摘要目的 探讨天津市大气污染对居民脑卒中死亡率的影响,为脑卒中的预防控制提供依据.方法 采用天津市疾病预防控制中心收集的居民全死因监测数据,气象资料和大气污染资料来源于天津市气象局和天津市环境监测中心.采用时间序列的泊松回归广义可加模型进行天津市每日大气污染与居民脑卒中死亡危险度分析,同时控制气象因素、长期趋势、星期几效应以及人口数等混杂因素的影响,进行单污染物和多污染物分析.结果 2001至2009年天津市脑卒中粗死亡率为136.67～160.01/10万,有逐年上升趋势(P=0.000),但天津市脑卒中世界标化死亡率为138.36～99.14/10万,呈逐年下降趋势(P=0.000)；大气中SO2、NO2、PM10日均浓度每升高10μg/m3,脑卒中死亡的风险RR值分别为1.0105(95％CI:1.0060～1.0153),1.0197(95％CI:1.0149～1.0246)和1.0064(95％CI:1.0052～1.0077).SO2效应在1日后达到最大,NO2、PM10效应在当日达到最大.结论 天津市大气污染能增加人群脑卒中死亡风险,可能对脑卒中急性发作起到诱导作用.

abstractsObjective To investigate the effect of air pollution on stroke mortality in Tianjin,China,and to provide a basis for stroke control and prevention.Methods Total data of mortality surveillance were collected by Tianjin Centers for Disease Control and Prevention.Meteorological data and atmospheric pollution data were from Tianjin Meteorological Bureau and Tianjin Environmental Monitoring Center,respectively.Generalized additive Poisson regression model was used in time-series analysis on the relationship between air pollution and stroke mortality in Tianjin.Single-pollutant analysis and multi-pollutant analysis were performed after adjustment for confounding factors such as meteorological factors,long-term trend of death,"days of the week"effect and population.Results The crude death rates of stroke in Tianjin were from 136.67 in 2001 to 160.01/100000 in 2009,with an escalating trend (P=0.000),while the standardized mortality ratios of stroke in Tianjin were from 138.36 to 99.14/100000,with a declining trend (P=0.000).An increase of 10 μg/m3 in daily average concentrations of atmospheric SO2,NO2 and PM10 led to 1.0105 (95％CI:1.0060～1.0153),1.0197 (95％CI:1.0149～1.0246) and 1.0064 (95％CI:1.0052～1.0077),respectively,in relative risks of stroke mortality.SO2 effect peaked after 1-day exposure,while NO2 and PM10 effects did within 1 day.Conclusion Air pollution in Tianjin may increase the risk of stroke mortality in the population and induce acute onset of stroke.It is necessary to carry out air pollution control and allocate health resources rationally to reduce the hazard of stroke mortality.