近日，美国哈佛公共卫生学院Francesca Dominici及其课题组，对短期接触细颗粒物（PM2.5）与住院风险和医疗保险人群经济成本的关系进行了研究分析。这一研究成果11月27日在线发表于《英国医学杂志》。

研究组对2000-2012年间95277169例美国65岁及以上医疗保险住院患者的索赔资料进行了统计，针对气象变量的非线性混杂效应，采用条件logistic回归进行了时间分层和病例交叉分析。

结果表明短期接触PM2.5与一些疾病的住院风险呈正相关，这些疾病普遍但很少有人研究，例如败血症、水电解质紊乱、急性和不明原因的肾衰竭等。住院风险也与心血管和呼吸系统疾病、帕金森氏病、糖尿病、静脉炎、血栓性静脉炎和血栓栓塞呈正相关，这与此前已发表的研究结果一致。当每日PM2.5浓度低于世界卫生组织（WHO）规定的24小时空气质量指南时，持续接触几天后，该关联性依然存在。

对于这些很少研究的疾病，PM2.5短期接触每增加1 µg/m³，每年住院患者增加2050人次，住院天数增加12216天，住院和急性期后的护理费用增加3100万美元，统计生命价值（即为了避免死亡而衡量的经济费用）增加25亿美元。而对于心血管疾病等先前已知的相关疾病，PM2.5短期接触每增加1 µg/m³，每年住院患者增加3642人次，住院天数增加20098天，住院和急性期后的护理费用增加6900万美元，统计生命价值增加41亿美元。

总之，该研究发现了短期接触PM2.5导致住院的相关新病因，并确定了先前病因。甚至当每日PM2.5浓度低于WHO24小时指南时，这些关联依然存在。短期PM2.5小幅增长会消耗大量的经济成本。

附：英文原文

Title: Short term exposure to fine particulate matter and hospital admission risks and costs in the Medicare population: time stratified, case crossover study

Author: Yaguang Wei, Yan Wang, Qian Di, Christine Choirat, Yun Wang, Petros Koutrakis, Antonella Zanobetti, Francesca Dominici, Joel D Schwartz

Issue&Volume: 2019/11/27

Abstract: 

Objective To assess risks and costs of hospital admission associated with short term exposure to fine particulate matter with diameter less than 2.5 µm (PM2.5) for 214 mutually exclusive disease groups.

Design Time stratified, case crossover analyses with conditional logistic regressions adjusted for non-linear confounding effects of meteorological variables.

Setting Medicare inpatient hospital claims in the United States, 2000-12 (n=95 277 169).

Participants All Medicare fee-for-service beneficiaries aged 65 or older admitted to hospital.

Main outcome measures Risk of hospital admission, number of admissions, days in hospital, inpatient and post-acute care costs, and value of statistical life (that is, the economic value used to measure the cost of avoiding a death) due to the lives lost at discharge for 214 disease groups.

Results Positive associations between short term exposure to PM2.5 and risk of hospital admission were found for several prevalent but rarely studied diseases, such as septicemia, fluid and electrolyte disorders, and acute and unspecified renal failure. Positive associations were also found between risk of hospital admission and cardiovascular and respiratory diseases, Parkinson’s disease, diabetes, phlebitis, thrombophlebitis, and thromboembolism, confirming previously published results. These associations remained consistent when restricted to days with a daily PM2.5 concentration below the WHO air quality guideline for the 24 hour average exposure to PM2.5. For the rarely studied diseases, each 1 µg/m3 increase in short term PM2.5 was associated with an annual increase of 2050 hospital admissions (95% confidence interval 1914 to 2187 admissions), 12 216 days in hospital (11 358 to 13 075), US$31m (£24m, €28m; $29m to $34m) in inpatient and post-acute care costs, and $2.5bn ($2.0bn to $2.9bn) in value of statistical life. For diseases with a previously known association, each 1 µg/m3 increase in short term exposure to PM2.5 was associated with an annual increase of 3642 hospital admissions (3434 to 3851), 20 098 days in hospital (18 950 to 21 247), $69m ($65m to $73m) in inpatient and post-acute care costs, and $4.1bn ($3.5bn to $4.7bn) in value of statistical life.

Conclusions New causes and previously identified causes of hospital admission associated with short term exposure to PM2.5 were found. These associations remained even at a daily PM2.5 concentration below the WHO 24 hour guideline. Substantial economic costs were linked to a small increase in short term PM2.5.

DOI: 10.1136/bmj.l6258

Source: https://www.bmj.com/content/367/bmj.l6258