美国老年人的低浓度空气污染与死亡率:一项全国队列分析(2001 - 2017年)

Low-Concentration Air Pollution and Mortality in American Older Adults: A National Cohort Analysis (2001-2017).

作者信息

Shi Liuhua, Rosenberg Andrew, Wang Yifan, Liu Pengfei, Danesh Yazdi Mahdieh, Réquia Weeberb, Steenland Kyle, Chang Howard, Sarnat Jeremy A, Wang Wenhao, Zhang Kuo, Zhao Jingxuan, Schwartz Joel

机构信息

Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, United States.

School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, Georgia 30332-0002, United States.

出版信息

Environ Sci Technol. 2022 Jun 7;56(11):7194-7202. doi: 10.1021/acs.est.1c03653. Epub 2021 Dec 21.

Abstract

Mounting epidemiological evidence has documented the associations between long-term exposure to multiple air pollutants and increased mortality. There is a pressing need to determine whether risks persist at low concentrations including below current national standards. Air pollution levels have decreased in the United States, and better understanding of the health effects of low-level air pollution is essential for the amendment of National Ambient Air Quality Standards (NAAQS). A nationwide, population-based, open cohort study was conducted to estimate the association between long-term exposure to low-level PM, NO, O, and all-cause mortality. The study population included all Medicare enrollees (ages 65 years or older) in the contiguous U.S. from 2001 to 2017. We further defined three low-exposure subcohorts comprised of Medicare enrollees who were always exposed to low-level PM (annual mean ≤12-μg/m), NO (annual mean ≤53-ppb), and O (warm-season mean ≤50-ppb), respectively, over the study period. Of the 68.7-million Medicare enrollees, 33.1% (22.8-million, mean age 75.9 years), 93.8% (64.5-million, mean age 76.2 years), and 65.0% (44.7-million, mean age 75.6 years) were always exposed to low-level annual PM, annual NO, and warm-season O over the study period, respectively. Among the low-exposure cohorts, a 10-μg/m increase in PM, 10-ppb increase in NO, and 10-ppb increase in warm-season O, were, respectively, associated with an increase in mortality rate ranging between 10 and 13%, 2 and 4%, and 12 and 14% in single-pollutant models, and between 6 and 8%, 1 and 3%, and 9 and 11% in tripollutant models, using three statistical approaches. There was strong evidence of linearity in concentration-response relationships for PM and NO at levels below the current NAAQS, suggesting that no safe threshold exists for health-harmful pollution levels. For O, the concentration-response relationship shows an increasingly positive association at levels above 40-ppb. In conclusion, exposure to low levels of PM, NO, and warm-season O was associated with an increased risk of all-cause mortality.

摘要

越来越多的流行病学证据记录了长期暴露于多种空气污染物与死亡率上升之间的关联。迫切需要确定在低浓度(包括低于当前国家标准)下风险是否依然存在。美国的空气污染水平已经下降,更好地了解低水平空气污染对健康的影响对于修订国家环境空气质量标准(NAAQS)至关重要。我们开展了一项全国性的、基于人群的开放性队列研究,以评估长期暴露于低水平的颗粒物(PM)、氮氧化物(NO)、臭氧(O₃)与全因死亡率之间的关联。研究人群包括2001年至2017年美国本土所有参加医疗保险的人员(年龄在65岁及以上)。我们进一步定义了三个低暴露亚队列,分别由在研究期间始终暴露于低水平PM(年平均浓度≤12 μg/m³)、NO(年平均浓度≤53 ppb)和O₃(暖季平均浓度≤50 ppb)的医疗保险参保人员组成。在6870万医疗保险参保人员中,分别有33.1%(2280万,平均年龄75.9岁)、93.8%(6450万,平均年龄76.2岁)和65.0%(4470万,平均年龄75.6岁)在研究期间始终暴露于低水平的年PM、年NO和暖季O₃。在低暴露队列中,使用三种统计方法,在单污染物模型中,PM每增加10 μg/m³、NO每增加10 ppb以及暖季O₃每增加10 ppb,死亡率分别增加10%至13%、2%至4%和12%至14%;在三污染物模型中,分别增加6%至8%、1%至3%和9%至11%。有强有力的证据表明,在低于当前NAAQS的水平下,PM和NO的浓度-反应关系呈线性,这表明对健康有害的污染水平不存在安全阈值。对于O₃,在浓度高于40 ppb时,浓度-反应关系显示出越来越强的正相关。总之,暴露于低水平的PM、NO和暖季O₃与全因死亡率风险增加有关。

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