兰州大学机构库 >公共卫生学院
大气污染和极端气温健康效应证据的报告质量评价和时间序列分析
Alternative TitleReporting Quality Assessment of Evidence and Time-series Analysis on Health Effects of Air Pollution and Extreme Temperature
马妍
Subtype硕士
Thesis Advisor宋旭萍
2023-05-20
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name公共卫生硕士
Degree Discipline公共卫生
Keyword大气污染 Air pollutants 极端气温 Extreme temperatures 报告质量 Reporting quality 证据图谱 Evidence mapping 时间序列 Time series study
Abstract

背景:大气污染和极端气温严重威胁人类健康,是全社会面临的重大挑战。为提升气候变化的应对能力,研究者们生产了一系列大气污染和极端气温健康效应的指南和系统评价证据。证据的报告质量有助于研究者清晰、透明、完整地呈现研究证据,提升证据的可推广性。然而,当前大气污染和极端气温健康效应证据的报告质量并不清楚,为政策制定者和研究人员筛选和使用高质量证据带来困难。

目的:(1)评价大气污染和极端气温健康效应指南的报告质量;(2)评价大气污染和极端气温健康效应系统评价和Meta分析证据的报告质量;(3)绘制大气污染和极端气温健康效应的证据图谱,基于研究不足生产时间序列分析原始研究证据。

方法:报告规范(Reporting Guidelines)指基于明晰的研发方法,用于指导作者报告特定类型研究的清单,本文根据不同研究类型分别采用不同的报告规范进行证据报告质量评价:(1)系统检索世界卫生组织(World Health Organization,WHO)、英国国家卫生与临床优化研究所(National institute for Health and Care Excellence,NICE)、国际指南协作网(Guidelines International Network,GIN)、苏格兰校际指南网络(Scottish Intercollegiate Guidelines Network,SIGN)4个网站,以及PubMed、中国知网(China National Knowledge Infrastructure,CNKI)、中国生物医学文献服务系统(China Biology Medicine disc,CBM)数据库,纳入大气污染和极端气温健康效应指南,使用卫生保健实践指南报告清单(Reporting Items for Practice Guidelines in Healthcare,RIGHT)对纳入指南报告质量进行评价;(2)检索PubMed、Embase、the Cochrane Library、Web of Science、the Cumulative Index to Nursing Allied Health Literature(CINAHL)、CNKI、CBM七个电子数据库,纳入大气污染和极端气温健康效应的系统评价或Meta分析(Systematic Reviews or Meta-Analyses,SR/MAs),使用系统评价和Meta分析优先报告的条目(The Preferred Reporting Items for Systematic Reviews and Meta-Analyses,PRISMA)进行报告质量评价。采用Origin软件绘制证据图谱,并基于该图谱分析现有研究空白;(3)基于证据图谱发现的研究空白,使用广义相加模型分析北京市大气污染和极端气温的协同作用对健康的影响,分析北京市《大气污染防治行动计划》实施前后二者协同作用健康风险的变化,探究不同性别的差异。

结果:(1)共纳入大气污染和极端气温健康效应指南12篇:①11篇为WHO制定的指南,1篇NICE指南;②仅7部指南在题目中报告了研究类型,未有指南报告资助者的作用;③极端气温指南在“审查和质量保证”和“资助与利益冲突声明及管理”领域均未进行报告。

(2)共纳入340篇大气污染和极端气温健康效应SR/MAs:①纳入研究报告质量评价分析表明,仅39.1%的研究报告相对完全,仅21.2%的纳入研究报告了研究方案和注册情况,49.7%报告了评估单个研究存在偏倚的方法,41.7%报告了研究内部偏倚风险的结果,47.4%报告了研究间偏倚的结果;②大气污染的SR/MAs的报告质量优于气温的SR/MAs,主要体现在评估偏倚风险的方法(55.0% vs. 35.3%)及偏倚风险的评估结果(46.4% vs. 28.2%)上有统计学差异。③大气污染SR/MAs有246篇,极端气温87篇,大气污染和极端气温协同作用7篇。证据图谱结果显示证据主要集中于颗粒物对循环和呼吸系统疾病的影响,黑碳(Black Carbon,BC)健康效应证据数量很少。

(3)北京市大气污染和极端气温协同效应对健康影响的时间序列分析结果显示:①北京市碳减排政策实施后,BC每增长10μg/m3,全因(RR=1.064,95%CI:1.047,1.081)、循环(RR=1.068,95%CI:1.045,1.091)和呼吸系统疾病(RR=1.148,95%CI:1.102,1.197)死亡的风险降低,且在极寒天气中关联更显著;②女性受BC对呼吸道疾病影响的风险(RR=1.360/10μg/m3,95%CI:1.237,1.495)更高

结论:(1)大气污染和极端气温健康效应指南在“证据”、“推荐意见”、“评审和质量保证”、“资助与利益冲突声明及管理”领域仍需进一步提升,尤其重视在题目中报告研究类型以及报告资助者作用;大气污染和极端气温健康效应系统评价和Meta总体报告质量不高,但大气污染健康效应的SR/MAs在报告质量上优于气温的SR/MAs,二者在研究计划书注册、偏倚风险的评估和解释方面均有较大缺陷。建议未来研发更适用于环境卫生指南和SR/MAs的报告规范,提升大气污染和极端气温健康效应证据的报告质量。

(2)证据图谱表明大气健康效应领域证据的研究热点为大气污染物,大气颗粒物PM10和PM2.5对全因死亡、心血管疾病和呼吸系统疾病发病和死亡影响的研究是环境领域的热点,对肿瘤、精神和行为障碍等疾病的关注需进一步加强。BC健康效应的证据有限,极端气温和协同作用证据较少。

(3)北京市极端低温下BC诱发全因死亡、呼吸和循环系统疾病死亡的风险更高,相较于PM2.5而言BC导致的疾病风险更大,控制BC排放的碳减排政策有效性也更显著。建议政府在制定碳减排政策时进一步考虑高危人群和高风险污染物,通过大气治理提升人群健康水平。

Other Abstract

Background: Air pollution and extreme temperature posed serious threat to human health, which are major challenges to society. To enhance the response to climate change, researchers have produced a series of evidence (guidelines and systematic reviews) on health effects of air pollution and extreme temperature. The reporting quality of evidence helps present research evidence clearly, transparently, and completely. It can improve the generalizability of evidence. However, the reporting quality of evidence on the health effects of air pollution and extreme temperatures currently are unclear, which brings difficulties for policymakers and researchers in screening and using high-quality evidence.

Objective: (1) To assess the reporting quality of guidelines on air pollution and extreme temperature; (2) to assess the reporting quality of SR/MAs on air pollution and extreme temperature; (3) to plot the evidence mapping for health effects of air pollution and extreme temperatures, and produce time-series evidence based on the research gaps of evidence mapping.

Methods: Reporting guidelines are a checklist to help authors in reporting specific types of research based on clear methodology. Thus, we used different report guidelines to assess the reporting quality: 1) World Health Organization (WHO), National Institute for Health and Care Excellence (NICE), Guidelines International Network (GIN), Scottish Intercollegiate Guidelines Network (SIGN) and three databases (PubMed, CNKI and CBM) were systematically searched. RIGHT was used to assess the reporting quality of included guidelines. 2) PubMed, Embase, the Cumulative Index to Nursing Allied Health Literature (CINAHL), the Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI) and China Biology Medicine disc (CBM) were systematically searched. SR/MAs for health effects of air pollution and extreme temperatures are included. PRISMA was chosen to evaluate the reporting quality of SR/Mas. Evidence mapping was plotted by Origin and evidence gaps were explored. 3) Based on the research gaps identified by the evidence map, we used generalized additive models (GAMs) to analyze the health effects of the interactive effect between air pollution and temperature extremes in Beijing. Analyzing the changes in health risks of interactive effects of pre-post Air Pollution Prevention and Control Action Plan and exploring the susceptible populations in Beijing.

Results: (1) A total of 12 guidelines on the health effects of air pollution and extreme temperatures were included: ① 11 guidelines were developed by WHO and 1 was developed by NICE; ② Only 7 guidelines reported as a guideline in the title, and no guideline reported the role of funder; ③ The extreme temperatures guidelines were not reported the areas of “review and quality assurance” and “funding and declaration and management of interests”.

(2) 340 SR/MAs were included in the evidence mapping: ① the analysis of reporting quality assessment showed that only 39.1% of included studies were relatively complete, only 21.2% reported study protocol and registration, 49.7% reported the method to assess the existence of bias in individual studies, 41.7% reported the risk of bias for intra-study, and 47.4% reported the risk of bias for inter-study; ② the reporting quality of air pollution SR/MAs was better than that of temperature, and statistically different at the method of assessing the risk of bias (55.0%/35.3%) and the assessment results of the risk of bias (46.4%/28.2%). ③ 246 SR/MAs on pollutants, 87 on temperature changes, and 7 on the interactions between air pollution and extreme temperatures. Evidence mapping showed that evidence was mainly focused on the effects of particulate matter on circulatory and respiratory diseases, and the number of evidence about black carbon (BC) was less.

(3) The time-series analysis on health effects of the interactive effects between air pollution and extreme temperatures indicated that ①After implementation of decarbonization policy, reductions were noted in non-accidental mortality (RR=1.064 per 10 μg/m3, 95%CI: 1.047, 1.081), circulatory mortality (RR=1.068 per 10 μg/m3, 95%CI: 1.045, 1.091) and respiratory mortality (RR=1.148 per 10 μg/m3, 95%CI: 1.102, 1.197) related to BC. And the association was more pronounced on cold days. ②Higher risks of the impact of BC on respiratory diseases were observed in females (RR=1.360 per 10 μg/m3, 95%CI: 1.237, 1.495).

Conclusions: (1) The reporting quality of guidelines in the areas of "evidence" and "recommendations", “review and quality assurance” and “funding and declaration and management of interests” need to be further improved, particular emphasis on “reported as a guideline in the title” and “the role of funder”. The reporting quality of SR/MAs on air pollution was better than extreme temperatures, and both have major shortcomings in the “registration of protocols” and “assessment and interpretation of risk of bias”. We recommend developing reporting guidances for guidelines and SR/MAs on health effects of air pollutants and extreme temperatures.

(2) Evidence mapping showed that evidence was mainly focused on pollutants. The effects of pollutants on cancer and congenital malformations were new research hotspots. Meanwhile, evidences on tumor, mental and behavioral disorders need to be further strengthened. However, the evidence of health effects on BC, extreme temperature, and the interactive effects between air pollution and extreme temperatures were limited.

(3) The health risk of BC on all-cause mortality, respiratory and circulatory mortalities during extreme low temperatures were higher in Beijing. Furthermore, compared with PM2.5, BC posed a greater disease risk and the effectiveness of the decarbonization policy was more obvious. We recommend the government furtherly consider high-risk populations and pollutants in formulating decarbonization policies, and improve population health by atmospheric management.

MOST Discipline Catalogue医学 - 公共卫生
URL查看原文
Language中文
Other Code262010_220200911080
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/536470
Collection公共卫生学院
Affiliation
兰州大学公共卫生学院
Recommended Citation
GB/T 7714
马妍. 大气污染和极端气温健康效应证据的报告质量评价和时间序列分析[D]. 兰州. 兰州大学,2023.
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