Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China.
China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No. 7 Panjiayuannanli Road, Chaoyang District, Beijing 100021, China.
Environ Int. 2022 Jul;165:107280. doi: 10.1016/j.envint.2022.107280. Epub 2022 May 17.
Evidence for the association between long-term exposure to ozone (O) and cause-specific cardiovascular disease (CVD) mortality is inconclusive, and this association has rarely been evaluated at high O concentrations.
We aim to evaluate the associations between long-term O exposure and cause-specific CVD mortality in a Chinese population.
From 2009 to 2018, 744,882 subjects (median follow-up of 7.72 years) were included in the CHinese Electronic health Records Research in Yinzhou (CHERRY) study. The annual average concentrations of O and fine particulate matter (PM), which were estimated using grids with a resolution up to 1 × 1 km, were assigned to the community address for each subject. The outcomes were deaths from CVD, ischemic heart disease (IHD), myocardial infarction (MI), stroke, and hemorrhagic/ischemic stroke. Time-varying Cox model adjusted for PM and individual-level covariates was used.
The mean of annual average O concentrations was 68.05 μg/m. The adjusted hazard ratio per 10 μg/m O increase was 1.22 (95% confidence interval [CI]: 1.13-1.33) for overall CVD mortality, 1.08 (0.91-1.29) for IHD, 1.21 (0.90-1.63) for MI, 1.28 (1.15-1.43) for overall stroke, 1.39 (1.16-1.67) for hemorrhagic stroke and 1.22 (1.00-1.49) for ischemic stroke, respectively. The study showed that subjects without hypertension had a higher risk for CVD mortality associated with long-term O exposure (1.66 vs. 1.15, p = 0.01).
We observed the association between long-term exposure to high O concentrations and cause-specific CVD mortality in China, independent of PM and other CVD risk factors. This suggested an urgent need to control O pollution, especially in developing countries.
长期暴露于臭氧（O）与特定原因心血管疾病（CVD）死亡率之间的关联证据尚无定论，并且这种关联在高 O 浓度下很少得到评估。
我们旨在评估中国人群中 O 长期暴露与特定原因 CVD 死亡率之间的关系。
2009 年至 2018 年，共纳入 744882 名受试者（中位随访 7.72 年），他们参与了中国鄞州区电子健康记录研究（CHERRY）。O 和细颗粒物（PM）的年平均浓度使用分辨率高达 1×1km 的网格进行估算，并分配给每个受试者的社区地址。结局为 CVD、缺血性心脏病（IHD）、心肌梗死（MI）、中风和出血性/缺血性中风的死亡。使用时间变化的 Cox 模型进行调整，以调整 PM 和个体水平的协变量。
年平均 O 浓度的平均值为 68.05μg/m。O 浓度每增加 10μg/m，整体 CVD 死亡率的调整后危险比为 1.22（95%置信区间 [CI]：1.13-1.33），IHD 为 1.08（0.91-1.29），MI 为 1.21（0.90-1.63），整体中风为 1.28（1.15-1.43），出血性中风为 1.39（1.16-1.67），缺血性中风为 1.22（1.00-1.49）。该研究表明，无高血压的受试者发生 CVD 死亡率与长期 O 暴露相关的风险更高（1.66 比 1.15，p=0.01）。
我们观察到中国长期暴露于高 O 浓度与特定原因 CVD 死亡率之间的关联，与 PM 和其他 CVD 危险因素无关。这表明迫切需要控制 O 污染，尤其是在发展中国家。
