| Objectives To quantitatively analyze the short-term impact of air pollutants on outpatient visits for skin diseases in Zhengding County,Shijiazhuang City.To investigate the modification effects of temperature,and relative humidity in the relationship between air pollutants and outpatient visits of skin diseases,in order to provide a scientific basis for disease prevention and control in the area.Methods The data of air pollutants(PM10,PM2.5,SO2,NO2,and O3)concentrations,meteorological factors（daily average temperature,and relative humidity）,and daily outpatient visits of skin diseases in People’s Hospital of Zhengding County from January 1,2014 to December 31,2019 were collected.The potential relationship between the exposure concentration of air pollutants and the risk of skin diseases was explored by drawing the expose-response relationship curve.Generalized additive model was chosen to construct single-pollutant models to quantitatively evaluate the impact of air pollutants on outpatient visits of skin diseases.The double-pollutant models were constructed to test the effect of other co-existing pollutants on the estimated value of its effect.A stratified analysis was performed based on gender,age,and season to identify population susceptibility,and seasonal characteristics of air pollutants’influence on skin diseases.A nonparametric bivariate response surface model was constructed to qualitatively analyze the modification effect of temperature,and relative humidity.Furthermore,a stratified model of temperature,and relative humidity was constructed to quantitatively evaluate the influence of air pollutants on outpatient visits of skin diseases under different levels of temperature,and relative humidity.Results 1 In the descriptive results,the median annual concentrations of PM10,PM2.5,SO2,NO2,and O3 were 150μg/m3,73μg/m3,27μg/m3,51μg/m3,and 97μg/m3 in Zhengding County from 2014 to 2019.Except for O3,the number of days exceeding the standard and the rate exceeding the standard showed a decreasing trend,but the average annual concentration of PM10,PM2.5,and NO2 still exceeded the national second-level standard concentration limit.2 The expose-response relationship between changes in air pollutants concentration and outpatient visits of skin diseases was approximately linear without obvious threshold.3 In single-pollutant models,with the concentration of SO2,NO2（lag0）increased by 10μg/m3,the total outpatient visits for skin diseases increased by0.48%（95%CI:0.05%,0.90%）,and 1.64%（95%CI:1.09%,2.19%）,the outpatient visits for dermatitis and eczema increased by 0.69%（95%CI:0.15%,1.23%）,and 1.63%（95%CI:0.93%,2.33%）.With the concentration of NO2（lag02）increased by 10μg/m3,the outpatient visits for urticaria increased by 2.51%（95%CI:0.40%,4.67%）.4 In double-pollutant models,the effect of SO2 on the total outpatient visits for skin diseases was no longer statistically significant after the introduction of PM2.5,and NO2.After the introduction of other co-existing pollutants,the effect of NO2 on the outpatient visits of various skin diseases was still statistically significant.5 Stratified analysis of gender and age showed that the effect of SO2 on the total outpatient visits for skin diseases,dermatitis and eczema was only statistically significant in females,and 0～14 years old.The effect of NO2 on the total outpatient visits for skin diseases,dermatitis and eczema was statistically significant in males,females,0～14 years old,and 15～64 years old,the effect value was higher in males,and 0～14 years old.The effect of NO2 on the outpatient visits for urticaria was statistically significant only in males,and 0～14 years old.6 Stratified analysis of season showed that the effect of SO2 on outpatient visits for dermatitis and eczema was statistically significant only in warm seasons.The effect of NO2 on the total outpatient visits for skin diseases,dermatitis and eczema was statistically significant in warm season,and cold season,the effect value was higher in warm season.7 The modification effect of temperature showed that with the concentration of SO2 increased by10μg/m3 at high temperature levels,the total outpatient visits for skin disease,dermatitis and eczema increased by 1.33%（95%CI:0.52%,2.15%）,2.02%（95%CI:1.05%,3.01%）.With the concentration of NO2 increased by 10μg/m3 at high,and low temperature levels,the total outpatient visits for skin diseases,dermatitis and eczema increased by 1.84%（95%CI:0.91%,2.77%）,2.33%（95%CI:1.20%,3.48%）,and 1.78%（95%CI:1.16%,2.41%）,1.56%（95%CI:0.76%,2.37%）,the effect value was higher at high temperature level.8The modification effect of relative humidity showed that with the concentration of SO2increased by 10μg/m3 at high,and low relative humidity levels,the total outpatient visits for skin disease,dermatitis and eczema increased by 0.62%（95%CI:0.16%,1.08%）,0.77%（95%CI:0.19%,1.36%）,and 0.64%（95%CI:0.07%,1.20%）,0.93%（95%CI:0.22%,1.64%）,the effect value was higher at low relative humidity level.With the concentration of NO2 increased by 10μg/m3 at high,and low relative humidity levels,the total outpatient visits of skin disease,dermatitis and eczema,urticaria increased by 1.44%（95%CI:0.76%,2.12%）,1.34%（95%CI:0.49%,2.20%）,2.33%（95%CI:0.05%,4.67%）,and 1.68%（95%CI:0.99%,2.38%）,1.71%（95%CI:0.85%,2.58%）,3.50%（95%CI:0.88%,6.19%）,the effect value was higher at low relative humidity level.Conclusions 1 The increase of SO2 and NO2 concentration may increase the risk of skin diseases.2 Females may be more sensitive to SO2,while males may be more sensitive to NO2.People aged 0～14 may be more sensitive to both SO2 and NO2.3 The effect of SO2,and NO2 on outpatient visits for skin diseases was higher in warm season than in cold season.4 Temperature and relative humidity had a certain modification effect on the relationship between air pollutants and outpatient visits for skin diseases,and the harmful effect of SO2 and NO2 for skin diseases was greatly affected by high temperature and low relative humidity.Figure 8;Table 12;Reference 141... |
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