大气污染与儿童炎症性肠病发病风险：基于人群的队列研究。
Ambient air pollution and the risk of pediatric-onset inflammatory bowel disease: A population-based cohort study.
机构信息
School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada; Air Health Sciences Division, Health Canada, Ontario, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ontario, Canada; ICES uOttawa, Ontario, Canada; CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ontario, Canada; Department of Pediatrics, University of Ottawa, Ontario, Canada.
出版信息
Environ Int. 2020 May;138:105676. doi: 10.1016/j.envint.2020.105676. Epub 2020 Mar 24.
BACKGROUND
High-income nations have the highest rates of inflammatory bowel disease (IBD). The incidence of pediatric-onset IBD is increasing faster than IBD diagnosed in older individuals. Previous epidemiological studies have shown that air pollution might be a risk factor for development of earlier-onset IBD, but results remain mixed.
OBJECTIVES
The objective of this study was to evaluate the associations between maternal and early-life exposures to nitrogen dioxide (NO), fine particulate matter (PM), ozone (O,) and oxidant capacity (O) and risk of pediatric-onset IBD diagnosis.
METHODS
We conducted a retrospective cohort study using linked population-based health administrative data. Singleton livebirths in Ontario, Canada between April 1st, 1991 and March 31st, 2014 were included. We investigated the association between weekly exposures during pregnancy and annual exposures from birth until the age of 18 years, and IBD diagnosed <18 years of age using Cox proportional hazards models. We reported hazard ratios (HR) and 95% confidence intervals (CI) for an associated increase in the interquartile range (IQR) of each pollutant. Models were mutually adjusted for exposures in both prenatal and postnatal periods, as well as for sex, rurality of residence at birth, maternal IBD, and neighborhood income.
RESULTS
2,218,789 newborns were included in this study, of whom 2491 developed IBD during follow-up. Increased associations with pediatric-onset IBD were noted for childhood exposure to O (HR 1.08, 95% CI 1.01-1.16). IBD development was also associated with O during the second trimester (HR 1.21, 95% CI 1.03-1.42), but not the overall pregnancy period (HR 1.12, 95% CI 0.79-1.59). There were no associations of IBD with exposure to NO, PM, or O.
DISCUSSION
Exposure to O during childhood was associated with IBD < 18 years. This suggests that air pollution may impact the developing child physiology in such a way that leads to early onset of IBD.
背景
高收入国家的炎症性肠病（IBD）发病率最高。儿科发病的 IBD 发病率增长速度高于老年个体发病的 IBD。先前的流行病学研究表明，空气污染可能是早发性 IBD 的一个危险因素，但结果仍存在差异。
目的
本研究旨在评估母体和儿童早期接触二氧化氮（NO）、细颗粒物（PM）、臭氧（O3）和氧化剂（O）与儿科发病 IBD 诊断之间的关系。
方法
我们进行了一项回顾性队列研究，使用了基于人群的健康行政数据进行关联。纳入了加拿大安大略省 1991 年 4 月 1 日至 2014 年 3 月 31 日之间出生的单胎活产儿。我们调查了妊娠期间每周暴露量与出生至 18 岁期间每年暴露量之间的关系，以及 <18 岁时诊断为 IBD 的情况。我们报告了每个污染物四分位距（IQR）增加时的风险比（HR）和 95%置信区间（CI）。模型在产前和产后期间相互调整了暴露因素，还调整了性别、出生时居住的农村程度、母体 IBD 和社区收入。
结果
本研究共纳入 2218789 名新生儿，其中 2491 名在随访期间发生了 IBD。儿童时期接触 O3 与儿科发病 IBD 的相关性增加（HR 1.08，95%CI 1.01-1.16）。IBD 的发展也与妊娠中期的 O3 暴露有关（HR 1.21，95%CI 1.03-1.42），但与整个妊娠期间无关（HR 1.12，95%CI 0.79-1.59）。IBD 与接触 NO、PM 或 O3 无关。
讨论
儿童时期暴露于 O3 与 <18 岁 IBD 相关。这表明，空气污染可能以某种方式影响发育中的儿童生理，导致 IBD 早发。
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