Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
Institute of Chronic Noncommunicable Disease Control and Prevention, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China.
J Am Coll Cardiol. 2021 Jan 26;77(3):271-281. doi: 10.1016/j.jacc.2020.11.033.
Short-term exposure to ambient air pollution has been linked to occurrence of myocardial infarction (MI); however, only a limited number of studies investigated its association with death from MI, and the results remain inconsistent.
This study sought to investigate the association of short-term exposure to air pollution across a wide range of concentrations with MI mortality.
A time-stratified case-crossover study was conducted to investigate 151,608 MI death cases in Hubei province (China) from 2013 to 2018. Based on each case's home address, exposure to particulate matter with an aerodynamic diameter ≤2.5 μm (PM), particulate matter with an aerodynamic diameter ≤10 μm (PM), sulfur dioxide, nitrogen dioxide (NO), carbon monoxide, and ozone on each of the case and control days was assessed as the inverse distance-weighted average concentration at neighboring air quality monitoring stations. Conditional logistic regression models were implemented to quantify exposure-response associations.
Exposure to PM, PM, and NO (mean exposure on the same day of death and 1 day prior) was significantly associated with increased odds of MI mortality. The odds associated with PM and PM exposures increased steeply before a breakpoint (PM, 33.3 μg/m; PM, 57.3 μg/m) and flattened out at higher exposure levels, while the association for NO exposure was almost linear. Each 10-μg/m increase in exposure to PM (<33.3 μg/m), PM (<57.3 μg/m), and NO was significantly associated with a 4.14% (95% confidence interval [CI]: 1.25% to 7.12%), 2.67% (95% CI: 0.80% to 4.57%), and 1.46% (95% CI: 0.76% to 2.17%) increase in odds of MI mortality, respectively. The association between NO exposure and MI mortality was significantly stronger in older adults.
Short-term exposure to PM, PM, and NO was associated with increased risk of MI mortality.
短期暴露于环境空气污染与心肌梗死（MI）的发生有关；然而，仅有少数研究调查了其与 MI 死亡的关系，且结果不一致。
本研究旨在调查广泛浓度范围内短期暴露于空气污染与 MI 死亡率的关系。
本研究采用时间分层病例交叉设计，调查了 2013 年至 2018 年湖北省 151608 例 MI 死亡病例。根据每个病例的家庭住址，在病例和对照日评估空气中可吸入颗粒物（PM2.5）、可吸入颗粒物（PM10）、二氧化硫、二氧化氮（NO）、一氧化碳和臭氧的暴露情况，采用邻近空气质量监测站的反比距离加权平均浓度进行评估。采用条件逻辑回归模型量化暴露-反应关系。
暴露于 PM2.5、PM10 和 NO（死亡当天和前一天的平均暴露水平）与 MI 死亡率增加的几率显著相关。PM2.5 和 PM10 暴露的关联在一个断点（PM2.5，33.3μg/m3；PM10，57.3μg/m3）之前急剧上升，而在较高的暴露水平下趋于平稳，而 NO 暴露的关联几乎呈线性。PM2.5（<33.3μg/m3）、PM10（<57.3μg/m3）和 NO 每增加 10μg/m3，与 MI 死亡率增加的几率分别显著相关 4.14%（95%置信区间[CI]：1.25%至 7.12%）、2.67%（95%CI：0.80%至 4.57%）和 1.46%（95%CI：0.76%至 2.17%）。NO 暴露与 MI 死亡率的关联在老年人中更强。
短期暴露于 PM2.5、PM10 和 NO 与 MI 死亡率增加的风险相关。
