Objective: To evaluate the association between atmospheric inhalable particulate matter (PM(10)) concentration and cardiovascular diseases burden in Tianjin. Methods: The data on daily mean concentrations of main pollutants (PM(10), nitrogen dioxide(NO(2)) and sulfur dioxide(SO(2))), meteorological factors (temperature and relative humidity) and population death monitoring data in Tianjin, from January 1, 2001 to December 31, 2010, were collected and analyzed in this study. The death counts and years of life lost were simultaneously used as the indicators of disease burden. The generalized additive model was used to assess the associations between PM(10) and daily death counts and years of life lost due to cardiovascular system diseases in Tianjin by adjusting the confounding factors such as long-term trend, seasons, meteorological factors and other factors related to the long-term variability. Results: The daily average concentration of PM(10) was 117.6 μg/m³ in Tianjin during 2001 to 2011. The daily average number of deaths of cardiovascular system diseases, cerebrovascular diseases and ischemic heart diseases in Tianjin were 38.4, 14.8 and 17.2 people respectively, and the daily average years of life lost were 776.8, 306.5 and 326.1 person years respectively. The effects of PM(10) on the daily death counts of the three diseases categories were statistically significant (all P<0.01) in Tianjin and the maximum effect occurs at the moment when PM(1)0 was at moving average concentration of today and lagged 1-day (Lag01). The effects of decreasing order were ischemic heart diseases, cardiovascular system diseases and cerebrovascular diseases, excess risks were 0.53% (95% CI 0.35%-0.71%), 0.40% (95%CI 0.28%-0.53%) and 0.38% (95%CI 0.19%-0.56%). The effects of atmospheric PM(10) on the years of life lost of the three diseases were also statistically significant on the different lag days (all P<0.01) in Tianjin and the maximum effect of PM(10) appeared in Lag01. The effects from the largest to the lowest were 2.86 (95%CI 1.79-3.93) person years for cardiovascular system diseases, 1.59 (95%CI 0.95-2.23) person years for ischemic heart diseases and 1.07 (95%CI 0.43-1.71) person years for cerebrovascular diseases, respectively. In multi-pollutant models, after controlling SO(2), the effect of PM(10) on the daily life loss of above 3 kinds of diseases was higher than that of single pollutant model. In contrast, after controlling SO(2) or SO(2) with NO(2), the effect was lower. After controlling NO(2), the effect of PM(10) on the daily life loss of cerebrovascular disease was no longer statistically significant (P>0.05). Conclusions: Exposure to atmospheric PM(10) can significantly increase the cardiovascular diseases burden in Tianjin, especially for ischemic heart diseases. These results suggested that particular attention should be paid to reduce the exposure to atmospheric inhalable particulate matter for patients with ischemic heart diseases.
目的： 探讨天津市大气可吸入颗粒物（PM(10)）浓度与暴露人群循环系统疾病负担之间的定量关系。 方法： 收集并整理2001年1月1日至2010年12月31日天津市每日大气主要污染物[PM(10)、二氧化氮（NO(2)）、二氧化硫（SO(2)）]的日均浓度、温度、相对湿度和人群死亡监测数据等，以死亡人数和寿命损失年作为疾病负担指标，采用广义相加模型，利用非参数平滑函数控制时间序列资料中的长期趋势、季节、气象因素和其他一些与时间长期变异有关的混杂因素，定量评价天津市大气PM(10)与循环系统疾病每日死亡和每日寿命损失年的暴露反应关系。 结果： 天津市2001年1月1日至2010年12月31日10年期间，大气PM(10)的日均浓度为117.6 μg/m³；天津市人群循环系统疾病、脑血管病和缺血性心脏病每日死亡平均数分别为38.4、14.8和17.2人，其相应的每日寿命损失年平均数分别为776.8、306.5和326.1人年。天津市大气PM(10)浓度的增加对上述3种病因别每日死亡的影响均具有统计学意义（P均<0.01），影响效应的最大值均出现在大气PM(10)滞后0日与滞后1日滑动平均值的浓度（Lag01），其效应值从大到小依次为缺血性心脏病、循环系统疾病和脑血管病，相应的超额危险度（ER）及95%可信区间（CI）分别为0.53%（95%CI 0.35%~0.71%）、0.40%（95%CI 0.28%~0.53%）和0.38%（95%CI 0.19%~0.56%）。天津市大气PM(10)浓度的增加对上述3种病因别每日寿命损失年的影响均具有统计学意义（P均<0.01），影响效应的最大值均出现在Lag01，其效应值从大到小依次为循环系统疾病、缺血性心脏病和脑血管病，相应的寿命年损失分别为2.86（95%CI 1.79~3.93）、1.59（95%CI 0.95~2.23）和1.07（95%CI 0.43~1.71）人年。多污染模型中，控制SO(2)后，大气PM(10)对人群上述3种病因别每日寿命损失年影响的效应值均高于单污染物模型；控制NO(2)或同时控制SO(2)和NO(2)后，大气PM(1)0对上述3种病因别每日寿命损失年影响的效应值均低于单污染物模型，且控制NO(2)后，对人群脑血管病每日寿命损失年影响的效应不再具有统计学意义（P>0.05）。 结论： 天津市大气PM(10)能显著增加暴露人群循环系统疾病负担，且对缺血性心脏病人群影响的效应值更大，提示缺血性心脏病患者更应注意大气污染的防护。.
Keywords: Cardiovascular diseases; Cerebrovascular disorders; Cost of illness; Death; Thoracic particulate matter; Years of life lost.