大氣PM2.5暴露與台灣民眾健康成本效益評估

流行病學研究持續發現地區大氣中PM2.5 濃度與心臟血管疾病及呼吸道疾病發作及死亡率有關。生物機制面相關亦研究指出細懸浮微粒(PM2.5)可深入下呼吸道，且有機會穿透微血管而誘發體內微血管發炎，間接與血管內血栓形成機會增加及提高血壓有關。本研究欲探討台灣地區大氣中每日PM2.5 濃度對心臟血管疾病及呼吸道系統疾病死亡率之影響，並透過BenMAP 估計不同PM2.5 減量情境而減少的死亡人次可獲致之經濟效益。本研究收集五個空氣污染監測站和周邊五公里內鄉鎮作為研究區域，並搭配中央氣象局氣象因子(每日平均氣壓、平均溫度、相對溼度、累積雨量、平均風速)、時間因子(季節、星期、年)、每日24小時平均PM2.5濃度和衛生署死因登記資料庫之心血管疾病死亡登錄( ICD-9: 390~459; ICD-10: I00-I99)及呼吸道疾病(ICD-9: 480-487; ICD10: J00-J99)，利用廣義加乘模式(Generalized additive models,GAMs)來進行資料分析，推算大氣中每上升10μg/m3的PM2.5增加的死亡相對風險(Relative Risks, RRs)。後續並利用整合分析(Meta-Analysis)估算出所有研究地區之整體風險，藉由BenMAP來估計兩個不同情境減少PM2.5相關的心血管疾病和呼吸道系統疾病死亡的健康效益。研究結果發現前一天的PM2.5濃度對心血管死亡及呼吸道系統死亡衝擊最為顯著，在考慮了氣象因子影響下，大氣中每上升10μg/m3PM2.5，將相對增加1.021倍(95% C.I.= 1.013-1.029 )心血管疾病死亡風險，相對增加1.037倍(95% C.I.=1.017-1.056) 呼吸道系統疾病死亡風險。 BenMAP評估結果顯示以2007年PM2.5濃度為基準年，2011年為對照年，共可減少約173人次(95% CIs = 110-240)因為心血管疾病及呼吸道系統疾病死亡，6.1億美元(95% CIs = 3.8-8.5)的損失。而引用假設情境2020年全台PM2.5濃度降至15μg/m3，可減少約1161人次(95% CIs = 742-1604)因為心血管疾病及呼吸道系統疾病的死亡，可減少38億美元(95% CIs = 25-55)的損失。我們從多個地區研究結果顯示PM2.5對每日心血管疾病和呼吸道系統疾病死亡率有顯著影響，減量政策對於減少PM2.5的排放可減少對健康的不良影響，並且可以獲得健康效益。

關鍵字

PM2.5 ；死亡率；心血管疾病；呼吸道系統疾病； BenMAP

並列摘要

Epidemiological studies have observed the relationship between regional atmospheric PM2.5 concentration and morbidity and mortality of cardiovascular and respiratory diseases. Biological mechanism also addressed inhaled fine particulate matter (PM2.5) can penetrate into microvascular system thorough lower respiratory system to induce inflammation which indirectly associated with increasing intravascular thrombosis and high blood pressure. This study aim to examine the effects of daily PM2.5 levels and meteorological factors on the mortality of cardiovascular and respiratory diseases in Taiwan. The health benefit through reducing deaths were also estimate by using BenMAP. We integrated data from five air quality monitoring stations (1998-2008), and mortality data from townships surrounding five kilometers of the station. Meteorological factors from the Central Weather Bureau (daily average pressure, temperature, relative humidity, cumulative rainfall and wind speed) and time factors (season, week, year), daily average PM2.5 concentrations, and the daily deaths due to cardiovascular diseases (ICD-9: 390~459; ICD-10: I00-I99)and respiratory diseases (ICD-9: 480-487; ICD10: J00-J99) from those townships were used for our study. Generalized additive model (GAM) was used to estimate the Relative Risks (RRs) due to increase 10μg/m3 PM2.5 in daily base. Meta-Analysis was used to estimate the overall risk for all study regions. We use BenMAP to estimate the health benefit through reduction in PM2.5 associated cardiovascular and respiratory deaths from two PM2.5 control scenarios. The PM2.5 concentration in one day lag have greater effects on the increasing risk of cardiovascular and respiratory mortality. When taking meteorological factors into account, the greatest relative risk were 1.021(95% C.I.= 1.013-1.029 ) with cardiovascular diseases, RR= 1.037(95% C.I. =1.017-1.056)with respiratory diseases when increasing 10μg/m3 in PM2.5. The results from BenMAP shown that the concentration of PM2.5 in 2007 as the Base year, 2011 for the Control year can be reduced total 173 people(95% CIs=110-240)death from cardiovascular and respiratory diseases which can save $6.1 million(95% CIs=3.8-8.5). When we achieve the annual levels of PM2.5 at 15μg/m3 in 2020, we could reduce total 1161 people(95% CIs=742-1604)deaths from cardiovascular and respiratory diseases which can save $38 million(95% CIs=25-55). Our study demonstrate the significant effects of PM2.5 in daily cardiovascular and respiratory mortality from multiple regions study. Control strategy in redueing PM2.5 emissions urgent in reducing health impacts in terms of gaining health benefits.

並列關鍵字

PM2.5 ； mortality ； cardiovascular diseases ； respiratory diseases ； BenMAP

參考文獻

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大氣PM2.5暴露與台灣民眾健康成本效益評估

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