Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Center for Public Health and Environmental Assessment, Oak Ridge Institute for Science and Education at the United States Environmental Protection Agency, Chapel Hill, NC, USA.
Environ Health. 2022 Mar 11;21(1):33. doi: 10.1186/s12940-022-00836-0.
Ambient PM is a ubiquitous air pollutant with demonstrated adverse health impacts in population. Hemodialysis patients are a highly vulnerable population and may be particularly susceptible to the effects of PM exposure. This study examines associations between short-term PM exposure and cardiovascular disease (CVD) and mortality among patients receiving maintenance in-center hemodialysis.
Using the United State Renal Data System (USRDS) registry, we enumerated a cohort of all US adult kidney failure patients who initiated in-center hemodialysis between 1/1/2011 and 12/31/2016. Daily ambient PM exposure estimates were assigned to cohort members based on the ZIP code of the dialysis clinic. CVD incidence and mortality were ascertained through 2016 based on USRDS records. Discrete time hazards regression was used to estimate the association between lagged PM exposure and CVD incidence, CVD-specific mortality, and all-cause mortality 1 t adjusting for temperature, humidity, day of the week, season, age at baseline, race, employment status, and geographic region. Effect measure modification was assessed for age, sex, race, and comorbidities.
Among 314,079 hemodialysis patients, a 10 µg/m increase in the average lag 0-1 daily PM exposure was associated with CVD incidence (HR: 1.03 (95% CI: 1.02, 1.04)), CVD mortality (1.05 (95% CI: 1.03, 1.08)), and all-cause mortality (1.04 (95% CI: 1.03, 1.06)). The association was larger for people who initiated dialysis at an older age, while minimal evidence of effect modification was observed across levels of sex, race, or baseline comorbidities.
Short-term ambient PM exposure was positively associated with incident CVD events and mortality among patients receiving in-center hemodialysis. Older patients appeared to be more susceptible to PM-associated CVD events than younger hemodialysis patients.
环境 PM 是一种普遍存在的空气污染物，已被证明对人群健康有不良影响。血液透析患者是一个高度脆弱的群体，他们可能特别容易受到 PM 暴露的影响。本研究考察了短期 PM 暴露与接受中心血液透析维持治疗的患者心血管疾病 (CVD) 和死亡率之间的关系。
我们使用美国肾脏数据系统 (USRDS) 登记处，对 2011 年 1 月 1 日至 2016 年 12 月 31 日期间开始接受中心血液透析的所有美国成年肾衰竭患者进行了队列研究。根据透析诊所的邮政编码，为队列成员分配了每日环境 PM 暴露估计值。根据 USRDS 记录，在 2016 年之前确定 CVD 发病率和死亡率。离散时间风险回归用于估计滞后 PM 暴露与 CVD 发病率、CVD 特异性死亡率和全因死亡率之间的关联，调整温度、湿度、星期几、季节、基线时的年龄、种族、就业状况和地理区域。评估了年龄、性别、种族和合并症对效应测量的修饰作用。
在 314079 名血液透析患者中，平均滞后 0-1 天的 PM 暴露每增加 10μg/m，与 CVD 发病率（HR：1.03（95%CI：1.02，1.04））、CVD 死亡率（1.05（95%CI：1.03，1.08））和全因死亡率（1.04（95%CI：1.03，1.06））相关。对于在较晚年龄开始透析的患者，这种关联更大，而在性别、种族或基线合并症水平上观察到的效应修饰证据很少。
短期环境 PM 暴露与接受中心血液透析的患者新发 CVD 事件和死亡率呈正相关。与年轻的血液透析患者相比，年龄较大的患者似乎更容易受到 PM 相关 CVD 事件的影响。
