Department of Environmental Medicine and.
Department of Population Health, New York University School of Medicine, New York, New York.
Am J Respir Crit Care Med. 2019 Oct 15;200(8):1022-1031. doi: 10.1164/rccm.201806-1161OC.
Many studies have linked short-term exposure to ozone (O) with morbidity and mortality, but epidemiologic evidence of associations between long-term O exposure and mortality is more limited. To investigate associations of long-term (annual or warm season average of daily 8-h maximum concentrations) O exposure with all-cause and cause-specific mortality in the NIH-AARP Diet and Health Study, a large prospective cohort of U.S. adults with 17 years of follow-up from 1995 to 2011. The cohort ( = 548,780) was linked to census tract-level estimates for O. Associations between long-term O exposure (averaged values from 2002 to 2010) and multiple causes of death were evaluated using multivariate Cox proportional hazards models, adjusted for individual- and census tract-level covariates, and potentially confounding copollutants and temperature. Long-term annual average exposure to O was significantly associated with deaths caused by cardiovascular disease (per 10 ppb; hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.01-1.06), ischemic heart disease (HR, 1.06; 95% CI, 1.02-1.09), respiratory disease (HR, 1.04; 95% CI, 1.00-1.09), and chronic obstructive pulmonary disease (HR, 1.09; 95% CI, 1.03-1.15) in single-pollutant models. The results were robust to alternative models and adjustment for copollutants (fine particulate matter and nitrogen dioxide), although some evidence of confounding by temperature was observed. Significantly elevated respiratory disease mortality risk associated with long-term O exposure was found among those living in locations with high temperature ( < 0.05). This study found that long-term exposure to O is associated with increased risk for multiple causes of mortality, suggesting that establishment of annual and/or seasonal federal O standards is needed to more adequately protect public health from ambient O exposures.
许多研究表明，短期臭氧（O）暴露与发病率和死亡率有关，但长期 O 暴露与死亡率之间的关联的流行病学证据更为有限。为了研究长期（每年或暖季每日 8 小时最大浓度的平均值）O 暴露与 NIH-AARP 饮食与健康研究中全因和特定原因死亡率之间的关系，该研究对美国成年人进行了一项大型前瞻性队列研究，随访时间为 1995 年至 2011 年，随访时间为 17 年。该队列（ = 548,780）与臭氧的普查区水平估计值相关联。使用多变量 Cox 比例风险模型评估长期 O 暴露（2002 年至 2010 年的平均值）与多种死因之间的关系，该模型调整了个体和普查区水平的协变量，以及潜在的混杂性污染物和温度。长期年均 O 暴露与心血管疾病（每 10ppb；风险比[HR]，1.03；95%置信区间[CI]，1.01-1.06）、缺血性心脏病（HR，1.06；95% CI，1.02-1.09）、呼吸疾病（HR，1.04；95% CI，1.00-1.09）和慢性阻塞性肺疾病（HR，1.09；95% CI，1.03-1.15）所致死亡显著相关在单污染物模型中。替代模型和对污染物（细颗粒物和二氧化氮）的调整结果稳健，但观察到温度混杂的一些证据。在高温（ < 0.05）地区居住的人群中，长期 O 暴露与呼吸疾病死亡率显著升高相关。这项研究发现，长期接触 O 与多种死亡率风险增加有关，这表明需要建立年度和/或季节性联邦 O 标准，以更充分地保护公众健康免受环境 O 暴露的影响。
