全球污染物与慢性阻塞性肺疾病住院率的关系。系统综述。
Global Associations between Air Pollutants and Chronic Obstructive Pulmonary Disease Hospitalizations. A Systematic Review.
机构信息
1 National Heart and Lung Institute, Imperial College London, London, United Kingdom.
2 Centre for Atmospheric Science, Department of Chemistry, University of Cambridge, Cambridge, United Kingdom.
出版信息
Ann Am Thorac Soc. 2016 Oct;13(10):1814-1827. doi: 10.1513/AnnalsATS.201601-064OC.
RATIONALE
Exacerbations are key events in chronic obstructive pulmonary disease (COPD), affecting lung function decline and quality of life. The effect of exposure to different air pollutants on COPD exacerbations is not clear.
OBJECTIVES
To carry out a systematic review, examining associations between air pollutants and hospital admissions for COPD exacerbations.
METHODS
MEDLINE, Embase, BIOSIS, Science Citation Index, and the Air Pollution Epidemiology Database were searched for publications published between 1980 and September 2015. Inclusion criteria were focused on studies presenting solely a COPD outcome defined by hospital admissions and a measure of gaseous air pollutants and particle fractions. The association between each pollutant and COPD admissions was investigated in metaanalyses using random effects models. Analyses were stratified by geographical clusters for investigation of the consistency of the evidence worldwide.
MEASUREMENTS AND MAIN RESULTS
Forty-six studies were included, and results for all the pollutants under investigation showed marginal positive associations; however, the number of included studies was small, the studies had high heterogeneity, and there was evidence of small-study bias. Geographical clustering of the effects of pollution on COPD hospital admissions was evident and reduced heterogeneity significantly.
CONCLUSIONS
The most consistent association was between a 1-mg/m increase in carbon monoxide level and COPD-related admissions (odds ratio, 1.02; 95% confidence interval, 1.01-1.03). The heterogeneity was moderate, and there was a consistent positive association in both Europe and North America, although levels were clearly below World Health Organization guideline values. There is mixed evidence on the effects of environmental pollution on COPD exacerbations. Limitations of previous studies included the low spatiotemporal resolution of pollutants, inadequate control for confounding factors, and the use of aggregated health data that ignored personal characteristics. The need for more targeted exposure estimates in a large number of geographical locations is evident.
背景
加重是慢性阻塞性肺疾病（COPD）的关键事件，影响肺功能下降和生活质量。暴露于不同空气污染物对 COPD 加重的影响尚不清楚。
目的
进行系统评价，研究空气污染物与 COPD 加重住院之间的关系。
方法
1980 年至 2015 年 9 月期间，检索 MEDLINE、Embase、BIOSIS、科学引文索引和空气污染流行病学数据库中的出版物。纳入标准主要集中在仅报告由住院治疗和气体空气污染物及颗粒分数定义的 COPD 结果的研究上。采用随机效应模型对每个污染物与 COPD 入院之间的关系进行荟萃分析。按地理聚类进行分析，以调查全球证据的一致性。
测量和主要结果
共纳入 46 项研究，所有研究均显示出轻微的阳性关联；然而，纳入的研究数量较少，研究具有较高的异质性，并且存在小样本研究偏倚的证据。空气污染对 COPD 住院的影响的地理聚类明显，且显著降低了异质性。
结论
最一致的关联是一氧化碳水平每增加 1mg/m，与 COPD 相关的入院率（优势比，1.02；95%置信区间，1.01-1.03）增加。异质性中等，在欧洲和北美均存在一致的正相关，尽管水平明显低于世界卫生组织的指导值。有关环境空气污染对 COPD 加重的影响的证据混杂。以往研究的局限性包括污染物的时空分辨率低、混杂因素控制不足以及使用忽略个人特征的综合健康数据。显然需要在更多的地理位置进行更有针对性的暴露估计。
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