Article(id=1324051187787497670, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202601448, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1769529600000, receivedDateStr=2026-01-28, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793608002849, onlineDateStr=2026-11-02, pubDate=1781020800000, pubDateStr=2026-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793608002849, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793608002849, creator=13701087609, updateTime=1793608002849, updator=13701087609, issue=Issue{id=1324050876230415089, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='1781020800000', pubDateStr='2026-06-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793607928569, creator='13701087609', updateTime=1793670049253, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324311429322507008, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324311429322507009, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1962, endPage=1968, ext={EN=ArticleExt(id=1324051188034961607, articleId=1324051187787497670, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Temporal variation in short-term ozone exposure-related circulatory and respiratory mortality risks in the Sichuan Basin, 2014—2022, columnId=1228016570660745413, journalTitle=Modern Preventive Medicine, columnName=Environmental and Occupational Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To evaluate the temporal variations in short-term mortality risks associated with ozone (O3) exposure for circulatory and respiratory diseases in the Sichuan Basin under the Clean Air Action, and to provide evidence for regional air pollution control and public health interventions.

Methods

Mortality data for circulatory and respiratory diseases were obtained from Sichuan Provincial Center for Disease Control and Prevention, and air pollution data (O3, NO2, and PM2.5) were obtained from the China High Air Pollutants dataset. A two-stage analysis was applied to estimate the short-term risks of circulatory, respiratory, and combined circulatory-respiratory mortality associated with O3 exposure during 2014—2022. In the first stage, quasi-Poisson generalized linear models were used to estimate the county-specific associations between O3 and mortality. In the second stage, random-effects meta-analysis was used to pool the estimates. Longitudinal meta-regression with a nonlinear time term was further used to assess temporal variations in risk. Two-pollutant models and subgroup analyses were conducted to examine the effects of co-pollutants and population heterogeneity on these temporal variations.

Results

Short-term mortality risks associated with O3 exhibited significant nonlinear temporal variations across all three mortality outcomes (P<0.001), with an increase during 2014—2016, a decline during 2017—2019, and a subsequent rise after 2020. For combined circulatory-respiratory mortality, the excess risk (ER) associated with each 10 μg/m3 increase in O3 rose from 0.86% (95% CI: 0.52%-1.20%) in 2014 to 1.51% (1.30%-1.72%) in 2016, then decreased to 0.93% (0.75%-1.11%) in 2019, and increased again to 1.58% (1.37%-1.79%) in 2022. This trend remained significant (P<0.01) in two-pollutant models, although the effects during 2016—2018 were attenuated, particularly for respiratory mortality. Subgroup analyses by sex and age showed similar temporal patterns, with overall higher risks in females and individuals aged ≥65 years.

Conclusion

From 2014 to 2022, short-term mortality risks associated with O3 in the Sichuan Basin showed a pattern of increase, decline, and re-increase. The post-2020 rebound suggests that future air quality management should strengthen coordinated control of PM2.5, NO2, and O3, and implement more targeted public health interventions in the context of population aging and climate change.

, authors=Yue OU1, Jian QIAN1, Sheng LI1, Jia-yi CHEN1, Jun-yu WANG1, Jing ZENG2, Xin-yin XU2, Ying DENG2, Fei YIN1, Meng-lu JIANG1, authorsList=Yue OU, Jian QIAN, Sheng LI, Jia-yi CHEN, Jun-yu WANG, Jing ZENG, Xin-yin XU, Ying DENG, Fei YIN, Meng-lu JIANG, authorCompany=null, correspAuthors=Fei YIN, Meng-lu JIANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324051192145379546, articleId=1324051187787497670, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=2014—2022年四川盆地短期臭氧暴露相关循环与呼吸系统死亡风险的时间变化特征, columnId=1228016571273113811, journalTitle=现代预防医学, columnName=环境与职业卫生, runingTitle=null, highlight=null, articleAbstract=
目的

评估清洁空气行动背景下四川盆地O3短期暴露相关循环和呼吸系统死亡风险的时间变化特征,为区域空气污染防治与公共卫生干预提供依据。

方法

循环与呼吸系统死亡数据来源于四川省疾病预防控制中心,空气污染物数据(O3、NO2和PM2.5)来源于中国高分辨率空气污染物数据集。采用两阶段分析评估2014—2022年O3暴露相关的循环系统、呼吸系统以及两者总死亡的短期风险:第一阶段采用准泊松广义线性模型估计各区县O3与死亡的短期关联;第二阶段采用随机效应meta分析汇总区县效应。在此框架下,通过纳入非线性时间项的纵向meta回归评估风险的时间变化。同时利用双污染物模型和亚组分析探讨共污染物及人群差异对该时间趋势的影响。

结果

三类死亡结局的O3短期死亡风险均呈显著非线性时间变化(P<0.001),总体表现为2014—2016年上升、2017—2019年下降、2020年后再次升高。以循环和呼吸系统总死亡为例,O3每增加10 μg/m3对应的超额风险从2014年的0.86%(95%CI:0.52%~1.20%)升至2016年的1.51%(95%CI:1.30%~1.72%),随后降至2019年的0.93%(95%CI:0.75%~1.11%),并于2022年再次升至1.58%(95%CI:1.37%~1.79%)。双污染物模型中此时间趋势仍然显著(P<0.01),但2016—2018年的超额风险有所减弱,且在呼吸系统死亡中更为明显。不同性别和年龄亚组中风险呈相似时间模式,女性和≥65岁人群的风险整体更高。

结论

2014—2022年四川盆地O3相关短期死亡风险呈现先升后降再上升的时间趋势。2020年后的风险反弹提示未来应加强PM2.5、NO2与O3的协同控制,并在老龄化与气候变化背景下实施更有针对性的公共卫生干预。

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欧悦(2000—),女,硕士在读,研究方向:卫生统计方法与应用

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殷菲,E-mail:;
江梦璐,E-mail:;
殷菲与江梦璐为共同通信作者
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Journal of the American College of Cardiology, 2022, 80(6): 631-640., articleTitle=Impact of the COVID-19 pandemic on cardiovascular health in 2020: JACC State-of-the-Art review, refAbstract=null)], funds=[Fund(id=1324051199078564138, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, awardId=82373689, language=CN, fundingSource=国家自然科学基金面上项目(82373689), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324051192367677659, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, xref=1., ext=[AuthorCompanyExt(id=1324051192376066268, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, companyId=1324051192367677659, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1324051192384454877, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, companyId=1324051192367677659, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川大学华西公共卫生学院/华西第四医院,四川 成都 610041)]), AuthorCompany(id=1324051192451563742, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, xref=2., ext=[AuthorCompanyExt(id=1324051192459952351, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, companyId=1324051192451563742, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.四川省疾病预防控制中心)])], figs=[ArticleFig(id=1324051197602169114, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, language=EN, label=Figure 1, caption=Temporal trends of air pollutants, meteorological factors, mortality, and the population aging rate in the Sichuan Basin, 2014—2022, figureFileSmall=fY0mnKuPLdkafOU/dab/mg==, figureFileBig=75Jc/pBRuVCKDw2MZhOn7A==, tableContent=null), ArticleFig(id=1324051197673472283, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, language=CN, label=图1, caption=2014—2022年四川盆地空气污染物、气象因素、死亡及老龄化率的时间趋势

注:A为空气污染物的时间趋势;B为各类死亡的时间趋势;C和D为气象因素的时间趋势;E为老龄化率(65岁以上人口所占比例)的时间趋势。

, figureFileSmall=fY0mnKuPLdkafOU/dab/mg==, figureFileBig=75Jc/pBRuVCKDw2MZhOn7A==, tableContent=null), ArticleFig(id=1324051197916741916, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, language=EN, label=Figure 2, caption=Temporal evolution of the short-term mortality risk associated with O3 in the Sichuan Basin from 2014 to 2022, figureFileSmall=55xIlgLHerRviF80ZBl6Uw==, figureFileBig=UB4aGmA4OYRGvZ6SoojMSg==, tableContent=null), ArticleFig(id=1324051197983850781, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, language=CN, label=图2, caption=2014—2022年四川盆地汇总的O3的短期死亡风险随时间的变化特征

注:A为2014—2022年各年度O3的短期死亡风险的时间趋势;B为按短期风险趋势分段估计的三个时段的短期死亡风险。

, figureFileSmall=55xIlgLHerRviF80ZBl6Uw==, figureFileBig=UB4aGmA4OYRGvZ6SoojMSg==, tableContent=null), ArticleFig(id=1324051198067736862, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, language=EN, label=Figure 3, caption=Annual trends in short-term O3 mortality risk under different outcomes and models in the Sichuan Basin from 2014 to 2022, figureFileSmall=uMEW06uugLwS+0Ql4YVfzA==, figureFileBig=Jp1NYQsOZpUWK+9LMt+u9g==, tableContent=null), ArticleFig(id=1324051198139040031, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, language=CN, label=图3, caption=2014—2022年四川盆地不同结局和模型下O3短期死亡风险的年度趋势, figureFileSmall=uMEW06uugLwS+0Ql4YVfzA==, figureFileBig=Jp1NYQsOZpUWK+9LMt+u9g==, tableContent=null), ArticleFig(id=1324051198206148896, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, language=EN, label=Figure 4, caption=Temporal trends in short-term mortality risks associated with O3 by sex group, 2014 to 2022, figureFileSmall=UMbwqlR0lG3/is6gHFMEtw==, figureFileBig=azVDlN/tijQH+BvY5ezT8w==, tableContent=null), ArticleFig(id=1324051198311006497, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, language=CN, label=图4, caption=2014—2022年不同性别亚组O3的短期死亡风险的时间趋势, figureFileSmall=UMbwqlR0lG3/is6gHFMEtw==, figureFileBig=azVDlN/tijQH+BvY5ezT8w==, tableContent=null), ArticleFig(id=1324051198378115362, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, language=EN, label=Figure 5, caption=Temporal trends in short-term mortality risks associated with O3 by age group, 2014 to 2022, figureFileSmall=glnUDkz+7DFDnETxFjheKg==, figureFileBig=WfTyWEwStEaYaJBPZIRDFA==, tableContent=null), ArticleFig(id=1324051198474584355, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, language=CN, label=图5, caption=2014—2022年不同年龄亚组O3的短期死亡风险的时间趋势, figureFileSmall=glnUDkz+7DFDnETxFjheKg==, figureFileBig=WfTyWEwStEaYaJBPZIRDFA==, tableContent=null), ArticleFig(id=1324051198550081828, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, language=EN, label=Figure 6, caption=Spatial distribution of county-level short-term mortality risks associated with O3 exposure in the Sichuan Basin, 2014—2022, figureFileSmall=95Zxr8iQy7jJj9aLaiyRhA==, figureFileBig=DNWcNn/drqHBKhPUVjIVIA==, tableContent=null), ArticleFig(id=1324051198617190693, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, language=CN, label=图6, caption=2014—2022年四川盆地县级O3暴露相关短期死亡风险的空间分布

注:图中ER表示2014—2022年四川盆地122个纳入主要分析区县的县级平均效应;审图号为GS(2024)0650号。

, figureFileSmall=95Zxr8iQy7jJj9aLaiyRhA==, figureFileBig=DNWcNn/drqHBKhPUVjIVIA==, tableContent=null), ArticleFig(id=1324051198692688166, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, language=EN, label=Table 1, caption=

Results of Spearman correlation analysis between meteorological variables and air pollutants

, figureFileSmall=null, figureFileBig=null, tableContent=
变量PM2.5O3NO2气温相对湿度
PM2.51
O3-0.29a1
NO20.65a-0.18a1
气温-0.44a0.67a-0.29a1
相对湿度-0.11a-0.45a-0.22a-0.05a1
), ArticleFig(id=1324051198789157159, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, language=CN, label=表1, caption=

气象因素和空气污染物的Spearman相关性分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量PM2.5O3NO2气温相对湿度
PM2.51
O3-0.29a1
NO20.65a-0.18a1
气温-0.44a0.67a-0.29a1
相对湿度-0.11a-0.45a-0.22a-0.05a1
), ArticleFig(id=1324051198864654632, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, language=EN, label=Table 2, caption=

Comparison of AIC between two alternative period definitions used in the temporal stratification analysis

, figureFileSmall=null, figureFileBig=null, tableContent=
时期划分依据具体的时段划分(年)循环和呼吸系统总死亡的AIC循环系统死亡的AIC呼吸系统死亡的AIC
按短期关联趋势划分2014—2016,2017—2019,2020—2022-4 006.1-3 852.8-3 733.6
按照政策阶段划分2014—2017,2018—2020,2021—2022-3 981.7-3 851.3-3 698.4
), ArticleFig(id=1324051198990483753, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051187787497670, language=CN, label=表2, caption=

分期分析中两种不同时期划分方式的AIC比较

, figureFileSmall=null, figureFileBig=null, tableContent=
时期划分依据具体的时段划分(年)循环和呼吸系统总死亡的AIC循环系统死亡的AIC呼吸系统死亡的AIC
按短期关联趋势划分2014—2016,2017—2019,2020—2022-4 006.1-3 852.8-3 733.6
按照政策阶段划分2014—2017,2018—2020,2021—2022-3 981.7-3 851.3-3 698.4
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2014—2022年四川盆地短期臭氧暴露相关循环与呼吸系统死亡风险的时间变化特征
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欧悦 1 , 钱渐 1 , 李胜 1 , 陈嘉怡 1 , 王俊予 1 , 曾晶 2 , 胥馨尹 2 , 邓颖 2 , 殷菲 1 , 江梦璐 1
现代预防医学 | 环境与职业卫生 2026,53(11): 1962-1968
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现代预防医学 |环境与职业卫生 2026 , 53 (11) : 1962 -1968
2014—2022年四川盆地短期臭氧暴露相关循环与呼吸系统死亡风险的时间变化特征
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欧悦1, 钱渐1, 李胜1, 陈嘉怡1, 王俊予1, 曾晶2, 胥馨尹2, 邓颖2, 殷菲1 , 江梦璐1
作者信息
  • 1.四川大学华西公共卫生学院/华西第四医院,四川 成都 610041
  • 2.四川省疾病预防控制中心
通讯作者:
殷菲,E-mail:;
江梦璐,E-mail:;
殷菲与江梦璐为共同通信作者
作者简介:

欧悦(2000—),女,硕士在读,研究方向:卫生统计方法与应用

Temporal variation in short-term ozone exposure-related circulatory and respiratory mortality risks in the Sichuan Basin, 2014—2022
Yue OU1, Jian QIAN1, Sheng LI1, Jia-yi CHEN1, Jun-yu WANG1, Jing ZENG2, Xin-yin XU2, Ying DENG2, Fei YIN1 , Meng-lu JIANG1
Affiliations
  • West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2026-06-10 doi: 10.20043/j.cnki.MPM.202601448
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目的

评估清洁空气行动背景下四川盆地O3短期暴露相关循环和呼吸系统死亡风险的时间变化特征,为区域空气污染防治与公共卫生干预提供依据。

方法

循环与呼吸系统死亡数据来源于四川省疾病预防控制中心,空气污染物数据(O3、NO2和PM2.5)来源于中国高分辨率空气污染物数据集。采用两阶段分析评估2014—2022年O3暴露相关的循环系统、呼吸系统以及两者总死亡的短期风险:第一阶段采用准泊松广义线性模型估计各区县O3与死亡的短期关联;第二阶段采用随机效应meta分析汇总区县效应。在此框架下,通过纳入非线性时间项的纵向meta回归评估风险的时间变化。同时利用双污染物模型和亚组分析探讨共污染物及人群差异对该时间趋势的影响。

结果

三类死亡结局的O3短期死亡风险均呈显著非线性时间变化(P<0.001),总体表现为2014—2016年上升、2017—2019年下降、2020年后再次升高。以循环和呼吸系统总死亡为例,O3每增加10 μg/m3对应的超额风险从2014年的0.86%(95%CI:0.52%~1.20%)升至2016年的1.51%(95%CI:1.30%~1.72%),随后降至2019年的0.93%(95%CI:0.75%~1.11%),并于2022年再次升至1.58%(95%CI:1.37%~1.79%)。双污染物模型中此时间趋势仍然显著(P<0.01),但2016—2018年的超额风险有所减弱,且在呼吸系统死亡中更为明显。不同性别和年龄亚组中风险呈相似时间模式,女性和≥65岁人群的风险整体更高。

结论

2014—2022年四川盆地O3相关短期死亡风险呈现先升后降再上升的时间趋势。2020年后的风险反弹提示未来应加强PM2.5、NO2与O3的协同控制,并在老龄化与气候变化背景下实施更有针对性的公共卫生干预。

臭氧  /  死亡率  /  时间趋势  /  清洁空气行动
Objective

To evaluate the temporal variations in short-term mortality risks associated with ozone (O3) exposure for circulatory and respiratory diseases in the Sichuan Basin under the Clean Air Action, and to provide evidence for regional air pollution control and public health interventions.

Methods

Mortality data for circulatory and respiratory diseases were obtained from Sichuan Provincial Center for Disease Control and Prevention, and air pollution data (O3, NO2, and PM2.5) were obtained from the China High Air Pollutants dataset. A two-stage analysis was applied to estimate the short-term risks of circulatory, respiratory, and combined circulatory-respiratory mortality associated with O3 exposure during 2014—2022. In the first stage, quasi-Poisson generalized linear models were used to estimate the county-specific associations between O3 and mortality. In the second stage, random-effects meta-analysis was used to pool the estimates. Longitudinal meta-regression with a nonlinear time term was further used to assess temporal variations in risk. Two-pollutant models and subgroup analyses were conducted to examine the effects of co-pollutants and population heterogeneity on these temporal variations.

Results

Short-term mortality risks associated with O3 exhibited significant nonlinear temporal variations across all three mortality outcomes (P<0.001), with an increase during 2014—2016, a decline during 2017—2019, and a subsequent rise after 2020. For combined circulatory-respiratory mortality, the excess risk (ER) associated with each 10 μg/m3 increase in O3 rose from 0.86% (95% CI: 0.52%-1.20%) in 2014 to 1.51% (1.30%-1.72%) in 2016, then decreased to 0.93% (0.75%-1.11%) in 2019, and increased again to 1.58% (1.37%-1.79%) in 2022. This trend remained significant (P<0.01) in two-pollutant models, although the effects during 2016—2018 were attenuated, particularly for respiratory mortality. Subgroup analyses by sex and age showed similar temporal patterns, with overall higher risks in females and individuals aged ≥65 years.

Conclusion

From 2014 to 2022, short-term mortality risks associated with O3 in the Sichuan Basin showed a pattern of increase, decline, and re-increase. The post-2020 rebound suggests that future air quality management should strengthen coordinated control of PM2.5, NO2, and O3, and implement more targeted public health interventions in the context of population aging and climate change.

Ozone  /  Mortality  /  Temporal trend  /  Clean air action
欧悦, 钱渐, 李胜, 陈嘉怡, 王俊予, 曾晶, 胥馨尹, 邓颖, 殷菲, 江梦璐. 2014—2022年四川盆地短期臭氧暴露相关循环与呼吸系统死亡风险的时间变化特征. 现代预防医学, 2026 , 53 (11) : 1962 -1968 . DOI: 10.20043/j.cnki.MPM.202601448
Yue OU, Jian QIAN, Sheng LI, Jia-yi CHEN, Jun-yu WANG, Jing ZENG, Xin-yin XU, Ying DENG, Fei YIN, Meng-lu JIANG. Temporal variation in short-term ozone exposure-related circulatory and respiratory mortality risks in the Sichuan Basin, 2014—2022[J]. Modern Preventive Medicine, 2026 , 53 (11) : 1962 -1968 . DOI: 10.20043/j.cnki.MPM.202601448
地表臭氧(ozone,O3)是当前制约我国空气质量改善的关键污染物。其短期暴露与循环系统和呼吸系统死亡风险增加的关联已被广泛证实[1]。然而,多数研究在评估O3健康风险时假设其在研究期间保持稳定[2-3],可能忽略了其潜在的时间变化。既往研究提示,空气污染物相关健康风险并非恒定,可能受到污染特征、气象条件及人口结构变迁等因素的共同影响[4]。自2013年以来,随着多轮清洁空气行动实施,我国经历了PM2.5下降而O3上升的污染谱重塑过程,同时人口老龄化加快,O3暴露相关的死亡风险可能已随时间发生改变[5-6]。因此,基于恒定风险假设的传统评估可能存在偏差,难以满足当前精准防控的需求。
尽管已有少数研究探索了短期O3死亡风险时间趋势,但结果并不一致。如日本和加拿大的研究报告了相对平稳的风险[7-8],而纽约的研究则观察到风险的非线性波动[9]。并且这些证据多来自空气质量改善较早、人口结构相对稳定的发达国家,其结论可能难以直接适用于空气污染严重和人口结构快速变动的发展中国家。尤其在中国污染谱重塑和人口快速老龄化的背景下[6],针对这一问题的系统研究仍然有限。
四川盆地位于中国西南地区,受独特的地形和不良扩散条件影响[10],是典型的高O3暴露区域[11]。近年来,该区域PM2.5下降而O3上升。与此同时,老龄化加深和高温相关影响增强,均可能影响人群对O3的敏感性。这些特征使四川盆地成为探索O3短期死亡风险时间变化特征的关键研究地区。
鉴于此,本研究利用2014—2022年四川盆地县级日死亡数据和O3浓度数据,采用两阶段时间序列模型评估O3短期暴露相关的循环及呼吸系统死亡风险的时间变化特征,为O3污染防控和公共卫生干预提供依据。
2014—2022年四川盆地各区县的日死亡数据来自四川省疾病预防控制中心。死亡结局包括循环系统死亡(ICD-10:I00-I99)、呼吸系统死亡(ICD-10:J00-J99)及两者总死亡,并按性别(男、女)和年龄(≥65岁、<65岁)分组。空气污染物数据(O3、NO2和PM2.5)来自中国高分辨率空气污染物数据集[12]。小时气温和露点温度数据来自ERA5-Land[13],相对湿度根据气温和露点温度计算获得[14]。年度人口数据来自LandScan Global[15]。各区县空气污染物浓度及气象因素均采用县级人口加权计算。
此外,本研究所界定的四川盆地研究区域为四川省行政区域内位于四川盆地范围的130个区县[16]。在该四川盆地130个区县中,金口河区、峨边彝族自治县、马边彝族自治县、嘉陵区、南部县、朝天区、丹棱县和宝兴县因<65岁年龄组死亡数过少,无法支持后续模型的稳定估计,未纳入主要分析。本研究最终纳入122个区县。
为避免共线性影响,首先对气象变量与空气污染物进行Spearman相关分析。然后以两阶段分析框架为基础,开展时间趋势分析、时间分段分析、双污染物模型、亚组分析及空间分布描述。
采用两阶段分析框架估计O3与死亡的短期关联[17]。第一阶段使用准泊松广义线性模型估计各区县的日死亡风险。模型如下:
其中,Yct是c区县在第t天死亡人数,X02,ct是O3浓度的3 d移动平均值,βc为O3暴露的回归系数。模型协变量参考既往研究[18]选定。自然样条(ns)用于控制长期和季节趋势、气温以及相对湿度的影响,星期几(Dow)用于控制周内周期性波动。长期和季节趋势项的自由度(v)设为每年7个v。气温采用7日移动平均值(temp06,ct),相对湿度采用当日相对湿度(rhct)。模型参数参考既往O3时间序列研究[3],并结合本研究数据特征通过最小化准赤池信息量准则(quasi Akaike information criterion,QAIC)确定。O3移动平均值的最大滞后天数候选范围为0~7 d;气温和湿度项最大滞后天数的候选范围为0~30 d,自由度候选范围为3~6;长期和季节趋势项自由度的候选范围为3~10。比较不同参数组合的QAIC后,最终主分析参数选择如模型所示。考虑到法定节假日数量相对有限,其影响可部分被长期和季节趋势及星期几效应吸收,主分析中未纳入节假日变量。第二阶段采用随机效应meta分析汇总各区县一阶段效应估计,并汇报I2以量化区县间异质性。结果以O3每增加10 μg/m3对应的死亡超额风险(excess risk,ER)及其95%置信区间(confidence interval,CI)表示。
在两阶段分析框架基础上,采用纳入非线性时间项的纵向meta回归评估O3短期死亡风险的时间变化。基于1.2.1中的一阶段模型,按区县-年份分别拟合,获得c区县第y年的对数相对风险估计值βcy;第二阶段建立如下纵向meta回归模型:
其中,f(yeary)是日历年的自然样条函数,用于刻画时间趋势;uc是区县随机效应,εcy是残差项。时间项的v(1~4)通过比较模型的赤池信息量准则(Akaike information criterion,AIC)确定,三类结局均以v=3时拟合最优。鉴于本研究的主要目的,且为了保持模型估计的稳定性、简洁性及结果的可解释性,模型未进一步设定显式空间相关结构,也未纳入区县层面的协变量。基于该模型预测年度的效应估计值,并使用Wald检验比较包含与不包含时间项的模型,以检验效应是否随时间变化。
为辅助验证时间趋势并评估阶段性差异,开展基于时间分段的补充分析。本研究预设了两类候选分段方案:一类依据四川省空气污染治理政策的实施节点,将研究时期划分为P1(2014—2017年)、P2(2018—2020年)和P3(2021—2022年);另一类根据整体风险估计随时间的变化特征进行分段。通过比较AIC选择最优划分方案。
确定最终分段方案后,第一阶段在模型中纳入时段指示变量与O3的交互项,以估计不同时段的效应。模型如下:
其中,β0c为参照时段内O3的主效应,γk为时间分段主效应,βkc为相对参照时段的交互效应,Pkt为第k个时段的指示变量,k由分段方案决定(≥2);Zct为与基本模型一致的协变量。第二阶段采用随机效应meta分析汇总各时段效应。
为评估NO2或PM2.5对O3效应的潜在混杂作用,进一步构建双污染物模型,滞后结构和协变量设定与主分析一致。同时按性别(男、女)和年龄(≥65岁、<65岁)进行亚组分析,以评估不同人群中O3的短期死亡风险及其时间变化特征。
为展示O3短期死亡风险的空间分布特征,基于年度效应估计值及其标准误,采用逆方差加权方法计算各区县在研究期间的平均效应,并绘制空间分布图。所有统计分析均使用R 4.2.2完成。
2014—2022年,四川盆地的年平均PM2.5和NO2浓度呈下降趋势,而O3浓度在逐年上升,从2014年的75.7 μg/m3升至2022年的103.0 μg/m3,见图1A。同期的循环和呼吸系统总死亡总体上升,仅2020年略有下降,从2014年的25.8万人增至2022年的32.5万人;其中循环系统死亡从16.4万人增至22.7万人,呼吸系统死亡从9.4万人增至9.8万人,见图1B。气象因素方面,2014—2021年平均气温基本稳定在16.8 ℃左右,2022年升至18.2 ℃,见图1C;相对湿度于2022年降至74.6%,为研究期间较低水平,见图1D。人口老龄化率总体呈上升趋势,仅2015年短暂下降,2022年达到18.1%,见图1E。
表1显示,除NO2与PM2.5、O3与气温呈中度相关外(相关系数分别为0.65和0.67),其他气象因素与空气污染物之间的相关性较低,未存在明显强共线性。
图2A显示,短期O3暴露相关的三类死亡结局的风险呈显著的非线性时间趋势(Wald检验的P<0.001),总体表现为2014—2016年持续升高,2017—2019年下降,2020年后再次升高。以循环和呼吸系统总死亡为例,O3每增加10 μg/m3,对应的ER从2014年的0.86%(95%CI:0.52%~1.20%)升至2016年的1.51%(95%CI:1.30%~1.72%),2019年降至0.93%(95%CI:0.75%~1.11%),2022年再次升至1.58%(95%CI:1.37%~1.79%)。循环系统死亡和呼吸系统死亡的ER的时间趋势相似。
为辅助验证该时间趋势并评估时期差异,构建了两类时间分段方案:一类基于图2A所示的年度效应变化趋势划分为P1(2014—2016年)、P2(2017—2019年)和P3(2020—2022年);另一类依据政策实施节点划分(见方法部分和表2)。表2显示,基于趋势的分段方案在三个死亡结局中均具有更低AIC值,因此作为最终分段方式,其结果见图2B。三个结局的分阶段ER均呈先降后升的趋势。以循环和呼吸系统总死亡为例,O3每增加10 μg/m3对应的ER在P1、P2和P3时期分别为1.32%(95%CI:1.11%~1.53%)、0.88%(95%CI:0.71%~1.05%)和1.25%(95%CI:1.11%~1.39%)。循环系统死亡和呼吸系统死亡的阶段性变化趋势类似。
校正NO2和PM2.5后,双污染物模型中O3短期死亡风险仍呈显著非线性时间趋势(P<0.01),总体表现为上升、下降、再上升的模式。见图3。与单污染物模型相比,纳入NO2或PM2.5后,三类死亡结局对应O3的ER在2016—2018年略有减弱,其中呼吸系统死亡最为明显。例如,2016年呼吸系统死亡的ER在单污染物模型中为1.79%(95%CI:1.48%~2.11%),分别控制PM2.5和NO2后降至1.48%(95%CI:1.14%~1.83%)和1.45%(95%CI:1.11%~1.79%)。
不同性别和年龄亚组的O3短期死亡风险呈相似的时间趋势,总体表现为上升、下降、再上升的模式,见图4、5。其中,女性ER在整个研究期间整体略高于男性,见图4。年龄亚组中,P1时期≥65岁组的呼吸系统死亡风险高于<65岁组,P2和P3时期两组差异缩小,趋势趋于一致,见图5;而循环系统死亡中,≥65岁组的ER在整个研究期间均高于<65岁组。以2020—2022年为例,≥65岁组的ER由0.94%(95%CI:0.72%~1.15%)升至1.58%(95%CI:1.32%~1.84%),同期<65岁组由0.30%(95%CI:-0.18%~0.77%)升至0.63%(95%CI:0.03%~1.23%)。
纳入年份后,纵向meta回归的残余异质性较低,三类结局的I2为9.4%~9.6%。进一步将各区县的逐年效应估计值采用逆方差加权汇总为研究期间县级平均ER,并绘制空间分布图,见图6。结果显示,西部的部分区县O3短期死亡风险相对较高,如天全县的平均ER为4.63%(95%CI:1.70%~7.67%);盆地东北部的部分区县的风险较低,如万源县的平均ER为0.41%(95%CI:-1.29%~2.14%)。
本研究系统评估了2014—2022年四川盆地短期O3暴露相关的循环和呼吸系统死亡风险的时间变化特征。研究发现O3的短期死亡风险呈显著非线性时间趋势,表现为2014—2016年上升、2017—2019年下降和2020—2022年再上升,且在调整了NO2和PM2.5后该趋势依然存在。
2014—2019年O3死亡风险先升后降,可能反映了污染谱变化、行为适应与政策干预的综合影响。在2014—2016年的风险上升期,虽然PM2.5浓度因治理而快速下降,但吸光组分减少[19]和NOx滴定效应减弱[20]可能推高了O3峰值与日内波动[21],增加居民高O3暴露机会。同时,公众对O3危害认知不足,往往忽视了蓝天白云下的隐形污染,导致高O3情况下的户外活动未得到有效规避,提高其实际吸入剂量[4]。在2017—2019年的风险下降期,随着《打赢蓝天保卫战三年行动计划》的深入,区域联防联控强化了对前体物的协同治理,这可能是O3相关死亡风险下降的原因之一。同期双污染物模型显示分别调整PM2.5和NO2后O3风险减弱,也提示该时期PM2.5和NO2的下降可能产生了协同作用。
2020—2022年O3短期死亡风险再次反弹,2022年较2020年增加0.66%,可能由多重环境与社会因素共同驱动。首先,气候变暖可能增强O3的急性健康效应。2022年气温偏高,同期四川平均气温较前八年升高约1.4 ℃。既往研究表明,高温既促进O3生成,又通过热应激加重机体负担[22],二者可产生协同作用[23]。其次,人口老龄化可能提升了人群易感性。2020—2022年四川的老龄化率从16.9%升至18.1%。而老龄化与心肺储备下降和慢性低度炎症相关[24],可能降低污染物触发健康事件的阈值。本研究亚组分析亦显示,≥65岁人群的循环系统死亡风险高于<65岁组。尽管两年龄组的O3短期死亡风险在2020—2022年均呈上升趋势,提示存在作用于全人群的外部驱动因素(如极端气候),但易感人群比例扩大会增强整体风险。最后,该时期与COVID-19流行重叠。病毒感染导致的心肺损伤、医疗资源挤兑及延迟就医等均可能增加人群对空气污染的脆弱性[25]。
基于近期O3死亡风险回升趋势,下一阶段空气质量管理应更加突出健康风险导向。在颗粒物治理取得成效的同时,O3浓度及其单位浓度健康风险在近年同步上升,提示仅关注单一污染物浓度的下降已不足以全面保障公众健康,需进一步加强O3、NO2和PM2.5的协同控制,如优化VOCs与NOx的减排比例,避免细颗粒物下降过程中O3反弹。同时,公共卫生部门应完善O3与极端高温的复合暴露预警,加强风险沟通,并针对老年人及循环和呼吸系统疾病患者等易感人群提供行为干预指导,以应对气候变化背景下日益复杂的环境健康挑战。
本研究仍存在一定局限性。第一,本研究为生态学研究,暴露和结局均基于群体水平,无法识别个体真实暴露和易感特征,因此不能直接作出个体因果推断。第二,本研究不能完全排除未测量因素所致的残余混杂,但模型已控制主要混杂因素,并通过双污染物模型和敏感性分析检验结果稳健性。第三,本研究未显式纳入空间相关结构,可能影响效应估计精度,但对时间变化结论的影响可能有限。此外,本研究未进一步系统探索区县层面特征对效应异质性的影响,有待后续研究深入分析。
综上,2014—2022年四川盆地O3短期死亡风险呈先升后降再上升的时间趋势,尤其2020年后出现明显反弹。污染谱变化、气候变暖及老龄化可能共同推动了这一趋势。结果提示未来清洁空气行动应加强多污染物的协同控制,并推进健康风险导向的干预措施。
  • 国家自然科学基金面上项目(82373689)
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2026年第53卷第11期
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doi: 10.20043/j.cnki.MPM.202601448
  • 接收时间:2026-01-28
  • 首发时间:2026-11-02
  • 出版时间:2026-06-10
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  • 收稿日期:2026-01-28
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国家自然科学基金面上项目(82373689)
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    1.四川大学华西公共卫生学院/华西第四医院,四川 成都 610041
    2.四川省疾病预防控制中心

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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