Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, United States Environmental Protection Agency, Research Triangle Park, North Carolina, USA.
Environ Health. 2012 Sep 24;11:71. doi: 10.1186/1476-069X-11-71.
Characterizing factors which determine susceptibility to air pollution is an important step in understanding the distribution of risk in a population and is critical for setting appropriate policies. We evaluate general and specific measures of community health as modifiers of risk for asthma and congestive heart failure following an episode of acute exposure to wildfire smoke.
A population-based study of emergency department visits and daily concentrations of fine particulate matter during a wildfire in North Carolina was performed. Determinants of community health defined by County Health Rankings were evaluated as modifiers of the relative risk. A total of 40 mostly rural counties were included in the study. These rankings measure factors influencing health: health behaviors, access and quality of clinical care, social and economic factors, and physical environment, as well as, the outcomes of health: premature mortality and morbidity. Pollutant concentrations were obtained from a mathematically modeled smoke forecasting system. Estimates of relative risk for emergency department visits were based on Poisson mixed effects regression models applied to daily visit counts.
For asthma, the strongest association was observed at lag day 0 with excess relative risk of 66% (28,117). For congestive heart failure the excess relative risk was 42% (5,93). The largest difference in risk was observed after stratifying on the basis of Socio-Economic Factors. Difference in risk between bottom and top ranked counties by Socio-Economic Factors was 85% and 124% for asthma and congestive heart failure respectively.
The results indicate that Socio-Economic Factors should be considered as modifying risk factors in air pollution studies and be evaluated in the assessment of air pollution impacts.
描述决定对空气污染易感性的因素是理解人群中风险分布的重要步骤，对于制定适当的政策至关重要。我们评估了社区健康的一般和具体措施，作为急性暴露于野火烟雾后哮喘和充血性心力衰竭风险的修饰因子。
对北卡罗来纳州野火期间的急诊就诊和细颗粒物日浓度进行了基于人群的研究。评估了由县健康排名定义的社区健康决定因素作为相对风险的修饰因子。共有 40 个主要是农村的县纳入了这项研究。这些排名衡量了影响健康的因素：健康行为、临床护理的可及性和质量、社会和经济因素以及物理环境，以及健康结果：过早死亡和发病。污染物浓度是从数学建模的烟雾预测系统中获得的。急诊就诊的相对风险估计是基于泊松混合效应回归模型应用于每日就诊计数。
对于哮喘，在滞后日 0 时观察到最强的关联，超额相对风险为 66%（28,117）。对于充血性心力衰竭，超额相对风险为 42%（5,93）。在基于社会经济因素进行分层时，观察到的风险差异最大。哮喘和充血性心力衰竭的社会经济因素排名最低和最高的县之间的风险差异分别为 85%和 124%。
结果表明，社会经济因素应被视为空气污染研究中风险因素的修饰因子，并应在评估空气污染影响时进行评估。
