环境对呼吸疾病急性加重的影响：一项真实世界的大数据研究。
Environmental effects on acute exacerbations of respiratory diseases: A real-world big data study.
机构信息
Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, United States of America; Center for Data Solutions, University of Florida College of Medicine - Jacksonville, United States of America.
Department of Epidemiology, University of Florida College of Medicine & College of Public Health and Health Professions, United States of America.
出版信息
Sci Total Environ. 2022 Feb 1;806(Pt 1):150352. doi: 10.1016/j.scitotenv.2021.150352. Epub 2021 Sep 20.
BACKGROUND
The effects of weather periods, race/ethnicity, and sex on environmental triggers for respiratory exacerbations are not well understood. This study linked the OneFlorida network (~15 million patients) with an external exposome database to analyze environmental triggers for asthma, bronchitis, and COPD exacerbations while accounting for seasonality, sex, and race/ethnicity.
METHODS
This is a case-crossover study of OneFlorida database from 2012 to 2017 examining associations of asthma, bronchitis, and COPD exacerbations with exposures to heat index, PM 2.5 and O 3. We spatiotemporally linked exposures using patients' residential addresses to generate average exposures during hazard and control periods, with each case serving as its own control. We considered age, sex, race/ethnicity, and neighborhood deprivation index as potential effect modifiers in conditional logistic regression models.
RESULTS
A total of 1,148,506 exacerbations among 533,446 patients were included. Across all three conditions, hotter heat indices conferred increasing exacerbation odds, except during November to March, where the opposite was seen. There were significant differences when stratified by race/ethnicity (e.g., for asthma in April, May, and October, heat index quartile 4, odds were 1.49 (95% confidence interval (CI) 1.42-1.57) for Non-Hispanic Blacks and 2.04 (95% CI 1.92-2.17) for Hispanics compared to 1.27 (95% CI 1.19-1.36) for Non-Hispanic Whites). Pediatric patients' odds of asthma and bronchitis exacerbations were significantly lower than adults in certain circumstances (e.g., for asthma during June - September, pediatric odds 0.71 (95% CI 0.68-0.74) and adult odds 0.82 (95% CI 0.79-0.85) for the highest quartile of PM 2.5).
CONCLUSION
This study of acute exacerbations of asthma, bronchitis, and COPD found exacerbation risk after exposure to heat index, PM 2.5 and O 3 varies by weather period, age, and race/ethnicity. Future work can build upon these results to alert vulnerable populations to exacerbation triggers.
背景
天气周期、种族/民族和性别对呼吸恶化的环境诱因的影响尚不清楚。本研究将 OneFlorida 网络（约 1500 万患者）与外部暴露组学数据库相关联，以分析哮喘、支气管炎和 COPD 恶化的环境诱因，同时考虑季节性、性别和种族/民族。
方法
这是一项 2012 年至 2017 年 OneFlorida 数据库的病例交叉研究，研究哮喘、支气管炎和 COPD 恶化与热指数、PM2.5 和 O3 暴露的关联。我们使用患者的居住地址在时空上链接暴露情况，以生成危害和控制期间的平均暴露情况，每个病例作为自己的对照。我们考虑年龄、性别、种族/民族和社区贫困指数作为条件逻辑回归模型中的潜在效应修饰剂。
结果
共纳入 533446 名患者的 1148506 例恶化。在所有三种情况下，热指数越高，恶化的几率就越大，但在 11 月至 3 月期间则相反。按种族/民族分层时存在显著差异（例如，在哮喘方面，4 月份、5 月份和 10 月份，热指数四分位 4 时，非西班牙裔黑人和西班牙裔的几率分别为 1.49（95%置信区间 1.42-1.57）和 2.04（95%置信区间 1.92-2.17），而非西班牙裔白人的几率为 1.27（95%置信区间 1.19-1.36））。在某些情况下，儿科患者的哮喘和支气管炎恶化几率明显低于成年人（例如，在 6 月至 9 月期间，哮喘方面，儿科几率为 0.71（95%置信区间 0.68-0.74），而成年几率为 0.82（95%置信区间 0.79-0.85）对于 PM2.5 的最高四分位）。
结论
这项关于哮喘、支气管炎和 COPD 急性恶化的研究发现，暴露于热指数、PM2.5 和 O3 后，恶化风险因天气期、年龄和种族/民族而异。未来的工作可以在此基础上进一步研究，提醒易感人群注意恶化的诱因。
Zotero 插件