Objective To understand the combined effect of multiple air pollutants on the number of outpatients with respiratory diseases in Chengdu from 2018 to 2019.Methods The data of daily outpatient visits for respiratory diseases and upper respiratory tract infections,meteorological factors and air pollutants(O3,PM2.5,SO2,NO2,CO and PM2.5-10)in Sichuan Provincial People's Hospital from 2018 to 2019 were collected.Bayesian Kernel Machine Regression(BKMR)model was used to analyze the combined effect of multiple pollutants on the number of respiratory diseases under single lag(1-2)and cumulative lag(01-04).According to the posterior inclusion probability(PIP)of exposure variables,four major air pollutants(PM2.5,SO2,NO2 and PM2.5-10)(PIP＞0.1)with the most significant impact on the incidence of respiratory diseases in the mixture were selected for further study on the health risk effects of the combined effects of the four major air pollutants.Results When the four air pollutants were combined,NO2 and PM2.5-10 played a dominant role in the health risk effect on respiratory diseases.For lag1,with a 10 μg/m3 increase in NO2 concentration,the risk of upper respiratory tract infection increased from 2.35％(95％CI:0.78％-5.30％)at the 50th percentile to 5.17％(95％CI:2.22％-10.83％)at the 75th percentile.The risk of total respiratory diseases increased from 2.29％(95％CI:0.80％-4.99％)at the 50th percentile to 19.50％(95％CI:9.42％-39.29％)at the 75 th percentile.Non-linear relationships between the four air pollutants and the incidence of diseases.There were significant differences in the interaction effects of the combined effects of the four air pollutants on diseases at different lag times.Specifically,there were interaction effects of NO2-PM2.5 and NO2-SO2 on total respiratory diseases at lag1,lag01 and lag02.Interaction effects of PM2.5-10-SO2 on total respiratory diseases were observed only in lag2.The effects of NO2-SO2 on upper respiratory tract infection showed an interaction effect only on lag01.Conclusion The combined effect of multiple pollutants on the incidence of respiratory diseases in Chengdu is significant.In terms of local area,the health risk of NO2 and PM2.5-10 for respiratory diseases has not been paid enough attention.Further research on the combined effect of multiple pollutants on population health should be strengthened.
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