Air pollution and case fatality of SARS in the People's Republic of China: an ecologic study.
Air pollution and case fatality of SARS in the People's Republic of China: an ecologic study.
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DOI：
10.1186/1476-069x-2-15
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发表时间：
2003-11-20
期刊：
影响因子：
--
通讯作者：
Detels, Roger
中科院分区：
文献类型：
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作者：
Cui, Yan;Zhang, Zuo-Feng;Detels, Roger
背景：自2002年11月以来，内地中国报告的严重急性呼吸系统综合症已导致349人死亡，5,327例疑似病例。SARS病例死亡率因地域而异，部分原因可能与空气污染程度有关。方法：数据分析采用可公开获取的SARS发病率和死亡率数据。空气污染指数(API)由颗粒物、二氧化硫、二氧化氮、一氧化碳和地面臭氧浓度得出。采用生态分析方法，通过模型拟合，探讨空气污染与SARS病死率之间的关系和相关性。结果：对5个地区100例以上病例进行了生态分析，病死率随空气污染指数的增加而升高(病死率=-0.063+0.001*API)。基于短期暴露的部分生态研究表明，与低API地区相比，来自中等API地区的SARS患者死于SARS的风险增加84%(RR=1.84，95%CI：1.41~2.40)。同样，来自空气污染指数高的地区的SARS患者死于SARS的可能性是来自低API地区的患者的两倍。(RR=2.18，95%CI：1.31~3.65)。基于长期暴露于环境空气污染的部分生态分析显示出类似的相关性。结论：我们的研究利用可公开获取的SARS统计数据和空气污染指数，证实了空气污染与中国人群SARS病例死亡之间的正相关关系。尽管生态谬误和不受控制的混杂效应可能会使结果产生偏差，但空气污染对SARS患者预后的不利影响的可能性值得进一步研究。
BACKGROUND: Severe acute respiratory syndrome (SARS) has claimed 349 lives with 5,327 probable cases reported in mainland China since November 2002. SARS case fatality has varied across geographical areas, which might be partially explained by air pollution level.METHODS: Publicly accessible data on SARS morbidity and mortality were utilized in the data analysis. Air pollution was evaluated by air pollution index (API) derived from the concentrations of particulate matter, sulfur dioxide, nitrogen dioxide, carbon monoxide and ground-level ozone. Ecologic analysis was conducted to explore the association and correlation between air pollution and SARS case fatality via model fitting. Partially ecologic studies were performed to assess the effects of long-term and short-term exposures on the risk of dying from SARS.RESULTS: Ecologic analysis conducted among 5 regions with 100 or more SARS cases showed that case fatality rate increased with the increment of API (case fatality = - 0.063 + 0.001 * API). Partially ecologic study based on short-term exposure demonstrated that SARS patients from regions with moderate APIs had an 84% increased risk of dying from SARS compared to those from regions with low APIs (RR = 1.84, 95% CI: 1.41-2.40). Similarly, SARS patients from regions with high APIs were twice as likely to die from SARS compared to those from regions with low APIs. (RR = 2.18, 95% CI: 1.31-3.65). Partially ecologic analysis based on long-term exposure to ambient air pollution showed the similar association.CONCLUSION: Our studies demonstrated a positive association between air pollution and SARS case fatality in Chinese population by utilizing publicly accessible data on SARS statistics and air pollution indices. Although ecologic fallacy and uncontrolled confounding effect might have biased the results, the possibility of a detrimental effect of air pollution on the prognosis of SARS patients deserves further investigation.