Elser Holly, Morello-Frosch Rachel, Jacobson Alice, Pressman Alice, Kioumourtzoglou Marianthi-Anna, Reimer Richard, Casey Joan A
Stanford University School of Medicine, Stanford Center for Population Health Sciences, Stanford, USA.
Department of Environmental Science, Policy, and Management and School of Public Health, University of California Berkeley, Berkeley, CA, USA.
Environ Health. 2021 Apr 17;20(1):45. doi: 10.1186/s12940-021-00727-w.
Migraine-an episodic disorder characterized by severe headache that can lead to disability-affects over 1 billion people worldwide. Prior studies have found that short-term exposure to fine particulate matter (PM), nitrogen dioxide (NO), and ozone increases risk of migraine-related emergency department (ED) visits. Our objective was to characterize the association between long-term exposure to sources of harmful emissions and common air pollutants with both migraine headache and, among patients with migraine, headache severity.
From the Sutter Health electronic health record database, we identified 89,575 prevalent migraine cases between 2014 and 2018 using a migraine probability algorithm (MPA) score and 270,564 frequency-matched controls. Sutter Health delivers care to 3.5 million patients annually in Northern California. Exposures included 2015 annual average block group-level PM and NO concentrations, inverse-distance weighted (IDW) methane emissions from 60 super-emitters located within 10 km of participant residence between 2016 and 2018, and IDW active oil and gas wells in 2015 within 10 km of each participant. We used logistic and negative binomial mixed models to evaluate the association between environmental exposures and (1) migraine case status; and (2) migraine severity (i.e., MPA score > 100, triptan prescriptions, neurology visits, urgent care migraine visits, and ED migraine visits per person-year). Models controlled for age, sex, race/ethnicity, Medicaid use, primary care visits, and block group-level population density and poverty.
In adjusted analyses, for each 5 ppb increase in NO, we observed 2% increased odds of migraine case status (95% CI: 1.00, 1.05) and for each 100,000 kg/hour increase in IDW methane emissions, the odds of case status also increased (OR = 1.04, 95% CI: 1.00, 1.08). We found no association between PM or oil and gas wells and migraine case status. PM was linearly associated with neurology visits, migraine-specific urgent care visits, and MPA score > 100, but not triptans or ED visits. NO was associated with migraine-specific urgent care and ED visits, but not other severity measures. We observed limited or null associations between continuous measures of methane emissions and proximity to oil and gas wells and migraine severity.
Our findings illustrate the potential role of long-term exposure to multiple ambient air pollutants for prevalent migraine and migraine severity.
偏头痛是一种发作性疾病，其特征为严重头痛，可导致功能障碍，全球有超过10亿人受其影响。先前的研究发现，短期接触细颗粒物（PM）、二氧化氮（NO）和臭氧会增加偏头痛相关的急诊就诊风险。我们的目的是描述长期接触有害排放源和常见空气污染物与偏头痛头痛以及偏头痛患者头痛严重程度之间的关联。
从萨特健康电子健康记录数据库中，我们使用偏头痛概率算法（MPA）评分在2014年至2018年期间识别出89575例偏头痛现患病例和270564例频率匹配的对照。萨特健康每年在北加利福尼亚为350万患者提供医疗服务。暴露因素包括2015年街区组水平的年度平均PM和NO浓度、2016年至2018年期间距离参与者住所10公里内60个超级排放源的反距离加权（IDW）甲烷排放量，以及2015年距离每个参与者10公里内的IDW活跃油气井。我们使用逻辑和负二项混合模型来评估环境暴露与（1）偏头痛病例状态；以及（2）偏头痛严重程度（即每人每年MPA评分>100、曲坦类药物处方、神经内科就诊、偏头痛紧急护理就诊和急诊偏头痛就诊）之间的关联。模型控制了年龄、性别、种族/族裔、医疗补助使用情况、初级保健就诊次数以及街区组水平的人口密度和贫困程度。
在调整分析中，NO每增加5 ppb，我们观察到偏头痛病例状态的几率增加2%（95% CI：1.00，1.05），IDW甲烷排放量每增加100000千克/小时，病例状态的几率也增加（OR = 1.04，95% CI：1.00，1.08）。我们发现PM或油气井与偏头痛病例状态之间无关联。PM与神经内科就诊、偏头痛特异性紧急护理就诊以及MPA评分>100呈线性相关，但与曲坦类药物或急诊就诊无关。NO与偏头痛特异性紧急护理和急诊就诊有关，但与其他严重程度指标无关。我们观察到甲烷排放的连续测量值以及与油气井的距离与偏头痛严重程度之间的关联有限或无关联。
我们的研究结果说明了长期接触多种环境空气污染物对偏头痛现患率和偏头痛严重程度的潜在作用。
