【作者】 阚海东；

【导师】 陈秉衡；

【作者基本信息】 复旦大学 ， 劳动卫生与环境卫生学， 2003， 博士

【摘要】 大气污染是我国主要的环境问题之一。从全国范围看，我国的大气污染类型以煤烟型为主；在部分大中城市，大气污染类型已由单纯的煤烟型污染向煤烟污染和机动车尾气混合型发展，构成双重负担。不合理的能源结构以及能源的严重浪费则是造成我国大气污染严重的主要原因之一。国内外流行病学研究均已证实，大气污染与居民一系列从发病到死亡的健康效应终点变化相关。在这样的背景下，将未来能源消费方式、大气污染和人群健康效应综合考虑，无疑将对我国各大城市的未来发展有着极大的影响。基于此，本课题采用健康危险度评价结合卫生经济学的理论，分析了上海市现在和未来不同能源场景下大气污染对居民的健康危害及其经济价值。本研究的结果可为上海市相关能源、环境决策以及大气污染改善措施的优先选择提供科学依据。本课题在健康危险度评价方法（包括危害认定、暴露评价、剂量－反应关系评价和危险度特性阐述）的基础上，结合国内外大气污染环境流行病学得出的暴露－反应关系，提出了定量评价大气污染健康损失的方法。该方法可用于我国各城市大气污染健康危险度评价工作。采用能源优化模型（MARKAL）对上海市现阶段（2000年）和未来（2000-2020年）不同能源场景下进行大气污染物排放情景研究，然后将排放情景传递给用于大气污染暴露水平的转移矩阵（transfer-matrix）。结合上海市地理信息系统，分析了上海市居民2000年和未来（2010、2020年）不同能源场景下暴露于大气PM10的情况。结果发现，上海市2000年人口加权的大气PM10暴露浓度为100.9μg/m3，能源政策的实施可以显著改善上海市居民对大气PM10的暴露水平。本课题的暴露－反应分析包括上海市大气污染与居民每日死亡关系的时间序列研究以及大气颗粒物暴露与人群健康效应暴露－反应关系的meta分析。采用时间序列的半参数广义相加模型，在控制死亡的长期趋势、季节趋势、“星期几效应”、气象因素等混杂因素的基础上，分析了上海市城区2000年6月1日至2001年12月31日大气污染物浓度变化与居民每日死亡的关系。结果表明，单污染物模型下，大气PM10，SO2和NO2日平均浓度每增加10μg/m3，居民总死亡发生的相对危险度分别为1.003 (95%可信限1.001-1.005)，1.014 (95%可信限1.008-1.020)和1.015 (95%可信限1.008-1.022)；多污染物模型下，引入其它污染物会降低大气PM10和NO2对死亡率的作用，对SO2则影响不大。同时，为获取适合我国情况的颗粒物－健康效应的暴露－反应关系，在联机检索文献的基础上，综合国内外流行病学文献，采用meta分析的方法估计了从发病到死亡各个健康效应终点上，大气颗粒物浓度每升高一定单位，人群不良健康效应发生的相对危险度。该meta分析结果可直接应用于我国其它城市大气污<WP=5>染相关的健康危险度评价工作。在上述研究的基础上，我们估算了上海市目前的大气污染水平对居民健康的定量危害。结果表明，2000年上海市大气PM10污染与8,220例居民超死亡相关，同时还与16,870例新发慢性支气管炎、5,240例呼吸系统住院、2,690例心血管系统住院、386,600次内科门诊、40,040次儿科门诊、540,300例急性支气管炎以及9,990例哮喘发作相关。同时，2000年长期暴露于大气PM10污染可使上海市各年龄层居民期望寿命减少0.61－1.00年不等，人年损失则为68,042年。不同能源方案的实施，可以通过改善大气污染水平而显著影响上海市居民未来的健康状况。与基线（BC）场景相比，上海市不同能源方案的推行，可以分别减少650-5,470（2010年）和1,270-11,130（2020年）例与大气污染相关的死亡；同时还可减少一定数量的急慢性支气管炎、哮喘、住院和门诊人数。在大气污染定量健康危险度评价的基础上，采用支付意愿法结合疾病成本法的技术路线，将大气污染相关的健康效应货币化。首先，综合分析国内外文献，采用成果参照法，提出了适合上海情况的大气污染相关健康效应终点的单位经济价值。对上海市2000年大气污染相关健康危害的经济分析表明，上海市目前的大气PM10污染相关的居民健康危害其经济损失达83.5亿元，占上海市当年GDP的1.84％；展望未来，在不同的能源方案下，由于居民健康状况改善而获得的经济收益在2010和2020年分别可达9.8-82.2和28.3-248.1亿元人民币。在Analytica(r)软件的基础上，与智利天主教大学合作，建立了大气污染健康危险度评价及其货币化的计算机平台。该软件采用了简洁明了、易于升级管理的模块化管理方式，并可通过内置的Monte Carlo模拟抽样引擎，可估计出复杂模型运算的最终分布及其可信限，较好地解决了危险度评价工作中的“不确定性和变异性分析”这一难题。本课题健康危险度评价和经济分析的结果均在该软件上计算所得；同时，该平台可推广应用于我国其它城市和地区的大气污染健康危险度评价工作。综上所述，本课题研究结果提示，上海市目前的大气污染水平已对居民健康构成一定负担；同时，积极的能源政策将降低大气污染物排放、改善环境空气质量、提高居民健康水平，进而可以获得可观的经济效益。本课题建立的“能源→大气污染→健康→经济”这一综合评价分析的思路，以及大气污染健康危害评?更多还原

【Abstract】 Ambient air pollution is a major environmental health problem in China. Coal combustion type air pollution is the major type of air pollution. However, in some large cities of China, air pollution has gradually changed from the conventional coal combustion type to the mixed coal combustion/motor vehicle emission type. Unoptimized energy structure and energy waste are among the major causes of severe air pollution. Epidemiologic studies have confirmed the association between ambient air pollution and increased mortality and morbidity both in China and worldwide. Under such circumstance, a comprehensive assessment of energy policies, ambient air pollution and its health impact is of great significance to the future development of China’s cities. Using the health-based risk assessment and health economics approach, this project aimed for an estimation of health impact due to air pollution currently and in the future under various energy scenarios in Shanghai. The results could be applied to priority setting in energy and environmental policies, air pollution intervention and improvement measures, and health-based cost-benefit analysis. Health-based risk assessment framework, including hazard identification, exposure assessment, dose-response assessment and risk characterization, combined with the unit increase in mortality or morbidity per unit increase of air pollutants level, was introduced into the estimation of health impact due to ambient air pollution. The recommended approach could be applied to the health impact estimation of ambient air pollution in other cities in China. The MARKAL (MARKet ALlocation) optimisation model was employed for estimation of pollutant emissions under various energy scenarios in Shanghai. One type of quick air quality model - the transfer-matrix was developed to link emission scenarios of MARKAL model and air pollutant concentrations. Population exposure level to ambient PM10 currently and in the future was presented in the Shanghai Geographical Information System (GIS). It was found that population-weighted PM10 level in 2000 was 100.9μg/m3 for Shanghai residents, and the implementation of various energy policies could significantly ameliorate the population exposure level to PM10 in Shanghai. The dose-response assessment included a time-series study of air pollution and daily mortality in Shanghai, and a meta analysis of<WP=7>exposure-response functions of air particulate matter and adverse health outcomes. In the time-series study, semi-parametric generalized additive model (GAM) was used to allow for the highly flexible long-term and seasonal trends, as well as nonlinear weather variables. In the single-pollutant models, it was found that an increase of 10μg/m3 of PM10, SO2 and NO2 corresponded to 1.003 (95%CI 1.001-1.005), 1.014 (95%CI 1.008-1.020), and 1.015 (95%CI 1.008-1.022) relative risk of all-causes mortality, respectively. In the multi-pollutants models, the association between SO2 and daily mortality was not affected by the inclusion of other pollutants. However, for PM10 and NO2, the inclusion of other pollutants may weaken their effects on mortality.In the meta analysis, electronic searches for relevant literatures were conducted to determine the exposure-response (E-R) functions for each health outcome associated with exposure to air particulate matter, and the "meta analysis" approach was used to combine the E-R functions when there were several studies describing the same health endpoint. As a result, for each health outcome from morbidity to mortality changes, the relative risks (mean and 95% CI) were estimated when the concentration of air particulate matter increased certain amount of units, which can then be applied to health risk assessment of air particulate matter in other cities in China. Based on the data mentioned above, the health impact of ambient air pollution in Shanghai was estimated quantitatively. It was estimated that PM10 level was associated with 8,220 excess deaths in Shanghai in 2000, and it accounted for 16,870 new cases o更多还原