Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong 510515, China; Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China.
Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China.
Sci Total Environ. 2020 Feb 10;703:135523. doi: 10.1016/j.scitotenv.2019.135523. Epub 2019 Nov 14.
Chronic obstructive pulmonary disease (COPD) and tracheal, bronchus, and lung (TBL) cancers are among the leading causes of mortality worldwide. Many environmental factors have been linked to COPD and TBL cancers. This study examined the associations of cumulative environmental quality indices with COPD mortality and TBL cancers mortality, respectively. Environmental Quality Index (EQI) was constructed to represent cumulative environmental quality for the overall environment and 5 major environmental domains (e.g., air, water, built). Associations of each EQI indices with COPD mortality and TBL cancers mortality, across 3109 counties in the 48 contiguous states of the US, were examined using simultaneous autoregressive (SAR) models. Stratified analyses were conducted in females versus males and according to rural-urban continuum codes (RUCC) to assess the heterogeneity across the overall population. Overall poor environmental quality was associated with a percent difference (PD) of 0.75 [95% confidence intervals (95% CI), 0.46, 1.05] in COPD mortality and an PD of 1.22 (95% CI, 0.97, 1.46) in TBL cancers mortality. PDs were higher in females than in males for both COPD and TBL cancers. The built domain had the largest effect on COPD mortality (PD, 0.85; 95% CI, 0.58, 1.12) while the air domain had the largest effect on TBL cancers mortality (PD, 1.54; 95% CI, 1.31, 1.76). The EQI-mortality associations varied among different RUCCs, but no consistent trend was found. This result suggests that poor environmental quality, particularly poor air quality and built environment quality may increase the mortality risk for COPD and that for TBL cancers. Females appear to be more susceptible to the effect of cumulative environmental quality. Our findings highlight the importance of improving overall and domain-specific cumulative environmental quality in reducing COPD and TBL cancer mortalities in the United States.
慢性阻塞性肺疾病（COPD）和气管、支气管和肺（TBL）癌症是全球主要的死亡原因之一。许多环境因素与 COPD 和 TBL 癌症有关。本研究分别检查了累积环境质量指数与 COPD 死亡率和 TBL 癌症死亡率的关联。环境质量指数（EQI）是为代表整体环境和 5 个主要环境领域（如空气、水、建筑）的累积环境质量而构建的。使用同时自回归（SAR）模型，在美国 48 个相邻州的 3109 个县，检查了每个 EQI 指数与 COPD 死亡率和 TBL 癌症死亡率之间的关联。在女性与男性之间以及根据城乡连续体代码（RUCC）进行分层分析，以评估总体人群中的异质性。整体环境质量差与 COPD 死亡率的百分比差异（PD）为 0.75 [95%置信区间（95%CI），0.46，1.05]，与 TBL 癌症死亡率的 PD 为 1.22（95%CI，0.97，1.46）。对于 COPD 和 TBL 癌症，女性的 PD 均高于男性。建筑环境领域对 COPD 死亡率的影响最大（PD，0.85；95%CI，0.58，1.12），而空气环境领域对 TBL 癌症死亡率的影响最大（PD，1.54；95%CI，1.31，1.76）。EQI-死亡率之间的关联在不同的 RUCC 之间有所不同，但没有发现一致的趋势。这一结果表明，较差的环境质量，特别是较差的空气质量和建筑环境质量可能会增加 COPD 和 TBL 癌症的死亡风险。女性似乎更容易受到累积环境质量的影响。我们的研究结果强调了改善整体和特定领域累积环境质量对于降低美国 COPD 和 TBL 癌症死亡率的重要性。
