Study On Relationship Between Fine Particulate Matter And Emergency Department Admission For Circulatory Disease In Shenyang,2017-2018

Objective:In recent years,the harmful effect of atmospheric pollution on population health have attracted more and more attention in worldwide.At the same time,circulatory system diseases have become the leading cause of non-communicable diseases death worldwide.Excluding unhealthy living habits,exposure to environment fine particles may also contribute to circulatory problems was also found in some studies.As the largest city in northeast China,Shenyang has been affected by serious atmospheric pollution problems.Meanwhile,extreme cold weather in winter may also aggravate the effect of atmospheric pollutants on population health.Therefore,the target of this study is to analyze the impact of atmospheric pollution on emergency department admissions to the circulatory system in Shenyang and the exposure-response relationship.Methods:In this study,a total of 26,168 cases of circulatory admissions from the Shenyang Emergency Center between January 1,2017 and December 31,2018 were selected.Patients with hypertension,ischemic heart disease,arrhythmia,heart failure and cerebrovascular events were selected according to these ICD-10 code.After adjusting the long-term trend,weekly effect,vacation and meteorological factors,the quasi-Poisson generalized additive model combined with the distributed lag nonlinear model was constructed.The subgroup analysis was stratified by temperature.Then,in order to analyze the robust of the model,the multiple gaseous pollutants,SO₂,NO₂,CO and O₃ were used to construct the dual-pollutant model.Finally,the exposure-response relationship was analyzed by penalty-spline function.Results:1.The average concentrations of PM_2.5,SO₂,NO₂,CO and O₃ in Shenyang during 2017-2018 were 46.15 g/m3,33.86 g/m3,37.56 g/m3,0.94 mg/m3 and 76.55g/m3,respectively.The average temperature was 9.44�C and the relative humidity was58.63%.The concentration of each pollutant has an obvious seasonal trend.Except For O3,other pollutants presented the characteristic that the concentration in cold season is higher than that in ware season.2.After adjusting for long-term trend and other confounding factors,PM_2.5 was positively correlated with daily circulatory system disease emergency department admissions.For every 10?g/m³ increase of PM_2.5concentration,the RR is 1.007(95%CI:1.001-1.013)in lag0,1.007(95%CI:1.000-1.013)in lag1 and 1.011(95%CI:1.002-1.021)in lag03.For different cause-specific circulatory system diseases,Acute,lag,and cumulative effects were found in hypertension and arrhythmia.A lag effect was found in ischemic heart disease;a cumulative effect was found in cerebrovascular events.In addition,harvest effects were observed in total circulatory disease and heart failure.3.Compared with the warm season,the RR value in the cold season is relatively higher,but there was no interaction between temperature and PM_2.5.4.There is an exposure-response relationship between PM_2.5 and total circulatory system diseases,arrhythmias,hypertension and cerebrovascular events,and there is no threshold effect.There was no exposure-response relationship between ischemic cardiomyopathy and heart failure.Conclusion:1.Environmental PM_2.5 exposure in Shenyang is associated with an increased risk of emergency department admission for total circulatory system diseases and other cause-specific circulatory system diseases.2.PM_2.5 has acute effect,lag effect and cumulative effect on emergency department admission for circulatory diseases.3.There is no interactive effect between temperature and PM_2.5 concentration on circulatory diseases.4.PM_2.5 has no threshold exposure-response relationship with circulatory diseases.