家庭燃料使用与心血管疾病死亡率：戈勒斯坦队列研究
Household Fuel Use and Cardiovascular Disease Mortality: Golestan Cohort Study.
作者信息
Mitter Sumeet S, Vedanthan Rajesh, Islami Farhad, Pourshams Akram, Khademi Hooman, Kamangar Farin, Abnet Christian C, Dawsey Sanford M, Pharoah Paul D, Brennan Paul, Fuster Valentin, Boffetta Paolo, Malekzadeh Reza
机构信息
From Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.M.); Zena and Michael A. Wiener Cardiovascular Institute (R.V., V.F.) and Tisch Cancer Institute and Institute for Translational Epidemiology (F.I., P.B.), Icahn School of Medicine at Mount Sinai, New York, NY; Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (F.I., A.P., R.M.); Surveillance and Health Services Research, American Cancer Society, Atlanta, GA (F.I.); International Agency for Research on Cancer, Lyon, France (H.K., P.B.); Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD (F.K.); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A.); Departments of Oncology and Public Health and Primary Care, University of Cambridge, UK (P.D.P.); Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.); and International Prevention Research Institute, Lyon, France (P.B.).
出版信息
Circulation. 2016 Jun 14;133(24):2360-9. doi: 10.1161/CIRCULATIONAHA.115.020288.
BACKGROUND
Household air pollution is the third largest risk factor for global disease burden, but direct links with cardiovascular disease mortality are limited. This study aimed to evaluate the relationship between household fuel use and cardiovascular disease mortality.
METHODS AND RESULTS
The Golestan Cohort Study in northeastern Iran enrolled 50 045 individuals 40 to 75 years of age between 2004 and 2008 and collected data on lifetime household fuel use and other baseline exposures. Participants were followed up through 2012 with a 99% successful follow-up rate. Cox proportional hazards models were fitted to calculate hazard ratios for associations between pehen (local dung), wood, kerosene/diesel, or natural gas burning for cooking and heating and all-cause and cause-specific mortality, with adjustment for lifetime exposure to each of these fuels and potential confounders. A total of 3073 participants (6%) died during follow-up; 78% of these deaths were attributable to noncommunicable diseases, including cardiovascular, oncological, and respiratory illnesses. Adjusted 10-year hazard ratios from kerosene/diesel burning were 1.06 (95% confidence interval, 1.02-1.10) and 1.11 (95% confidence interval, 1.06-1.17) for all-cause and cardiovascular mortality, respectively. Subtype-specific analyses revealed a significant increase in ischemic heart disease (10-year hazard ratio, 1.14; 95% confidence interval, 1.06-1.21) and a trend toward cerebrovascular accident (10-year hazard ratio, 1.08; 95% confidence interval, 0.99-1.17) mortality. Stratification by sex revealed a potential signal for increased risk for all-cause and cardiovascular disease mortality among women compared with men, with similar risk for ischemic heart disease mortality.
CONCLUSIONS
Household exposure to high-pollution fuels was associated with increased risk for all-cause and cardiovascular disease mortality. Replicating these results worldwide would support efforts to reduce such exposures.
背景
家庭空气污染是全球疾病负担的第三大风险因素，但与心血管疾病死亡率的直接联系有限。本研究旨在评估家庭燃料使用与心血管疾病死亡率之间的关系。
方法与结果
伊朗东北部的戈勒斯坦队列研究在2004年至2008年间招募了50045名40至75岁的个体，并收集了终生家庭燃料使用情况及其他基线暴露数据。对参与者随访至2012年，随访成功率为99%。采用Cox比例风险模型计算使用牛粪（当地粪便）、木材、煤油/柴油或天然气做饭和取暖与全因死亡率及特定病因死亡率之间关联的风险比，并对这些燃料的终生暴露情况和潜在混杂因素进行了调整。共有3073名参与者（6%）在随访期间死亡；其中78%的死亡归因于非传染性疾病，包括心血管疾病、肿瘤疾病和呼吸道疾病。煤油/柴油燃烧的校正10年风险比，全因死亡率为1.06（95%置信区间为1.02 - 1.10），心血管疾病死亡率为1.11（95%置信区间为1.06 - 1.17）。亚型特异性分析显示，缺血性心脏病死亡率显著增加（10年风险比为1.14；95%置信区间为1.06 - 1.21），脑血管意外死亡率有上升趋势（10年风险比为1.08；95%置信区间为0.99 - 1.17）。按性别分层显示，与男性相比，女性全因死亡率和心血管疾病死亡率增加的风险有潜在信号，缺血性心脏病死亡率风险相似。
结论
家庭接触高污染燃料与全因死亡率和心血管疾病死亡率增加有关。在全球范围内重复这些结果将有助于支持减少此类暴露的努力。
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