臺灣地區空氣污染與心血管疾病住院關係之研究

Air Pollution and Hospital Admissions for Cardiovascular Diseases in Taiwan

謝亞倫(Ya-Lun Hsieh)

指導教授 ： 楊俊毓

高雄醫學大學/健康科學院/公共衛生學系環境暨職業安全衛生博士班/博士(2015年)

摘要

臺灣是地狹人稠小島，人口密度之高，位居世界第二位。在臺灣，機動車之廢氣排放是除了工業地區排放外，另一個重要空氣污染來源。本研究是採用「病例自我對照」研究法，探討臺北市空氣污染與心肌梗塞及充血性心臟衰竭住院之相關性。
本研究的疾病住院資料來源為全民健保資料檔，以心肌梗塞及充血性心臟衰竭住院病人為研究對象，其「國際疾病分類臨床修訂第九版」（ICD-9-CM）之分類碼為410與428；每日的逐時空氣污染物濃度資料來源為環保署位於臺北市的六個測站資料；所用的溫度與濕度資料來源為中央氣象局之臺北測站資料。以每個月的時間分層方式，將每個疾病住院之指標日，以其他同月份的同一星期別之住院日當作對照組作為比較，再以條件式邏輯斯迴歸分析空氣污染與疾病住院日之關係。
第一部分研究探討1996–2006年間臺北市空氣污染和心肌梗塞住院日關係。在單一污染物模式下（不校正其他污染物），無論是在暖天氣（≥ 23°C），或在冷天氣（<23°C）時，心肌梗塞疾病每日住院人數均與PM10、NO2、CO、O3 有統計上的正相關。進一步探討兩種污染物模式時，O3和NO2 在控制其他四種污染物後，無論在冷天氣，或是暖天氣下均與心肌梗塞每日住院人數之增加具有統計相關。
第二部分研究在探討2006至2010年間臺北市空氣污染和充血性心臟衰竭疾病住院關係。在單一污染物模式下，無論是在暖天氣（≥ 23°C）或在冷天氣（<23°C），細懸浮微粒（PM2.5）與充血性心臟衰竭疾病每日住院人數的增加有統計上的相關性，每增加一個四分位數差的PM2.5濃度（17.46μg/m3）時，分別增加了13%（95% CI＝9-17%）與3%（95% CI＝0-7%）的住院危險性。再進一步探討兩種污染物模式時，PM2.5 在控制了SO2和O3污染物後，無論在暖天氣，或是冷天氣均與心肌梗塞每日住院人數之增加具有統計相關。
本研究提供了暴露於空氣污染物，特別是NO2和O3，與心肌梗塞疾病每日住院人數增加之相關證據。另外，暴露在高濃度PM2.5的環境下，也會增加充血性心臟衰竭疾病住院的風險。

關鍵字

空氣污染 ； 病例自我對照 ； 心肌梗塞 ； 充血性心臟衰竭 ； 細懸浮微粒住院人數

並列摘要

Taiwan is a small island with the second highest population density in the world. In Taiwan, automobile exhaust emission is an important air pollution source other than the industrial emission. This study was undertaken to determine whether there was a correlation between air pollutant levels and hospital admissions for myocardial infarction (MI) and congestive heart failure (CHF) in Taipei, Taiwan, using a case-crossover approach.
The daily counts of hospital admissions for MI and CHF (the international classification of diseases, 9th revision﹝ICD-9﹞, code 410 and 428) were extracted from the National Health Insurance (NHI) medical files. For each day, hourly air pollution data were obtained for the six air quality monitoring stations in Taipei city by the Taiwanese Environmental Protection Administration (EPA). And the daily information on temperature and humidity was provided by the Taipei Observatory of the Central Weather Bureau. A stratification of time into separate months was made to select referent days as the days falling on the same day of the week within the same month as the index day. Air pollution levels during the case period were compared with exposures occurring on all referent days. The associations between hospital admissions and levels of air contaminants were estimated using conditional logistic regression.
The first study evaluated relationship between hospital admissions for myocardial infarction (MI) and ambient air pollution from 1996–2006. In the single-pollutant model (without adjustment for other pollutants), whether on warm days (≥ 23°C) or on cool days (<23°C), MI had significant positive associations with suspended particulates (PM10), nitrogen dioxide (NO2), carbon monoxide (CO) and ozone (O3). In the two-pollutant model, O3 and NO2 were significantly associated with higher admissions for MI after controlling for pollutants in both warm and cool days.
The second study evaluated relationship between hospital admissions for congestive heart failure (CHF) and ambient air pollution during the period 2006–2010. In the single pollutant model, increased of CHF admissions were significantly associated with fine particles (PM2.5) both on warm days and cool days, with an interquartile range (17.46μg/m3) increase associated with a 13%（95% CI＝9-17%）and 3%（95% CI＝0-7%） increase in CHF admissions, respectively. In the two-pollutant model, PM2.5 remained a significant relationship after controlling for sulfur dioxide (SO2) and O3 both on warm and cool days.
This study provides evidences that higher levels of ambient air pollutants (especially NO2 and O3) increase the risk of hospital admissions for MI, in addition, it also provides evidences that higher levels of PM2.5 increase the risk of hospital admissions for CHF.

並列關鍵字

air pollution ； case-crossover ； myocardial infarction ； congestive heart failure ； fine particles ； hospital admissions

參考文獻

Abbey, D. E., Nishino, N., McDonnell, W. F., Burchette, R. J., Knutsen, S. F., Beeson, W. L., and Yang, J. X. 1999. Long-term inhalable particles and other air pollutants related to mortality in nonsmokers. Am J Respir Crit Care Med 159 (2):373-382.

Allred, E. N., Bleecher, E. R., and Chairman, B. R. 1991. Effects of carbon monoxide onmyocardial ischemia. Environ Health Perspect 91:89-132.

Allred, E. N., Bleecker, E. R., Chaitman, B. R., Dahms, T. E., Gottlieb, S. O., Hackney, J. D., Pagano, M., Selvester, R. H., Walden, S. M., and Warren, J. 1989. Short term effects of carbon monoxide exposure on the exercise performance of subjects with coronary artery disease. N Engl J Med 321:1426–1432.

Analitis, A., Katsouyanni, K., Dimakopoulou, K., Samoli, E., Nikoloulopoulos, A. K., Petasakis, Y., Touloumi, G., Schwartz, J., Anderson, H. R., Cambra, K., Forastiere, F., Zmirou, D., Vonk, J. M., Clancy, L., Kriz, B., Bobvos, J., and Pekkanen, J. 2006. Short-term effects of ambient particles on cardiovascular and respiratory mortality. Epidemiology 17:230–233.

Anderson, H. R., Ponce de Leon, A., Bland, J. M., Bower, J. S., and Strachan, D. P. 1996. Air pollution and daily mortality in London: 1987–1992. Br Med J 312:665–669.