ความสัมพันธ์ระหว่างระดับฝุ่นละออง PM2.5 รายวันในอากาศกับการมารับการรักษาด้วยโรคระบบการหายใจและระบบหัวใจและหลอดเลือด ณ โรงพยาบาลราชบุรี อ.เมือง จ.ราชบุรี

Denduangchai S; Wiwatanadate P; Jiamjarasrangsi W

Authors

Denduangchai S Department of Outpatient Service, Phramongkutklao Hospital, Thailand
Wiwatanadate P Department of Community Medicine, Faculty of Medicine Chiang Mai University, Thailand
Jiamjarasrangsi W Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Thailand

Keywords:

Particulate matter PM2.5, Acute coronary syndrome, Acute ischemic stroke, Pneumonia, Influenza, Acute asthmatic attack, Chronic obstructive pulmonary disease with acute exacerbation

Abstract

Objectives To study the association between daily PM₂_.₅ levels in Ratchaburi District and daily emergency department (ED) visits at Ratchaburi Hospital due to respiratory and cardiovascular diseases.

Methods A time-series study was conducted using air pollution data from the Thai Pollution Control Department (Thai PCD), meteorological data from the Thai Meteorological Department and medical records of patients who visited the ED of Ratchaburi Hospital between 1 August 2014 and 30 April 2020. Analysis was done using a generalized linear model.

Results The daily average and maximum levels of particulate matter 2.5 micrometers or less in diameter (PM₂_.₅) and 10 micrometers or less in diameter (PM₁₀), ozone (O₃) and sulfur dioxide (SO₂) during the study period were higher than Thai PCD and World Health Organization (WHO) standards. The daily PM₂_.₅ average level exceeded Thai PCD and WHO standards for an average of 137 ± 36 days and 137 ± 36 days per year, respectively. During that period, there were a total of 38,377 ER visits of which 26,762 and 16,345 visits were due to respiratory and cardiovascular diseases, respectively. A 10 µg/m³ increase in the daily PM₂_.₅ level was statistically significantly associated with an increase in ER visits for acute exacerbation of chronic obstructive pulmonary disease (Lag 1; IRR 1.06 95% CI 1.01-1.11) and upper respiratory tract infection (Lag 6; IRR 1.04 95%CI 1.02-1.07). Persons aged between 0-14 years and those 65 years or more with an underlying disease had a greater magnitude of association.

Conclusion Daily PM₂_.5 levels in Mueang District, Ratchaburi Province exceeding recommended standards was associated with increased ED visits for both respiratory and cardiovascular diseases, especially in the high-risk population. To reduce the incidence of disease, PM₂_.5 source control measures should be rigorously and regularly enforced. During periods of high levels of air pollution, public health agencies should communicate that risk and advise citizens, especially individuals at high-risk, on how to reduce their PM₂_.5 pollution exposure, and hospitals should prepare for an increase in the number of visits by sick individuals.

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