Division of General Internal Medicine.
University of Utah Health Thrombosis Service, University of Utah Medical Center.
Ann Am Thorac Soc. 2021 Dec;18(12):1988-1996. doi: 10.1513/AnnalsATS.202010-1337OC.
Exposure to outdoor air pollution is associated with increased cardiovascular disease, respiratory illness, and mortality. The effect of air pollution on venous thromboembolism (VTE) is less certain. To test for associations between short-term exposure to air pollution and VTE. This is a retrospective case-crossover study of adult patients with an objectively confirmed VTE event. Exposure to the mean and maximum particulate matter ⩽2.5 μm in aerodynamic diameter (PM) and ozone were estimated with inverse distance squared weighting from multiple stationary air quality monitors. Conditional logistic regression with a 7-day individual lag model estimated the odds ratio (OR) of VTE occurrence during the case period relative to the referent period. Prespecified subgroup analysis was performed to further test associations in higher risk patients. A total of 2,803 VTE events met inclusion criteria for analysis. Deep vein thrombosis was identified in 1,966 (70.1%) and pulmonary embolism in 915 (32.6%) subjects. Median age was 57 years. Small negative associations were observed for the maximum PM exposure at 1 day (OR, 0.992; 95% confidence interval [CI], 0.986-0.997) and the mean PM exposure at 1 day (OR, 0.982; 95% CI, 0.97-0.994), 5 days (OR, 0.987; 95% CI, 0.975-0.999), 6 days (OR, 0.984; 95% CI, 0.972-0.996), and 7 days (OR, 0.982; 95% CI, 0.971-0.994) before VTE diagnosis. Similar negative associations were observed for the 8-hour mean (OR, 0.989; 95% CI, 0.981-0.997) and 8-hour maximum (OR, 0.992; 95% CI, 0.985-0.999) ozone exposure 4 days before VTE diagnosis. Positive relationships (ORs of ∼1.02) between the 8-hour mean and maximum ozone exposures 6-7 days preceding VTE diagnosis were observed in a recently hospitalized subgroup. Short-term exposure to PM and ozone does not appear to be associated with an overall increased risk of VTE. Further well-designed studies are needed to test whether previously reported associations between VTE and air pollution exist.
暴露于室外空气污染与心血管疾病、呼吸道疾病和死亡率的增加有关。空气污染对静脉血栓栓塞症（VTE）的影响尚不确定。本研究旨在检验短期暴露于空气污染与 VTE 之间的关联。
这是一项针对成人 VTE 患者的回顾性病例交叉研究，通过来自多个固定空气质量监测站的倒数平方加权法，对平均和最大空气动力学直径 ⩽2.5 μm 的颗粒物（PM）和臭氧暴露进行评估。采用 7 天个体滞后模型的条件逻辑回归估计了 VTE 发生病例期相对于参照期的比值比（OR）。进行了预设的亚组分析，以进一步检验高危患者中的关联。
共有 2803 例 VTE 事件符合分析纳入标准。深静脉血栓形成（DVT）发生于 1966 例（70.1%）患者，肺栓塞（PE）发生于 915 例（32.6%）患者。中位年龄为 57 岁。观察到最大 PM 暴露 1 天（OR，0.992；95%置信区间[CI]，0.986-0.997）和平均 PM 暴露 1 天（OR，0.982；95% CI，0.97-0.994）、5 天（OR，0.987；95% CI，0.975-0.999）、6 天（OR，0.984；95% CI，0.972-0.996）和 7 天（OR，0.982；95% CI，0.971-0.994）前 VTE 诊断的负相关存在微小差异。在 VTE 诊断前 4 天，8 小时平均（OR，0.989；95% CI，0.981-0.997）和 8 小时最大（OR，0.992；95% CI，0.985-0.999）臭氧暴露也观察到类似的负相关。在最近住院的亚组中，观察到 VTE 诊断前 6-7 天 8 小时平均和最大臭氧暴露之间存在正相关（OR 约为 1.02）。
短期暴露于 PM 和臭氧似乎与 VTE 总体风险增加无关。需要进一步进行设计良好的研究，以检验先前报道的 VTE 与空气污染之间的关联是否存在。
