基于大气污染物与呼吸系统疾病暴露反应关系的AQHI构建及其预报能力评估

Air pollution as the most widespread hazardous risk on population recently in China, investigation on its health impact is of great public health significance. Many countries use the air quality index to represent the air quality. However, this index has defects in the forecasting of the public health risk of air quality. Air quality health index (AQHI), as a new index that could assess the air quality and the public health risk of air quality, could consider the differences of the exposure response relationships of multi-pollutants. Meanwhile, it also takes the differences of the exposure response relationships among different countries and districts into consideration. At present, there are few foreign researches on the construction of AQHI, and much fewer in China. As our previous studies which were focusing on the building of the exposure response relationship between air pollution and health effects shown, only using mortality as the indicator of health outcome may lose parts of health information and the association between air pollution and respiratory diseases was more remarkable than other diseases. In order to construct district-specific AQHI, this research will use generalized additive models to assess the exposure response relationships between air pollution and respiratory diseases (mortality and years of life lost). Then the AQHI will be constructed basing on the exposure response relationships and using principal component analysis and fuzzy hierarchical analysis to control the combined effects of air pollutants. Finally, epidemiological investigation will be used to assess the forecasting ability of AQHI. This research may have an important demonstration effect for the construction of other cities. Meanwhile, it might forecast the health risk of air quality for the public more efficiently.

大气污染受危害人群范围最大，探讨其与健康的关系具有重要的公共卫生意义。国内外多采用空气质量指数（AQI）来表征空气质量，但使用AQI向公众传递空气质量健康风险存在一定缺陷。空气质量健康指数（AQHI）是一种新型评估空气质量健康风险的指数，综合考虑了不同国家和地区、多种大气污染物对健康影响暴露反应关系的差异。目前国内外构建AQHI的研究较少，国内更是极少。本课题组在前期建立大气污染物与健康效应的关系中发现仅以死亡作为健康结局会丢失部分信息；同时发现呼吸系统疾病对大气污染物最为敏感。本项目拟采用广义相加模型建立多种大气污染物和呼吸系统疾病（死亡率和寿命损失年）的暴露反应关系，采用主成分分析和模糊分层分析方法处理污染物的联合作用，进而构建AQHI，并对其预报能力进行流行病学评估。以期构建符合地区特点的AQHI，为公众更有效提示空气质量的健康风险，为全国其他城市构建AQHI起到一定的示范作用。

目前大气污染已经成为我国最主要的环境问题之一，探讨大气污染与人群健康的关系成为环境卫生领域的热点和难点问题之一。构建能够准确提供健康信息的空气质量表征指数具有重要的公共卫生意义，是目前环境卫生研究者亟待解决的科学问题。课题以天津市作为研究现场，以每日死亡和YLL作为健康效应指标，以包括呼吸系统疾病在内的多种疾病作为目标疾病，从暴露-反应关系的建立、AQHI的构建、AQHI的评估、AQHI软件平台开发四个方面开展一系列研究，主要的研究成果体现在以下几个方面：（1）建立了天津市大气主要污染（PM10、NO2、SO2）对暴露人群健康影响的暴露-反应关系，阐明了天津市大气主要污染（PM10、NO2、SO2）对暴露人群不同目标疾病的影响特征，同时发现多种污染物对健康的效应存在一定的交互作用；（2）基于前述研究发现，为控制多污染对健康影响的交互作用，分别采用主成分分析和层次分析两种方法构建天津市AQHI指数，并通过K折交叉验证法、与AQI比较和流行病学调查评估三种方法对建立的AQHI指数的预报能力进行评估；（3）基于前述研究所建立的AQHI构建方法，结合软件开发技术，完成AQHI预报软件开发，实现AQHI实时更新、健康风险建议、AQHI趋势分析、AQHI对比分析和AQHI模型管理等功能，同时该软件平台可快速集成到包含微信公众平台或者第三方系统中，能很好的实现多端服务的扩展要求。综上，本研究从理论研究到软件应用开发形成了一套完整体系，可为全国其他城市构建AQHI起到一定的示范作用。后期将推进该软件平台集成到包含微信公众平台或者第三方系统中，即可实现向公众实时预报天津市AQHI及其健康风险，具有较好的应用前景。