臺灣極端溫度、空氣污染與緊急救護關聯性分析

The Associations between Extreme Temperatures, Air Pollution and Emergency Ambulance Dispatches in Taiwan

陳奕志(Yi-Jhih Chen)

指導教授 ： 王玉純

中原大學/工學院/環境工程學系/碩士(2019年)

https://doi.org/10.6840/cycu201900687

摘要

極端溫度與空氣污染皆會對人體健康產生影響，過去的研究中常以急診就醫與環境因子進行分析以了解環境變化對健康造成的影響。但比起急診就醫，緊急救護更具嚴重度及急迫性，所以本研究評估2006-2015年全臺灣（不含大臺北地區）緊急救護資料與氣溫、空氣污染物（PM10, PM2.5, and O3）之相關性，以了解極端高低溫以及空氣污染物濃度變化對緊急救護發生的風險。
本研究使用衛生福利部緊急救護中求救原因為呼吸問題、昏迷/意識不清、精神異常及到院前心肺功能停止（非創傷類）（Out-of-hospital Cardiac Arrest, OHCA）之每日求救數作為主要分析變項，環境數據則以中央氣象局地面氣象站天氣監測以及行政院環境保護署空氣品質監測逐時資料為主。使用遞延非線性模式（distributed lag non-linear models, DLNM）進行關聯性分析，分別以日跟小時尺度探討極端氣溫（第1、5、95及99百分位溫度）以及空氣污染物濃度變化下（第99百分位測值比上第25百分位測值）與緊急救護案件發生數之延遲效應、風險變化以及顯著相關區域。最終則以整合分析彙整全臺灣（不含大臺北地區）極端溫度與空氣污染物對緊急救護求救數之相對風險（relative risk, RR）及95%信賴區間（confidence interval, CI）風險結果。
在以日為時間尺度的分析中發現，高溫對緊急救護案件發生的影響為0-3天。呼吸問題（喘/呼吸急促）、昏迷/意識不清以及OHCA與高低溫皆顯著正相關。而精神異常與高溫顯著正相關，在第99百分位溫度（30°C）時發生精神異常的相對風險 （Relative Risk, RR）值為1.47（95% CI：1.36-1.59）。PM2.5以及O3濃度升高皆與呼吸問題（喘/呼吸急促）的發生風險顯著正相關，O3濃度升高也與昏迷/意識不清以及OHCA的發生風險顯著正相關，O3在第99百分位濃度（53 ppb）時昏迷/意識不清發生的RR值為1.07（95% CI：1.02-1.11），同時OHCA發生的RR值為1.08（95% CI：1.01-1.14）。在以小時為時間尺度的分析中發現，高溫與呼吸問題（喘/呼吸急促）、昏迷/意識不清、精神異常以及OHCA的發生風險皆顯著正相關，顯示高溫確實會影響緊急救護案件發生。PM2.5以及O3濃度升高皆與呼吸問題（喘/呼吸急促）、昏迷/意識不清以及精神異常的發生風險顯著正相關，但是PM10與呼吸問題（喘/呼吸急促）、昏迷/意識不清、精神異常以及OHCA的相關性皆不顯著。
本研究中依序分析氣溫、PM10、PM2.5以及O3變化下緊急救護案件風險變化情形，發現小時尺度的氣溫對精神異常發生風險的影響比日尺度的影響更顯著，而PM2.5對呼吸問題（喘/呼吸急促）發生風險的影響又比PM10顯著，建議政府持續監測小時數據，並於極端高低溫或空氣污染濃度升高時進行宣導或預防。

關鍵字

溫度 ； 空氣污染物 ； 緊急救護調度 ； 精神異常 ； 到院前心肺功能停止

並列摘要

Studies have reported risk of emergency room visits were related with ambient extreme temperatures and concentrations of air pollutants. However, emergency ambulance dispatches （EAD）, i.e. ambulance call, are even more severe and urgent than emergency room visits. Therefore, this study aims to evaluate the associations between ambient temperature, air pollution level and risk of cause-specific EAD in Taiwan （excluding Taipei metropolitan） from 2006 to 2015.
Daily EAD numbers for respiratory distress, coma and unconsciousness, mental anomaly, and out-of-hospital cardiac arrest （OHCA） were collected from Ministry of Health and Welfare. Hourly and daily measurements of weather variables were obtained from Taiwan Central Weather Bureau and air pollutants （PM10, PM2.5, and O3） were collected from Taiwan Environmental Protection Administration. Distributed lag non-linear models and meta-analysis were adopted to estimate the daily and hourly relative risk （RR） and 95% confidence interval （CI） for cause-specific EAD in association with extreme temperatures （average temperature at 1st, 5th, 95th, and 99th percentiles measurements） and levels of PM10, PM2.5, and O3 （99th percentile measurements vs. 25th percentile measurement）.
Immediate effects, lag0-3, were observed for EAD associated with daily extreme high temperature. Risks of EADs of respiratory distress, coma and unconsciousness, and OHCA were positively associated with extreme high and low temperatures. But, only extreme high temperature caused significant effect on EAD of mental anomaly with RR of 1.47 （95% CI: 1.36-1.59） at the 30°C （99th percentile measurement） environment. Daily O3 and PM2.5 concentrations were positively associated with EAD of respiratory distress, but only O3 had significant effects on EADs of coma and unconsciousness and OHCA with RRs of 1.07 （95% CI: 1.02-1.11） and 1.08 （95% CI: 1.01-1.14）, respectively, as ambient O3 concentration at 53 ppb （99th percentile measurement）. In the hourly time series analysis, extreme high temperature significantly elevated the studied EADs. Hourly PM2.5 and O3 concentrations were significantly associated with EADs of respiratory distress, coma and unconsciousness, and mental anomaly. This study didn’t observed the effects of PM10 on studied EADs.
This study concluded that the risks of EAD associated with ambient environment were clearly identified in daily and hourly time series analyses, and this is particular true for hourly EAD of mental anomaly in association with hourly temperature. In addition, the concentration of PM2.5, but not PM10, caused significant risk on EAD of respiratory distress. The findings of the present study provide scientific evidence that the elevated EAD were associated with short-term extreme temperatures and poor air quality, thus, the health promotion and risk prevention during extreme temperatures and poor air quality are recommended.

並列關鍵字

temperature ； air pollution ； emergency ambulance dispatched ； mental anomaly ； out-of-hospital cardiac arrest

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