关键词: 肺疾病, 慢性阻塞性；死亡；颗粒物；大气；广义相加模型；时间序列分析

Abstract: Background　The health hazards of chronic obstructive pulmonary disease（COPD）has caused widespread concern around the world due to its high prevalence rate and high mortality rate，but the study about the relationship between the concentration of particulate matters and daily COPD mortality was still rare.Objective　To explore the relationship between the concentration of particulate matters（PM2.5，PM10）and daily COPD mortality in Pudong New Area，so as to provide a reference to establish intervention measures.Methods　The daily COPD mortality data between 1 January 2013 and 31 December 2017 was originated from the local death surveillance database.The data of air pollution in Shanghai including the concentration of particulate matters（PM2.5，PM10，SO2，NO2）were offered by Shanghai Environmental Monitoring Center，and the data of meteorology in Pudong New Area including temperature，relative humidity，atmospheric pressure and wind speed were received from Meteorological Bureau of Pudong New Area.A generalized additive model（GAM）based on Poisson distribution was performed to analyze the association between particulate matters（PM2.5，PM10）and daily COPD death，and the COPD death data was stratified according to age（young group <80 years，old group≥80 years）and education level（the low educated group without the middle school education，the highly educated group with middle school education and above）．The concentration of particulate matters（PM2.5，PM10）at the day that the COPD death happen，one day before，two days before and three days before the death and the average concentration of particulate matters in the four days were presented as lag0，lag1，lag2，lag3 and lag03，respectively.Results　The concentration of PM2.5 was positively correlated with the concentration of PM10，SO2，NO2 and atmospheric pressure，and negatively correlated with temperature，relative humidity and wind speed（P<0.05）；the concentration of PM10 was positively correlated with the concentration of SO2，NO2 and atmospheric pressure，and negatively correlated with temperature，relative humidity and wind speed（P<0.05）；the concentration of SO2 was positively correlated with the concentration of NO2 and atmospheric pressure，and negatively correlated with temperature，relative humidity and wind speed（P<0.05）；the concentration of NO2 was negatively correlated with air temperature and relative humidity，and positively correlated with atmospheric pressure and wind speed（P<0.05）．Temperature was positively correlated with relative humidity，and negatively correlated with atmospheric pressure（P<0.05）．Relative humidity was negatively correlated with atmospheric pressure and wind speed（P<0.05）．The results of the single pollutant model showed that the effect of PM2.5 on daily COPD mortality was significant at lag0，lag1，lag2 and lag03（P<0.05），and not significant at lag3（P>0.05）；the effect of PM10 was significant at lag0，lag1，lag2，lag3 and lag03（P<0.05）．After stratification according to age，the effect of PM2.5 and PM10 on daily COPD death count was not significant at lag0，lag1，lag2，lag3 and lag03 among young group（P>0.05）；the effect of PM2.5 on daily COPD mortality among the old group was significant at lag0，lag1，lag2 and lag03（P<0.05），and not significant at lag3（P>0.05）；the effect of PM10 was significant at lag0，lag1，lag2，lag3 and lag03 among the old group（P<0.05）．After stratification according to education level，the effect of PM2.5 and PM10 on daily COPD mortality among low educated group was significant at lag0，lag1，lag2 and lag03（P<0.05），and not significant at lag3（P>0.05）；the effect of PM2.5 was significant on daily COPD mortality among highly educated group at lag1（P<0.05），and not significant at lag0，lag2，lag3 and lag03（P>0.05）；the effect of PM10 was significant on daily COPD mortality among highly educated group at lag1 and lag03（P<0.05），and not significant at lag0，lag2 and lag3（P>0.05）．The results of multi-pollutant model showed that the effect of PM2.5 was not significant on the daily COPD mortality among the whole crowd，old group，young group，low educated group and highly educated group after the effect of SO2 and NO2 had been controlled separately and simultaneously（P>0.05）．The effect of PM10 was not significant on the daily COPD mortality among the whole crowd，old group，young group，low educated group and highly educated group after the effect of SO2 had been controlled or the effect of SO2 and NO2 had been controlled simultaneously（P>0.05）．When the effect of NO2 had been independently controlled，the effect of PM10 was not significant among the whole crowd，young group，low educated group and highly educated group（P>0.05），and its effect was significant among the old group（P<0.05）．Conclusion　Increased concentrations of atmospheric particulate matters（PM2.5，PM10）have a significant impact on the mortality of chronic obstructive pulmonary disease（COPD）in Pudong New Area.The old group and the low educated group of patients with chronic obstructive pulmonary disease were more sensitive to the concentration change of particulate matters（PM2.5，PM10），and relative measures should be enhanced to protect the sensitive population from the hazard of particulate matters（PM2.5，PM10）．

Key words: Pulmonary disease, chronic obstructive；Death；Particulate matter；Atmosphere；Generalized additive model；Time-series analysis