Public Health Ontario, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China.
Public Health Ontario, Toronto, ON, Canada; ICES, Toronto, ON, Canada.
Environ Int. 2021 Sep;154:106570. doi: 10.1016/j.envint.2021.106570. Epub 2021 Apr 23.
Air pollution has been associated with increased mortality. However, updated evidence from cohort studies with detailed information on various risk factors is needed, especially in regions with low air pollution levels. We investigated the associations between long-term exposure to air pollution and mortality in a prospective cohort.
We studied 88,615 participants aged ≥30 years from an ongoing cohort study in Ontario, Canada from 2009 to 2017. Exposure to ambient fine particulate matter (PM) and nitrogen dioxide (NO) was estimated at participants' residence. Cox proportional hazard models were used to investigate the associations between air pollution and non-accidental, cardiovascular, and respiratory mortality, adjusted for a wide array of individual-level and contextual covariates. Potential effect modification by socio-demographic and behavioral factors was also examined in exploratory stratified analyses.
The fully adjusted hazard ratios (HRs) per 1 µg/m increment in PM were 1.037 [95% confidence interval (CI): 1.018, 1.057]¸ 1.083 (95% CI: 1.040, 1.128) and 1.109 (95% CI: 1.035, 1.187) for non-accidental, cardiovascular, and respiratory mortality, respectively. Positive associations were also found for NO; the corresponding HRs per 1 ppb increment were 1.027 (95% CI: 1.021, 1.034), 1.032 (95% CI: 1.019, 1.046) and 1.044 (95% CI: 1.020, 1.068). We found suggestive evidence of stronger associations in physically active participants, smokers, and those with lower household income.
Long-term exposure to PM and NO was associated with increased risks for non-accidental, cardiovascular, and respiratory mortality, suggesting potential benefits of further improvement in air quality even in low-exposure environments.
空气污染与死亡率的增加有关。然而，需要有关于各种风险因素的详细信息的队列研究的最新证据，特别是在空气污染水平较低的地区。我们在一个前瞻性队列中研究了长期暴露于空气污染与死亡率之间的关系。
我们研究了加拿大安大略省一项正在进行的队列研究中的 88615 名年龄≥30 岁的参与者，该研究从 2009 年至 2017 年进行。在参与者的住所估计了环境细颗粒物（PM）和二氧化氮（NO）的暴露情况。使用 Cox 比例风险模型调查了空气污染与非意外、心血管和呼吸道死亡率之间的关系，这些关系经过了广泛的个体和环境协变量的调整。还在探索性分层分析中检查了社会人口统计学和行为因素的潜在效应修饰作用。
PM 每增加 1μg/m³，完全调整后的危害比（HR）分别为 1.037（95%置信区间（CI）：1.018，1.057）、1.083（95% CI：1.040，1.128）和 1.109（95% CI：1.035，1.187），分别用于非意外、心血管和呼吸道死亡率。对于 NO 也发现了正相关关系；每增加 1ppb 的相应 HR 分别为 1.027（95% CI：1.021，1.034）、1.032（95% CI：1.019，1.046）和 1.044（95% CI：1.020，1.068）。我们发现有迹象表明，在体力活动较多的参与者、吸烟者和家庭收入较低的人群中，这种关联更强。
长期暴露于 PM 和 NO 与非意外、心血管和呼吸道死亡率的风险增加有关，这表明即使在低暴露环境中，进一步改善空气质量也可能带来潜在的益处。
