长期暴露于空气污染与妇女健康倡议队列中心律失常风险的关系。
Long-Term Exposures to Air Pollution and the Risk of Atrial Fibrillation in the Women's Health Initiative Cohort.
机构信息
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.
出版信息
Environ Health Perspect. 2021 Sep;129(9):97007. doi: 10.1289/EHP7683. Epub 2021 Sep 15.
BACKGROUND
Atrial fibrillation (AF) is associated with substantial morbidity and mortality. Short-term exposures to air pollution have been associated with AF triggering; less is known regarding associations between long-term air pollution exposures and AF incidence.
OBJECTIVES
Our objective was to assess the association between long-term exposures to air pollution and distance to road on incidence of AF in a cohort of U.S. women.
METHODS
We assessed the association of high resolution spatiotemporal model predictions of long-term exposures to particulate matter ( and ), sulfur dioxide (), nitrogen dioxide (), and distance to major roads with incidence of AF diagnosis, identified through Medicare linkage, among 83,117 women in the prospective Women's Health Initiative cohort, followed from enrollment in Medicare through December 2012, incidence of AF, or death. Using time-varying Cox proportional hazards models adjusted for age, race/ethnicity, study component, body mass index, physical activity, menopausal hormone therapy, smoking, diet quality, alcohol consumption, educational attainment, and neighborhood socioeconomic status, we estimated the relative risk of incident AF in association with each pollutant.
RESULTS
A total of 16,348 incident AF cases were observed over 660,236 person-years of follow-up. Most exposure-response associations were nonlinear. was associated with risk of AF in multivariable adjusted models [; 95% confidence interval (CI): 1.13, 1.24, comparing the top to bottom quartile, ]. Women living closer to roadways were at higher risk of AF (e.g., ; 95% CI: 1.01, 1.13 for living within of A3 roads, compared with , ), but we did not observe adverse associations with exposures to , , or . There were adverse associations with (top quartile ; 95% CI: 1.05, 1.16, ) and (top quartile ; 95% CI: 1.03, 1.14, ) in sensitivity models adjusting for census region.
DISCUSSION
In this study of postmenopausal women, and distance to road were consistently associated with higher risk of AF. https://doi.org/10.1289/EHP7683.
背景
房颤（AF）与大量发病率和死亡率相关。短期暴露于空气污染与 AF 发作有关; 对于长期空气污染暴露与 AF 发病率之间的关联，了解较少。
目的
我们的目的是评估美国女性队列中长期暴露于空气污染和道路距离与 AF 发病率之间的关系。
方法
我们评估了高分辨率时空模型对颗粒物（ 和 ）、二氧化硫（）、二氧化氮（）和主要道路距离的长期暴露预测与通过医疗保险链接在妇女健康倡议前瞻性队列中确定的 AF 诊断发生率之间的关联，在 Medicare 登记后随访 83117 名女性，直至 2012 年 12 月，AF 发病或死亡。使用时间变化的 Cox 比例风险模型调整年龄、种族/民族、研究组成部分、体重指数、身体活动、绝经激素治疗、吸烟、饮食质量、酒精摄入量、教育程度和邻里社会经济地位，我们估计了与每种污染物相关的新发 AF 的相对风险。
结果
在 660236 人年的随访中，共观察到 16348 例新发 AF 病例。大多数暴露-反应关联是非线性的。 在多变量调整模型中与 AF 风险相关[; 95%置信区间（CI）：1.13，1.24，比较四分位数的顶部和底部]。居住在道路附近的女性发生 AF 的风险更高（例如，与 相比，居住在 A3 道路内的风险更高[; 95%CI：1.01，1.13]），但我们没有观察到与暴露于 、 或 的不良关联。 在调整人口普查区域的敏感性模型中，与 （四分位间距顶部 ; 95%CI：1.05，1.16）和 （四分位间距顶部 ; 95%CI：1.03，1.14）呈负相关。
讨论
在这项针对绝经后妇女的研究中， 和道路距离与 AF 风险增加一致相关。https://doi.org/10.1289/EHP7683.
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