女性慢性疾病患病率与空气污染——一项 30 年的纵向队列研究。

Chronic disease prevalence in women and air pollution--A 30-year longitudinal cohort study.

机构信息

Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Dalla Lana School of Public Health, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.

出版信息

Environ Int. 2015 Jul;80:26-32. doi: 10.1016/j.envint.2015.03.017. Epub 2015 Apr 6.

DOI:10.1016/j.envint.2015.03.017

PMID:25863281

Abstract

BACKGROUND

Air pollution, such as fine particulate matter (PM2.5), can increase risk of adverse health events among people with heart disease, diabetes, asthma and chronic obstructive pulmonary disease (COPD) by aggravating these conditions. Identifying the influence of PM2.5 on prevalence of these conditions may help target interventions to reduce disease morbidity among high-risk populations.

OBJECTIVES

The objective of this study is to measure the association of exposure of PM2.5 with prevalence risk of various chronic diseases among a longitudinal cohort of women.

METHODS

Women from Ontario who enrolled in the Canadian National Breast Screening Study (CNBSS) from 1980 to 1985 (n = 29,549) were linked to provincial health administrative data from April 1, 1992 to March 31, 2013 to determine the prevalence of major chronic disease and conditions (heart disease, diabetes, asthma, COPD, acute myocardial infarction, angina, stroke and cancers). Exposure to PM2.5 was measured using satellite data collected from January 1, 1998 to December 31, 2006 and assigned to resident postal-code at time of entry into study. Poisson regression models were used to describe the relationship between exposure to ambient PM2.5 and chronic disease prevalence. Prevalence rate ratios (PRs) were estimated while adjusting for potential confounders: baseline age, smoking, BMI, marital status, education and occupation. Separate models were run for each chronic disease and condition.

RESULTS

Congestive heart failure (PR = 1.31, 95% CI: 1.13, 1.51), diabetes (PR = 1.28, 95% CI: 1.16, 1.41), ischemic heart disease (PR = 1.22, 95% CI: 1.14, 1.30), and stroke (PR = 1.21, 95% CI: 1.09, 1.35) showed over a 20% increase in PRs per 10 μg/m(3) increase in PM2.5 after adjusting for risk factors. Risks were elevated in smokers and those with BMI greater than 30.

CONCLUSIONS

This study estimated significant elevated prevalent rate ratios per unit increase in PM2.5 in nine of the ten chronic diseases studied.

摘要

背景

空气污染，如细颗粒物（PM2.5），可通过加重这些病症，增加心脏病、糖尿病、哮喘和慢性阻塞性肺疾病（COPD）患者不良健康事件的风险。识别 PM2.5 对这些病症患病率的影响可能有助于针对高危人群实施干预措施，以降低疾病发病率。

目的

本研究旨在测量 PM2.5 暴露与纵向队列中女性各种慢性疾病患病率之间的关联。

方法

1980 年至 1985 年参加加拿大国家乳房筛查研究（CNBSS）的安大略省妇女（n=29549）与 1992 年 4 月 1 日至 2013 年 3 月 31 日的省级卫生行政数据相关联，以确定主要慢性疾病和病症（心脏病、糖尿病、哮喘、COPD、急性心肌梗死、心绞痛、中风和癌症）的患病率。使用 1998 年 1 月 1 日至 2006 年 12 月 31 日收集的卫星数据来测量 PM2.5 的暴露情况，并将其分配给进入研究时居住的邮政编码。使用泊松回归模型来描述暴露于环境 PM2.5 与慢性疾病患病率之间的关系。在调整潜在混杂因素（基线年龄、吸烟、BMI、婚姻状况、教育程度和职业）后，估计患病率比（PR）。为每种慢性疾病和病症分别运行单独的模型。

结果

充血性心力衰竭（PR=1.31，95%CI：1.13，1.51）、糖尿病（PR=1.28，95%CI：1.16，1.41）、缺血性心脏病（PR=1.22，95%CI：1.14，1.30）和中风（PR=1.21，95%CI：1.09，1.35）在调整风险因素后，PM2.5 每增加 10μg/m3，PR 增加超过 20%。在吸烟者和 BMI 大于 30 的人群中，风险升高。