細懸浮微粒(PM2.5)短期暴露與急性心肌梗塞致死之關聯性

Abstract

我國 PM2.5 自動監測機制起步較晚，關於 PM2.5 對民眾健康的影響大多引用國 外研究之結論。然而台灣位於東亞季風帶，除了境內排放的空氣污染物，鄰近國家 產生的污染物質亦會伴隨季風飄散到台灣上空與本土污染物混合，形成化學組成 更複雜的污染物。其次，台灣地狹人稠，工業區和住宅區比鄰而居，民眾暴露空氣 污染物的程度更為嚴重，而且國人生活習慣與疾病型態亦與歐美國家不同，歐美之 研究結果並不能完全推論我國的情況。心臟疾病持續數年蟬聯我國十大死因第二 名，心臟疾病罹病率與死亡率正逐年增加，防治國人心血管疾病已成為我國重要的 公共衛生議題。急性心肌梗塞為心臟疾病中最致命的殺手，近年來歐美各國研究證 實誘發急性心肌梗塞的風險因子除了個人因素之外，暴露空氣中 PM2.5 污染物與急 性心肌梗塞就診及死亡率增加有顯著相關性。本研究的目的在探討台灣西部地區 民眾短期暴露 PM2.5 對急性心肌梗塞致死的影響，以驗證是否與國外研究之結論一 致。 本研究分析台灣西部空氣品質區 2010 至 2014 年每日空氣污染物濃度變化對 於全死因與急性心肌梗塞死亡之影響，資料來源為行政院環保署空氣品質監測站 之監測資料與國家衛生研究院全民健康保險研究資料庫死因統計檔，使用時間分 層病例交叉研究法(Time-stratified case crossover study)選擇研究之病例組及對照組， 以條件羅吉斯回歸進行統計分析。考慮暴露空氣污染物具有延遲效應，本研究分別 以暴露當日至暴露前三日(Lag-0~Lag-3)為暴露危險期，探討不同延遲日的健康效 應。過去研究顯示急性心肌梗塞致死與性別和氣候條件有關連性，本研究亦以性別 和氣候分層探討在不同條件之下，短期暴露 PM2.5 對急性心肌梗塞致死的影響。 ii 研究結果顯示，短期暴露空氣污染物與全死因和急性心肌梗塞致死有關。在單 一污染物模式中，NO2、O3、和 PM2.5 的暴露濃度增加會顯著增加全因疾病死亡率， 其 勝 算 比 分 別 為 1.015(Lag-1, 95% CI: 1.004~1.025) 、 1.004(Lag-2, 95% CI: 1.000~1.008)、1.047(Lag-2, 95% CI: 1.018~1.076)，PM10、SO2 和 CO 濃度增加也會 提高全因死亡率，但統計分析未達顯著性。SO2 濃度增加會顯著增加急性心肌梗塞 致死之風險，勝算比為 1.133(Lag-1, 95% CI: 1.026~1.331)，PM2.5 和 PM10 濃度增加 也會提高心肌梗塞致死的風險，但統計分析未達顯著性。以性別和氣溫分層分析， 發現女性為暴露 PM2.5 引發心肌梗塞致死的高危險群，在氣溫較低的季節，暴露 PM2.5 顯著增加急性心肌梗塞死亡的風險，較溫暖的季節則以 O3 對急性心肌梗塞 死亡影響最顯著。研究顯示急性心肌梗塞在不同性別和氣候條件間呈現不同的易 感性。

Due to PM2.5 automatic monitoring mechanism started late 2005 in Taiwan. So, the health effects on exposure of PM2.5 are mostly referenced from the conclusion of foreign research. However, geographically Taiwan is located in the East Asia monsoon region, in addition the domestic air pollution, and air pollution from neighboring countries will accompany by monsoon drift over to Taiwan. These air pollutants mixed with local pollutants form a more complex chemical composition of contaminants. Second, Taiwan is small and crowded country, industrial and residential neighbors reside side by side people exposed to more serious levels of air pollutants. Life habits and disease patterns of Taiwanese are different from most of the European and American countries. Heart disease is being ranked second leading cause of death for several years in Taiwan, and morbidity and mortality of heart disease has been increasing year by year. So, prevention and control of cardiovascular diseases have become an important public health issue. Acute myocardial infarction(AMI), the cardiac diseases are most lethal killer. Numerous epidemiological studies have consistently reported that in spite of personal factors, ambient air pollution, especially fine particular factors (PM2.5) have significantly increased the morbity and mortality cases. Therefore, the aims of this thesis are to investigate the short-term effects of PM2.5 on AMI in Taiwan, and compare the results of the study with the previously published studies. This study investigates the AMI and all kind of death caused by the effects of daily air pollutant concentrations, changing from 2010-2014 in western air quality region of Taiwan. Information of air pollution and meteorology were obtained from air monitoring stations, administrated by the Taiwan Environmental Protection Agency. The data regarding daily mortality were obtained from the National Health Research Institute (NHRI). Data were analyzed using the time-stratified case crossover study, to select case group and control group, and applied conditional logistic model to assess the relationships between air pollutants and AMI mortality. There are lag effects of air iv pollution to daily AMI mortality, in this study, exposure to three days before the date of exposure to the risk of exposure days(Lag-0~Lag-3) to explore different lag effects. Previous studies have shown that onset of AMI associated with gender and climate conditions and this study also stratified that different gender and climate conditions explore short-term PM2.5 and exposure effects for mortality of AMI disease. In conclusion, short-term exposure to air pollutants has a positive relation with allcause mortality and mortality of AMI disease, increasing exposure concentrations, which increases mortality. In the single pollutant model, NO2, O3 and PM2.5 concentrations are increasing significantly and increased the rate of all-cause disease morality, the odds ratio are 1.015(Lag-1, 95% CI: 1.004~1.025)、1.004(Lag-2, 95% CI: 1.000~1.008)、1.047(Lag-2, 95% CI: 1.018~1.076) respectively. Increasing exposure concentrations of PM10, SO2 and CO will increase all-cause mortality, but these are not statistically significant. SO2 has significant positive relation with the risk of AMI mortality, the odds ratio is 1.133(Lag-1, 95% CI: 1.026~1.331). PM2.5 and PM10 are also positively related with AMI mortality, but not statistically significant. Temperature and gender stratified analysis found that women at high risk who exposed to PM2.5 more than other, which cause fatal AMI. During the winter season PM2.5 exposures increases significantly and the risk of death from AMI also increased. During the summer season O3 exposures affect AMI death most significantly. The study results also demonstrate that different gender and climatic conditions may modify the effects of short-term PM2.5 exposures on AMI mortality.