การศึกษาระบาดวิทยาเชิงพื้นที่และเวลาของการเข้ารับการรักษาของผู้ป่วยโรคหืดกับปัจจัยสภาพภูมิอากาศและมิลพิษทางอากาศที่เกิดจากการเปลี่ยนแปลงตามฤดูกาลในจังหวัดสงขลา

Abstract

Introduction: Disease situations have specific attributed in each area and do not occur randomly. Physical and biological characteristics in each area are the factors of spatial epidemiology whereas respiratory symptoms are mainly caused by climate change and air pollution. For instance, asthma is abnormally health condition resulting in allergenic substance reactions and pollution. There were no study on epidemiology to determine spatial, temporal and personal distributions. These are resulted in policy planning, prevention and control in order to take care of human health in the community. Objectives: 1) To examine trends of seasonal changes among asthma outpatients caused by air pollution and meteorological factors. 2) To study the association of asthma outpatients and level of air pollutant contact. 3) To create epidemiological map displaying spatial distribution of asthma patients morbidity rate. Methodology: Spatio-temporal analysis was used to analyze secondary data, from 1 January 2013 to 31 December 2018, of patients in Thailand who are diagnosed as asthma in all sexes and ages and admitted as outpatients in government health care agencies, in charged by Songkhla Provincial Public Health Office. The data were collected from 43 databases of Health Data Center (HDC). Air pollutant data were collected from Ambient Air Quality Monitoring Mobile Unit, Pollution Control Department. The data were analyzed based on Time-series Analysis using Poisson Regression with Generalized Additive model (GAM) and Distributed lag non-linear models (DLNMs) as statistical methods. Results: The overall results showed that 250,127 diagnosed as asthma from 36,761 patients was 448.86 of morbidity rate per 10,000 population. The majority of asthma patients were female (61.1%) which was 529.97 of morbidity rate per 10,000 population. The asthma tended to rapidly increase among children and continuously increase among elderly. The result also showed that the asthma tended to increase distinctly when seasonal changes due to changing of atmosphere and a high humidity, that is, in early of June and the end of raining season in December. GAM was employed to analyze associations between six air pollutants (namely CO, NO2, SO2, O3, PM10 and PM2.5) and daily asthma visits after adjusting confounding i.e. meteorological factors, time, day of the week effects and number of population. In year 2015-2017, the overall asthma visits was increased when air pollutant concentration increase in every 10% ranging from 0.99% (CO at lag 1), 0.95% (NO2 at lag 3), 0.37% (SO2 at lag 1), 0.59% (O3 at lag 0), 2.06% (PM10 at lag 1) and 2.03% (PM2.5 at lag 0) in the Model 3. DLNMs results also suggested that a heterogeneity of the health effects across different populations. There was a significant associations between children under 20 years old group and a lag of 9-14 days during 2015-2017. Multiple regression analysis also reccomended that CO is the highest risk of asthma-patients in the entire population. In addition, the finding of spatial epidemiology illustrated the risk rate at district level showing that the morbidity rate of asthma is higher, especially in Mueang and Hatyai Districts while Saba Yoi District is the lowest. The result also explained the movement across the time period revealing morbidity rate of asthma and the risk of asthma occurrence still increase the same areas. The morbidity rate in high risk areas was 550 to 650 per 10,000 population. Conclusion: This present study showing that asthma patients had high asthmatic attacks caused by high humidity of the weather. Relative humidity and dew point were significant factors of asthma attack. In addition, CO was the significantly highest impacts of visit to health-care facilities among all asthma-patients. In order to reduce and protect human health effects, a humidity controller should be set up in a building. Public health policies should be created for children, women and elderly who were the high risk group to guard from air pollution exposure.