台灣可歸因於PM2.5 暴露之死亡負擔

過去數十年來的研究顯示，細懸浮微粒（PM2.5）的暴露會造成明顯的健康危害。在制定與PM2.5 相關的環境與公共衛生政策時，透過風險評估的方式，可以整合PM2.5 的暴露資料以及流行病學上的關連性，進而量化因為過度暴露所造成的群體健康危害，以及減少暴露所能帶來的健康益處。過去數年來，全球疾病負擔（global burden of disease, GBD）的研究發展日益蓬勃，同時也被用來量化不同健康危險因子對於疾病負擔的影響。本文回顧全球疾病負擔報告中，關於台灣的比較性風險評估，尤其是PM2.5 暴露評估的結果。同時，我們也利用台灣高覆蓋率的空氣品質偵測系統以及健康資訊系統，分析台灣在全國以及地方縣市層級可歸因於PM2.5 暴露之疾病死亡負擔。我們發現，無論是在全球疾病負擔報告中的台灣PM2.5健康風險評估，或是利用本土資料進行的健康風險評估，都發現每年有超過6,000 個以上來自缺血性心臟病、中風、肺癌、慢性阻塞性肺病的死亡個案與PM2.5 的暴露有關（約佔這四個疾病的18.6%）。此外，PM2.5之族群可歸因分率在縣市別分布上有顯著差異。環境中的PM2.5 暴露是引起台灣族群死亡的主要危險因子。為了降低空氣汙染對環境及人體健康的影響，積極、跨部門的介入計畫是必要的措施。

There is compelling epidemiological evidence that links air pollution to increased risk of mortality from cardiopulmonary disease and lung cancer. We reviewed the Global Burden of Disease (GBD) 2013 report on the attributable mortality burden due to PM2.5 exposure in Taiwan. We also conducted a local analysis to quantify the burden of mortality attributable to PM2.5 among Taiwan population in 2014 at the national and subnational levels. Subnational PM2.5 exposure levels were obtained from Taiwan Air Quality Monitoring Network. Relative risks were derived from previously developed exposure-response model. Population attributable fraction for cause-specific mortality was estimated at the county level using the estimated ambient PM2.5 concentrations and the relative risk functions. We found that, both in the GBD analysis and the local analysis, PM2.5 exposure accounted for a substantial mortality burden (over 6,000 deaths) in the Taiwanese population. Nationally the population attributable mortality fraction of PM2.5 for the four disease causes (ischemic heart disease, stroke, COPD, and lung cancer) was 18.6%. Substantial geographic variation in PM2.5 attributable mortality fraction was found. Ambient PM2.5 pollution is a major mortality risk factor in Taiwan. Aggressive and multi-sectoral intervention strategies are urgently needed to bring down the impact of air pollution on environment and health.