School of Community Health Sciences, University of Nevada, Reno, Nevada, United States of America.
PLoS One. 2012;7(3):e33385. doi: 10.1371/journal.pone.0033385. Epub 2012 Mar 14.
Particulate matter (PM) air pollution is increasingly recognized as an important and modifiable risk factor for adverse health outcomes including cardiovascular disease (CVD). However, there are still gaps regarding large population risk assessment. Results from the nationwide Behavioral Risk Factor Surveillance System (BRFSS) were used along with air quality monitoring measurements to implement a systematic evaluation of PM-related CVD risks at the national and regional scales. CVD status and individual-level risk factors were collected from more than 500,000 BRFSS respondents across 2,231 contiguous U.S. counties for 2007 and 2009. Chronic exposures to PM pollutants were estimated with spatial modeling from measurement data. CVD outcomes attributable to PM pollutants were assessed by mixed-effects logistic regression and latent class regression (LCR), with adjustment for multicausality. There were positive associations between CVD and PM after accounting for competing risk factors: the multivariable-adjusted odds for the multiplicity of CVD outcomes increased by 1.32 (95% confidence interval: 1.23-1.43) and 1.15 (1.07-1.22) times per 10 µg/m(3) increase in PM(2.5) and PM(10) respectively in the LCR analyses. After controlling for spatial confounding, there were moderate estimated effects of PM exposure on multiple cardiovascular manifestations. These results suggest that chronic exposures to ambient particulates are important environmental risk factors for cardiovascular morbidity.
颗粒物（PM）空气污染日益被认为是导致不良健康后果（包括心血管疾病（CVD））的重要且可改变的风险因素。然而，在大规模人群风险评估方面仍存在差距。利用全国性的行为危险因素监测系统（BRFSS）的结果，并结合空气质量监测测量数据，在国家和地区范围内对与 PM 相关的 CVD 风险进行了系统评估。2007 年和 2009 年，从 BRFSS 的 50 多万名受访者中收集了 CVD 状况和个体风险因素，这些受访者来自美国 2231 个相邻县。利用空间建模从测量数据中估算了 PM 污染物的慢性暴露。利用混合效应逻辑回归和潜在类别回归（LCR），在多病因调整的基础上评估了归因于 PM 污染物的 CVD 结局。在考虑到竞争风险因素后，CVD 与 PM 之间存在正相关关系：LCR 分析中，PM(2.5)和 PM(10)每增加 10 µg/m(3)，多重 CVD 结局的多变量调整比值分别增加 1.32（95%置信区间：1.23-1.43）和 1.15（1.07-1.22）倍。在控制空间混杂后，PM 暴露对多种心血管表现的估计影响适中。这些结果表明，环境颗粒物的慢性暴露是心血管发病率的重要环境风险因素。
