A significant reduction in hand-foot-mouth disease (HFMD) cases has occurred across the country, since EV-A71 vaccine was licensed for use in China in 2016. We compared the epidemiology and virological characteristics before and after the implementation of EV-A71 vaccination over a 15-y period in Minhang district, Shanghai, and conducted a test-negative design to estimate the vaccine effectiveness (VE) of EV-A71 vaccine against HFMD. A total of 73,160 HFMD cases, 361 severe cases, and 3 fatalities were reported in the Minhang district, Shanghai during 2009-2023. After the implementation of EV-A71 vaccine program, the incidence rate, case-severity rate, and fatality rate of HFMD showed a significant decline by 56.7%, 95.2%, and 100.0%, respectively. The proportion of age group 6-10 y increased by 105.7%. The predominance of EV-A71 and CV-A16 was replaced by CV-A6 and CV-A10 in the post-2017 period. Full-dose immunization coverage rate maintained 50% during 2019-2023. The overall VE against EV-A71-associated HFMD and herpangina was 89.9% (95% CI: 74.5-96.0) for two-dose series and 67.9% (95% CI: 2.6-89.6) for one-dose vaccination. The VE for two-dose vaccination was 92.2%, 88.1%, and 100% against EV-A71-associated outpatient visit, non-severe hospitalization, and severe complications, respectively. There was no cross-protective effect of EV-A71 vaccination against non-EV-A71 serotype infection. EV-A71 vaccination program substantially reduced HFMD burden in Shanghai, with two-dose series providing robust protection against EV-A71-associated HFMD and herpangina. The shift of non-EV-A71 serotypes warrants an effort to develop multivalent vaccines to control HFMD epidemics.

Metabolic syndrome (MS) is a well-established risk factor for chronic kidney disease (CKD), especially in hypertensive patients. These patients are more likely to exhibit additional components of MS, further elevating their risk of developing CKD. This study aimed to investigate the association between the components of MS and the risk of CKD in hypertensive patients. This retrospective cohort study included 51,470 hypertensive patients who participated in the national basic public health services for hypertension management in Minhang District, Shanghai, China. Cases of CKD were identified through linkage with elderly physical examination statistics. Multivariable-adjusted Cox proportional hazard models were used to assess the relationship between the number of MS components and the risk of CKD. Additionally, the study explored the associations between different combinations of MS components and CKD. During the 3-year follow-up period, the incidence of CKD was significantly higher in hypertensive patients with MS compared to those without MS (33.77 vs. 25.67 per 1000 person-years). Hypertensive patients with MS had a 15

ObjectiveTo analyze the impact of diabetes-related deaths on the probability of premature mortality and life expectancy in Minhang District of Shanghai from 2004 to 2023, and to provide reference data for the optimization of targeted prevention and control strategies.MethodsAll death cases involving diabetes among the registered residents of Minhang District from 2004 to 2023 were collected. The probability of premature mortality and life expectancy was computed using the abridged life table method. The average annual percent change (AAPC) was calculated with Joinpoint 4.9.0.0. The Arriaga decomposition method was employed for statistical analyses of the influence of cause-specific and age-specific mortality related to diabetes on life expectancy.ResultsThe total number of diabetes-related mortality, crude mortality, and standardized mortality for both males and females in Minhang District from 2004 to 2023 exhibited an increasing trend (P<0.001). The primary causes of death among diabetes-related cases were cardiovascular disease (37.68%), diabetes mellitus (31.95%), and malignant tumor (17.80%). From 2004 to 2023, probability of premature mortality to diabetes-related diseases demonstrated a rising trend (P<0.001), contrasting with the declining trend observed in the overall population (P=0.001). Males showed a significant upward trajectory (P<0.001), while females displayed a stable pattern. Among the diseases exerting considerable influence, cardiovascular disease and malignant tumor revealed a marked increase over time (P<0.001), whereas diabetes mellitus maintained a stable trend; both factors negatively impacted the reduction in probability of premature mortality. From 2004 to 2023, diabetes-related mortality reduced life expectancy among residents by an average of 1.22 years (-49.89%), indicating a negative impact; the reduction was 1.41 years in males and 0.90 years in females. The age groups exhibiting greater negative contributions differed by genders, namely males aged 50‒54 years and females aged 70‒74 years. Cardiovascular disease, diabetes mellitus, and malignant tumor contributed significantly to this decline (-0.46 years, -0.42 years, -0.20 years, respectively), with male experiencing higher negative contributions than females.ConclusionIn Minhang District, the rising mortality associated with diabetes-related diseases negatively impact both the reduction of the probability of premature mortality and the increase in life expectancy. This trend is primarily attributed to the rapid escalation of mortality and younger age demographic of male residents, which warrants significant attention. It is recommended that, based on the enhancement of case management, efforts should be directed towards the targeted prevention and control of risk factors and high-risk populations.

[Background]Ozone(O3)pollution has gradually become a primary problem of air pollution in recent years.Conducting epidemiological studies on the correlation between O3 concentration variation and risk of cardiovascular and cerebrovascular diseases can provide reference data for O3 risk assessment and related policy making. [Objective]To quantitatively evaluate the effects of O3 exposure on mortalities of cardiovascular and cerebrovascular diseases among residents in Minhang District,Shanghai. [Methods]Data of mortalities of cardiovascular and cerebrovascular diseases,air pollutants,and meteorological factors in Minhang District of Shanghai from January 1,2016 to December 31,2021 were collected.Associations between O3 concentration and the mortalities due to total cardiovascular and cerebrovascular diseases,coronary heart disease,and stroke were analyzed by generalized additive models with a quasi Poisson distribution with different lag patterns,such as current day effect(lag0),single-day lag effects(lag1-lag3),and cumulative lag effects(lag01-lag03).The subgroup analyses of age,sex,and season were conducted.Furthermore,temperature was divided into low,middle,and high levels based on the 25th percentile(P25)and the 75th percentile(P75)to perform hierarchical analyses.Increased excess risks(ER)of death from target diseases caused by a 10 μg·m-3 increase in daily maximum 8 h concentration of O3(O3-8 h)and their 95%confidence intervals(CI)were used to indicate the effects of O3. [Results]The associations between O3 and the risks of death from cardiovascular and cerebrovascular diseases were statistically significant at lag2,lag3,lag02,and lag03(P<0.05),with the greatest effect size observed at lag03.The ER values of death from cardiovascular and cerebrovascular diseases in general population,male residents,and people aged 65 years and older,from coronary heart disease in male residents,and from stroke in general population increased by 1.02%(95%CI:0.36%,1.69%),1.40%(95%CI:0.47%,2.34%),0.87%(95%CI:0.19%,1.55%),1.96%(95%CI:0.49%,3.44%),and 1.02%(95%CI:0.07%,1.98%)for a 10 μg·m-3 increase in O3-8 h concentration at lag03,respectively.During the warm season(from April 1 to September 30),the ER values of death from cardiovascular and cerebrovascular diseases and coronary heart disease per 10 μg·m-3 increase in O3 were 1.18%(95%CI:0.33%,3.33%)and 2.69%(95%CI:0.39%,5.03%),while the O3 effect was only statistically significant on cardiovascular and cerebrovascular diseases during the cold season(from October 1 to March 31 next year).At the middle and high temperature levels,the ER values of death from cardiovascular and cerebrovascular dis-eases increased by 1.63%(95%CI:0.32%,2.96%)and 1.14%(95%CI:0.17%,2.12%)respectively.The two-pollutant models showed similar results after including other pollutants(carbon monoxide,nitrogen dioxide,sulfur dioxide,fine particulate matter,or inhalable particulate matter). [Conclusion]Ambient O3 pollution may increase the mortality risks of cardiovascular and cerebrovascular diseases,coronary heart dis-ease,and stroke in Minhang District of Shanghai.

The vaccination rate of COVID-19 in preschool children is low, and parents' intention to vaccinate their children is also low due to multiple factors. This study aimed to establish an integrated model based on the Health Belief Model (HBM)and Theory of Planned Behavior (TPB), to explore the factors influencing parents' intention to vaccinate their preschool children with the first and second doses of COVID-19 vaccines. A total of 1264 parents of preschool children from 10 kindergartens participated in this study. Hierarchical multiple logistic regression was used to analyze the intention separately. For the integrated model with the first dose of vaccine of COVID-19, introducing the HBM variable in model 1 explained 33.98% of the variance (F = 398.71, p < .001), then upon adding the TPB variable in model 2, the explanation of variance increased to 41.93% (F = 491.94, p < .001) and parents' intention were associated with their perceived barriers, cues to action, and subjective norms. For the integrated model with the second dose of vaccine of COVID-19, introducing the HBM variable in Model 1 explained 23.76% of the variance (F = 68.82, p < .001), then upon adding the TPB variable in model 2, the explanation of variance increased to 26.67% (F = 77.24, p < .001), and parents' intention was associated with cues to action and subjective norms. The combination of the two theories improves the explanatory power of parents' intention to vaccinate their preschool children against COVID-19, and provides a basis for the development of effective interventions for vaccination of COVID-19 for preschool children.

Objective To analyze the changes of birth defects among migrating population in Minhang District in order to provide relevant basis for birth defects prevention and relevant policies improvement. Methods The data of newborn birth cases were collected through the “Shanghai Birth Medical Certificate Information System”. The detection rates of newborn birth defects among migrating population in Minhang District from 2007 to 2021 were calculated. Single factor Poisson regression analysis was used for trend analysis. Results From 2007 to 2021, the detection rate of newborn birth defects in Minhang District was 12.57 ‰, among which migrating population was 12.31‰ and showed an upward trend（Wald χ~2=168.23, P＜0.001）. The top five diseases were congenital heart disease, polydactyly and syndactyly, cleft lip and palate, congenital absence of（ear） auricle and microtia, congenital deformities of feet. Among the top five diseases, the detection rate of congenital heart disease showed an upward trend（Wald χ~2=145.25, P＜0.001）, and the detection rates of polydactyly and syndactyly, cleft lip and palate, congenital absence of（ear） auricle and microtia showed a downward trend（P＜0.05）. Conclusion The detection rates of some serious birth defects among the migrating population are still high. It is suggested that the migrating population should still be treated as focus population for birth defects prevention. Thus, the prenatal examination should be strengthened, in order to avoid the occurrence of serious birth defects.

ObjectiveTo analyze the changing trend of cerebrovascular disease burden in Minhang District of Shanghai from 1996 to 2021， and to provide scientific evidence for government to formulate targeted cerebrovascular disease prevention and control strategies.MethodsMortality， years of life lost（YLL）， years of lived with disability（YLD） and disability⁃adjusted life years（DALY） were used to evaluate the burden of cerebrovascular diseases in Minhang District. Joinpoint linear regression was used to analyze the trend of disease burden.ResultsFrom 1996 to 2021， the YLL rate of cerebrovascular diseases in Minhang District showed a downward trend （whole population： APC=-1.69%， t=-6.9， P<0.05）， The YLD rate of cerebrovascular diseases showed a slow upward trend （whole population： APC=1.17%， t=3.5， P<0.05）， The DALY rate of cerebrovascular diseases showed a downward trend， and fluctuated since 2003 （whole population： APC= -1.43%， t=-5.6， P<0.05）. The YLL rate of cerebrovascular diseases in men was higher than that in women， and the YLD rate of cerebrovascular diseases in women was higher than that in men. After 2014， the DALY of cerebrovascular diseases in men was higher than that in women. With the increase of age， the burden of cerebrovascular diseases increased， and the burden of disease increased significantly in the age group above 70.ConclusionThe burden of cerebrovascular diseases in Minhang District is at a high level， and there are differences in age， gender and other aspects. Measures such as screening， intervention and rehabilitation need to be improved to reduce disability and premature death caused by cerebrovascular diseases and to reduce the burden of cerebrovascular diseases on individuals， families and society.

新冠疫情发生后,公共卫生体系建设再次引起社会关注.2020年6月,闵行区疾控中心实施品牌科室建设.本文从疾控品牌科室建设出发,阐述品牌科室建设的意义,探讨品牌科室建设的原则、作用以及策略.

目的 分析女性生育年龄与不良出生结局的关系,以探索女性适宜生育年龄.方法 收集2008-2019年上海市闵行区出生登记信息,应用方差分析与x2检验比较各年龄组产妇和新生儿出生特征.采用多元logistic回归模型分析产妇生育特征与不良出生结局的关系.结果 2008-2019年女性平均生育年龄自26.68岁上升至29.97岁,增长3.29岁.高龄产妇(＞35岁)占比自7.77％上升至峰值17.58％.低龄组(＜20岁)早产、低出生体重的风险分别是20～24岁组的1.36倍(95％CI:1.26～1.47)和1.35倍(95％CI:1.21 ～ 1.50);35～39岁组早产、低出生体重与剖宫产的风险分别是20 ～ 24岁组的1.60倍(95％CI:1.47～ 1.73),1.47倍(95％CI:1.33～1.62)和2.21倍(95％CI:2.13～2.29);≥40岁组早产、低出生体重与剖宫产的风险增高为20～24岁组的2.09倍(95％CI:1.81～2.41),2.15倍(95％CI:1.82～2.55)和2.85倍(95％CI:2.64～3.06).结论 低龄与高龄生育均会增加不良出生结局风险,20～24岁组不良出生结局的风险最低,应鼓励育龄妇女在适龄期生育.

[目的]了解上海市闵行区2016—2020年1—4月份居民死亡率及其特征,分析2020年新型冠状病毒肺炎流行期居民死亡率及死因变化.[方法]居民死亡监测数据来自上海市居民死因登记系统,疾病死因分类依据《国际疾病分类》(ICD-10)进行编码、分类.以中国1990年标准人口计算标化死亡率,采用Excel 2016、SPSS 20.0进行分析.[结果]2016—2020年上海市闵行区1—4月份居民平均粗死亡率为281.75/10万,标化死亡率为66.57/10万.近5年死因顺位前五位均依次为循环系统疾病、肿瘤、呼吸系统疾病、内分泌营养代谢疾病和损伤中毒.2020年1—4月份死亡率为近5年最低,呼吸系统疾病死亡率下降较多.[结论]2020年上海市闵行区1—4月份居民死亡率的性别、年龄、死亡地点及死因顺位构成等特征与往年具有一致性,但在具体数值上均有一定差异,存在受新型冠状病毒肺炎疫情影响的可能.

目的 分析T2DM患者与当地户籍人口中全死因死亡及常见死因死亡的风险差异,为国家基本公共卫生服务DM患者管理项目进一步推进及评价提供参考.方法 以上海市闵行区2004～2015年各社区卫生服务中心进行登记管理的52073例新诊断T2DM患者为研究对象,采用回顾性队列研究设计,通过与上海市生命统计系统进行数据链接,追踪研究对象全死因死亡结局.计算患者全死因和常见死因死亡率,通过研究对象全死因及常见死因相对于当地同期户籍人口的标化死亡比(SMR)及95％CI,揭示社区管理对T2DM患者全死因死亡风险的影响.结果 经过349492.69人年随访,发生全死因死亡4535例,其中男2374例,女2161例,粗死亡率分别为1471.92/10万、1160.76/10万,低于全人群,SMR 95％CI为0.79(0.76,0.82)、0.83(0.79,0.86).60岁以上男性及70岁以上女性患者死亡风险低于全人群(P<0.05).结论 经过年龄标化后,本研究T2DM患者中全死因死亡风险低于全人群,基于社区的T2DM患者管理在一定程度上可能降低T2DM患者死亡风险.

The aim of our study was to examine the association between body mass index (BMI) and the risk of cardiovascular disease (CVD)-specific mortality among Chinese adults with hypertension by sex. This study included 212,394 adult hypertensive patients aged 20-85 years registered in the records of Minhang District during 2007-2018. Cox proportional hazards regression was performed to evaluate the association between BMI and CVD-specific mortality among Chinese adults with hypertension. There were 14,029 deaths over an average of 8.24 years (range, 0.19-11.96 years). The multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) across BMI categories (< 18.5 kg/m2, 18.5-24.9 kg/m2 [reference group], 25.0-29.9 kg/m2, and ≥ 30 kg/m2) for CVD-specific mortality were 1.37 (1.22-1.53), 1.00 (reference), 0.95 (0.90-1.01), and 1.21 (1.04-1.40) in males, and 1.44 (1.31-1.59), 1.00 (reference), 0.96 (0.91-1.01), and 1.04 (0.92-1.17) in females. A U-shaped relationship was observed between BMI and CVD-specific mortality (overall association P< 0.001; non-linearity P< 0.001). This association was attenuated in old age. This study revealed a U-shaped relationship between BMI and CVD-specific mortality among hypertensive men and women. In older people, overweight and obesity are potential factors that reduce the risk of CVD death.

Background Relationship between BMI and all-cause mortality in patients with hypertension remains controversial. This study aimed to evaluate the time-varying association between BMI in patients with hypertension and all-cause mortality. Methods This population-based cohort study included 212,394 Chinese adults with hypertension from 2007 to 2015 and was followed up until death, loss-to-follow-up, or December 31, 2018. According to the World Health Organization criteria for Asians, BMI was categorized into five groups: underweight (BMI < 18.5 kg/m 2 ), normal weight (18.5–22.9 kg/m 2 ), overweight (23–24.9 kg/m 2 ), class I obesity (25–29.9 kg/m 2 ) and class II obesity (BMI ≥ 30 kg/m 2 ). Cox model was used to estimate the time-varying association of BMI on the risk of mortality by including the interaction term between BMI and time using restricted cubic spline. Results Compared with normal weight, underweight and class II obesity were associated with higher mortality (Hazard ratio [HRs] at 1 and 10 years of follow-up: 1.51 [95% CI: 1.39–1.65], and 1.27 (1.15–1.41) for underweight, respectively; 1.08 (0.96–1.21), and 1.16 (1.03–1.30) for class II obesity, respectively). However, overweight and class I obesity were associated with lower mortality, although the protective effects gradually attenuated over time (HRs at 1 and 10 years of follow-up: 0.85 (0.81–0.90), and 0.96 (0.91–1.02) for overweight, respectively; 0.80 (0.76–0.84), and 1.04 (0.99–1.10) for class I obesity, respectively). Conclusions We found increased mortality among hypertensive patients with underweight and class II obesity while decreased mortality with overweight and class I obesity was observed during the first 5 years of follow-up. Management efforts for hypertension may target controlling body weight in a reasonable range for patients, and probably more attention should be given to underweight patients.

目的 探讨大气低浓度一氧化碳(CO)对上海市闵行区居民呼吸系统疾病死亡人群的影响,为保护易感人群,评价人群健康效应提供依据.方法 收集2013-01-01/2018-12-31期间CO逐日浓度数据、气象数据及呼吸系统疾病死亡资料,采用时间序列广义相加模型进行分析.结果2013-2018年上海市闵行区CO日均浓度为0.74(0.30～3.02)mg/m3,呼吸系统疾病死亡共4 236例,日均死亡1.93例.滞后4d,CO日均浓度每升高1 mg/m3导致总人群、男性和＞65岁人群呼吸系统疾病死亡风险RR值分别为 1.144(95％CI:1.034～1.255)、1.185(95％CI:1.050～1.320)和 1.141(95％CI:1.027～1.255),但对女性和≤65岁人群的影响无统计学意义.在污染物浓度移动平均值(lag05)时,CO对总人群、男性和＞65岁人群呼吸系统疾病死亡表现出最强累积健康效应.结论 大气低浓度CO与上海市闵行区居民呼吸系统疾病死亡风险增加相关,相关部门应采取措施降低CO污染水平,保护重点高危人群,降低居民呼吸系统疾病死亡率.

目的 应用双变量响应模型分析高血压人群中体质指数(body mass index,BMI)和年龄两个因素对心血管死亡(cardiovascular death,CVD)的共同作用.方法 使用上海市闵行区2007-2015年高血压患者随访数据,建立可加COX比例风险模型,分析BMI、年龄与CVD之间的非线性关联以及两变量的共同作用.结果 BMI、年龄与CVD的关联分别呈"U"型和"J"型.不同年龄,BMI对CVD的影响略有差异.青年和老年群体的死亡风险随BMI的增加而降低,中年群体的死亡风险与BMI的关联略微呈"U"型.结论 双变量响应模型是一种全面了解两变量共同作用的有效的方法.

目的 研究闵行区糖尿病死亡率变化趋势,分析糖尿病死亡的影响因素.方法 运用Joinpoint线性回归模型对1996-2018年闵行区糖尿病死亡率进行时间趋势分析.对2016-2018年闵行区所有提及糖尿病的死亡病例做回顾性调查,运用Cox回归分析2型糖尿病死亡的影响因素.结果 全人群和女性糖尿病标化死亡率以2001年为拐点(全人群APC=14.56％,P＜0.05,女性APC=18.14％,P＜0.05),男性糖尿病标化死亡率呈逐步上升趋势(APC=2.7％,P＜0.05).对3 813例2型糖尿病死亡病例的影响因素分析显示,注射胰岛素、规律服药和患有慢性病的患者死于糖尿病的风险小(P＜0.05),男性、年龄和糖尿病并发症的患者死于糖尿病的风险大(P＜0.05).结论 糖尿病危险因素和并发症均增加死于糖尿病的风险,建议相关部门有针对性地开展糖尿病综合防治工作.

目的 了解上海市闵行区猩红热流行动态,研究猩红热发病规律和趋势,对今后进一步防控提供有效措施.方法 对2008—2018年中国疾病预防控制中心疫情网猩红热监测资料进行描述性统计分析,应用Excel、SPSS等统计软件进行数据分析.结果 2008—2018年闵行区猩红热发病从2011年起明显上升,分别在2011、2015、2017年发病达到小高峰.全区各个街道镇均有疾病发生.发病年龄分布在0～45岁,主要集中在4～15岁,占发病总数的92.71％.男性发病高于女性.发病病例中,学生和幼托机构儿童发病占到95.5％,散居儿童占4.2％.结论 2008—2018年闵行区猩红热发病明显上升,每年4—6月、11月—次年1月为发病高峰季节,学校和托幼机构是发病的高危场所.应进一步加强监测和健康教育,有效控制猩红热的发生.

BackgroundThe relationship between body mass index (BMI) and mortality in hypertension patients remains controversial. This study aimed to evaluate the association and the time-varying effects of different BMI categories on the risk of all-cause mortality in hypertension patients. MethodsThis retrospective cohort study was conducted among 212,394 Chinese people with hypertension. All deaths were identified based on Shanghai Vital Statistics. Cox model combined with time-by-covariate interactions was used to estimate the association and the time-varying effects of BMI on the risk of all-cause mortality. The potential non-linear effects across follow-up period for BMI were examined by the application of restricted cubic spline (RCS).ResultsOverall, 31,130 deaths occurred (14.7%) within an average follow-up of 8.24 years. Underweight (<18.5 kg/m2) showed a progressively weakening negative effect on all-cause mortality over time. For both sexes, overweight (23.0-24.9 kg/m2) and class I obesity (25.0-29.9 kg/m2) showed protective effects within 5 years after registration, but these became insignificant in later years. There was no significant difference in the effect on all-cause mortality between class II obesity (≥30.0 kg/m2) and normal weight. in the elderly patients, overweight, class I obesity and class II obesity had continuous protective effects on mortality.ConclusionsAlthough the effect of baseline body mass index on the risk of all-cause mortality varied at different follow-up periods, underweight persistently remained a risk factor for all-cause mortality in hypertension, whereas overweight and class I obesity had protective effects. Thus, in the long-term management of hypertension, more attention should be given to underweight patients.

This study aims to investigate the serial multiple mediation of physical activity and perceived stress in the relationship between individual social capital and quality of life (QOL) in breast cancer survivors (BCSs). This study was conducted among 520 BCSs between March and April 2017 in Shanghai, China. Data were collected using the Individual Social Capital Scale, the Health-Promoting Lifestyle Profile-II, the Perceived Stress Scale-14 and the EORTC QLQ-C30. Ordinary least-squares regression and the bootstrap method was used to test the significance of the serial multiple mediation model. The serial-multiple mediations of physical activity and perceived stress were found significant in the relationship of QOL with all five dimensions of individual social capital. The separate mediations of two single mediating variables were found significant in the relationship of QOL with control over life and feeling about the community. In the relationship of QOL with social participation, social network and social support, the separate mediation of physical activity was significant, while the separate mediation of perceived stress was not significant. A multidisciplinary team approach and a variety of delivery systems are needed to address the social, physical and psychological issues for improving QOL among BCSs.

[背景]针对低浓度一氧化碳(CO)暴露对人群心脑血管疾病死亡的短期效应,在不同地域不同的人群中开展流行病学研究,可为制定控制大气CO污染的行政决策提供参考,为CO毒理、生理学研究提供线索,具有一定的现实意义.[目的]定量评价低浓度CO对人群心脑血管疾病死亡的短期效应.[方法]收集2013年1月1日-2018年12月31日上海市闵行区居民总心脑血管疾病及冠心病、中风的每日死亡数据以及同期上海市大气污染物[CO、二氧化硫(SO2)、二氧化氮(NO2)、细颗粒物(PM2.5)、可吸入颗粒物(PM10)]浓度和气象资料(平均温度和相对湿度).采用广义相加模型,在控制了长期趋势、星期几效应及气象因素等混杂因素的基础上,将当日至前5d单日滞后(lag0～lag5)的污染物浓度和当日至前1、3、5d的污染物浓度移动平均值(lag01、lag03、lag05)分别引入模型,分析低浓度CO与总心脑血管疾病、冠心病和中风死亡的关联性,然后同时引入其他大气污染物进行多污染物模型拟合.以超额危险度(ER)及其95％可信区间(CI)表示增加的死亡风险.[结果]研究期间,CO的每日质量浓度(下称浓度)为(0.74±0.28) mg·m-3,远低于我国现行的环境空气质量标准(4 mg·m-3),浓度呈现逐年下降趋势,且具有明显的季节周期性.闵行区因心脑血管疾病死亡总数为19 544人.单污染模型中,CO与总心脑血管疾病、冠心病和中风死亡风险的关联均在lag05时最高,CO浓度每升高0.1mg·m-3,居民总心脑血管疾病、冠心病和中风死亡风险升高,其ER (95％ CI)分别为2.23％(1.34％～3.12％)、1.53％(0.19％～2.89％)和2.76％(1.57％～3.97％).双污染物模型中,在分别调整了PM2.5、PM10、SO2和NO2以后,其效应失去了统计学意义.在最大效应滞后时间(lag05)条件下,CO浓度与3类死因死亡的暴露-反应关系曲线均呈近似线性的缓慢上升状态,且无明显阈值.[结论]低浓度CO暴露对人群总心脑血管疾病、冠心病和中风死亡风险存在急性影响,控制其他空气污染物后的独立效应有待进一步研究.