归因于环境细颗粒物空气污染的全球和国家慢性肾脏病负担：一项建模研究。

The global and national burden of chronic kidney disease attributable to ambient fine particulate matter air pollution: a modelling study.

机构信息

Clinical Epidemiology Center, VA Saint Louis Health Care System, Saint Louis, Missouri, USA.

Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA.

出版信息

BMJ Glob Health. 2020 Mar 25;5(3):e002063. doi: 10.1136/bmjgh-2019-002063. eCollection 2020.

DOI:10.1136/bmjgh-2019-002063

PMID:32341805

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7173767/

Abstract

INTRODUCTION

We aimed to integrate all available epidemiological evidence to characterise an exposure-response model of ambient fine particulate matter (PM) and the risk of chronic kidney disease (CKD) across the spectrum of PM concentrations experienced by humans. We then estimated the global and national burden of CKD attributable to PM.

METHODS

We collected data from prior studies on the association of PM with CKD and used an integrative meta-regression approach to build non-linear exposure-response models of the risk of CKD associated with PM exposure. We then estimated the 2017 global and national incidence, prevalence, disability-adjusted life-years (DALYs) and deaths due to CKD attributable to PM in 194 countries and territories. Burden estimates were generated by linkage of risk estimates to Global Burden of Disease study datasets.

RESULTS

The exposure-response function exhibited evidence of an increase in risk with increasing PM concentrations, where the rate of risk increase gradually attenuated at higher PM concentrations. Globally, in 2017, there were 3 284 358.2 (95% UI 2 800 710.5 to 3 747 046.1) incident and 122 409 460.2 (108 142 312.2 to 136 424 137.9) prevalent cases of CKD attributable to PM, and 6 593 134.6 (5 705 180.4 to 7 479 818.4) DALYs and 211 019.2 (184 292.5 to 236 520.4) deaths due to CKD attributable to PM. The burden was disproportionately borne by low income and lower middle income countries and exhibited substantial geographic variability, even among countries with similar levels of sociodemographic development. Globally, 72.8% of prevalent cases of CKD attributable to PM and 74.2% of DALYs due to CKD attributable to PM were due to concentrations above 10 µg/m, the WHO air quality guidelines.

CONCLUSION

The global burden of CKD attributable to PM is substantial, varies by geography and is disproportionally borne by disadvantaged countries. Most of the burden is associated with PM levels above the WHO guidelines, suggesting that achieving those targets may yield reduction in CKD burden.

摘要

引言

本研究旨在整合所有现有流行病学证据，以描述人类暴露于细颗粒物（PM）浓度范围内的浓度与慢性肾脏病（CKD）风险之间的暴露-反应模型。然后，我们估计了归因于 PM 的全球和国家 CKD 负担。

方法

我们收集了先前关于 PM 与 CKD 关联的研究数据，并使用综合荟萃回归方法构建了与 PM 暴露相关的 CKD 风险的非线性暴露-反应模型。然后，我们估计了 194 个国家和地区 2017 年归因于 PM 的 CKD 的全球和国家发病率、患病率、残疾调整生命年（DALY）和死亡人数。通过将风险估计与全球疾病负担研究数据集联系起来，生成了负担估计值。

结果

暴露-反应函数显示出随着 PM 浓度的增加风险增加的证据，其中在更高的 PM 浓度下风险增加的速度逐渐减弱。在全球范围内，2017 年归因于 PM 的新发 CKD 病例为 3284358.2 例（95%UI 为 2800710.5 至 3747046.1），122409460.2 例（108142312.2 至 136424137.9）为 CKD 患者，6593134.6 例（5705180.4 至 7479818.4）为 DALY 和 211019.2 例（184292.5 至 236520.4）归因于 CKD 的死亡。低收入和中低收入国家的负担不成比例，并且即使在社会人口发展水平相似的国家之间，也存在很大的地理差异。全球范围内，72.8%的归因于 PM 的 CKD 患者和 74.2%的归因于 PM 的 CKD DALY 是由高于 10μg/m3 的浓度引起的，这是世界卫生组织的空气质量指南。