Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ann Epidemiol. 2013 Jul;23(7):395-400. doi: 10.1016/j.annepidem.2013.05.001.
Frailty, a multidimensional syndrome of increased vulnerability, is prevalent post-myocardial infarction (MI) and predicts mortality and recurrent events. We investigated whether chronic exposure to particulate matter ≤2.5 μm in diameter (PM2.5) is associated with the development of post-MI frailty.
Participants (n = 1120) were aged 65 or less and admitted to hospital in central Israel with first MI in 1992 and 1993. Daily measures of PM2.5 recorded at air quality monitoring stations were summarized and chronic exposure was estimated individually using the geo-coded residential location. Frailty assessment was conducted via an index based on deficit accumulation, and those defined as frail (applying a threshold of ≥0.25) at baseline were excluded. Remaining participants who survived to follow-up 10 to 13 years post-MI (n = 848) were reassessed for frailty. Logistic regression models were constructed to evaluate the role of PM2.5 exposure in frailty risk prediction.
Mean exposure to PM2.5 was 24.2 μg/m(3) (range, 16.9-28.6). A total of 301 participants (35.5%) developed frailty during follow-up. Adjusting for sociodemographic and clinical variables, PM2.5 exposure was associated with increased odds of developing frailty (odds ratio, 1.53; 95% confidence interval, 1.22-1.91, comparing the 75th vs. 25th percentiles). Addition of PM2.5 exposure to the multivariable model resulted in an integrated discrimination improvement of 1.60% (P = .005) and a net reclassification index of 6.51% (P = .02).
An association was observed between exposure to PM2.5 and incidence of frailty, providing a potential intermediary between air pollution and post-MI outcomes.
衰弱是一种易损性增加的多维综合征，在心肌梗死后（MI）很常见，并预测死亡率和复发性事件。我们研究了慢性暴露于直径≤2.5μm 的颗粒物（PM2.5）是否与 MI 后衰弱的发展有关。
参与者（n=1120）年龄在 65 岁以下，1992 年和 1993 年在以色列中部因首次 MI 住院。在空气质量监测站记录的 PM2.5 日剂量汇总，并使用地理编码的居住地点单独估计慢性暴露。衰弱评估是通过基于缺陷积累的指数进行的，那些在基线时定义为衰弱（应用阈值≥0.25）的人被排除在外。在 MI 后 10 至 13 年随访期间幸存下来的其余参与者（n=848）再次评估衰弱情况。构建逻辑回归模型评估 PM2.5 暴露在衰弱风险预测中的作用。
PM2.5 的平均暴露量为 24.2μg/m3（范围为 16.9-28.6）。在随访期间，共有 301 名参与者（35.5%）发展为衰弱。调整社会人口统计学和临床变量后，PM2.5 暴露与衰弱发生的几率增加相关（比值比，1.53；95%置信区间，1.22-1.91，比较第 75 百分位与第 25 百分位）。将 PM2.5 暴露纳入多变量模型可使综合鉴别改善 1.60%（P=0.005），净重新分类指数为 6.51%（P=0.02）。
观察到 PM2.5 暴露与衰弱发生率之间存在关联，为空气污染与 MI 后结局之间提供了一个潜在的中介。
