短期暴露于环境颗粒物与血液透析患者死亡之间的关联：一项在中国的全国性纵向病例对照研究。
Associations between short-term exposure of ambient particulate matter and hemodialysis patients death: A nationwide, longitudinal case-control study in China.
作者信息
Lou Xiaowei, Zhang Ping, Shi Nan, Ding Zhe, Xu Zhonggao, Liu Bicheng, Hu Wenbo, Yan Tiekun, Wang Jinwen, Liu Ling, Zha Yan, Wang Jianqin, Chen Wei, Xu Chenyun, Xu Jinsheng, Jiang Hongli, Ma Huichao, Yuan Weijie, Wang Caili, Liao Yunhua, Wang Deguang, Yao Li, Chen Menghua, Li Guisen, Li Yun, Wang Pei, Li Xuemei, Lu Chen, Tang Wenzhuang, Wan Jianxin, Li Rongshan, Xiao Xiangcheng, Zhang Chun, Jiao Jundong, Zhang Wei, Yuan Jing, Lan Lan, Li Jingsong, Zhang Peng, Zheng Weijun, Chen Jianghua
机构信息
Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; National Key Clinical Department of Kidney Diseases, PR China; Institute of Nephropathy, Zhejiang University, Hangzhou, PR China; College of Medicine, Zhejiang University, Hangzhou, PR China.
Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; National Key Clinical Department of Kidney Diseases, PR China; Institute of Nephropathy, Zhejiang University, Hangzhou, PR China; Zhejiang Dialysis Quality Control Center, PR China.
出版信息
Sci Total Environ. 2022 Dec 15;852:158215. doi: 10.1016/j.scitotenv.2022.158215. Epub 2022 Aug 24.
BACKGROUND
Long-term exposure to particulate air pollutants can lead to an increase in mortality of hemodialysis patients, but evidence of mortality risk with short-term exposure to ambient particulate matter is lacking. This study aimed to estimate the association of short-term exposure to ambient particulate matter across a wide range of concentrations with hemodialysis patients mortality.
METHODS
We performed a time-stratified case-crossover study to estimate the association between short-term exposures to PM and PM and mortality of hemodialysis patients. The study included 18,114 hemodialysis death case from 279 hospitals in 41 cities since 2013. Daily particulate matter exposures were calculated by the inverse distance-weighted model based on each case's dialysis center address. Conditional logistic regression were implemented to quantify exposure-response associations. The sensitivity analysis mainly explored the lag effect of particulate matter.
RESULTS
During the study period, there were 18,114 case days and 61,726 control days. Of all case and control days, average PM and PM levels were 43.98 μg/m and 70.86 μg/m, respectively. Each short-term increase of 10 μg/m in PM and PM were statistically significantly associated with a relative increase of 1.07 % (95 % confidence interval [CI]: 0.99 % - 1.15 %) and 0.89 % (95 % CI: 0.84 % - 0.94 %) in daily mortality rate of hemodialysis patients, respectively. There was no evidence of a threshold in the exposure-response relationship. The mean of daily exposure on the same day of death and one-day prior (Lag 01 Day) was the most plausible exposure time window.
CONCLUSIONS
This study confirms that short-term exposure to particulate matter leads to increased mortality in hemodialysis patients. Policy makers and public health practices have a clear and urgent opportunity to pass air quality control policies that care for hemodialysis populations and incorporate air quality into the daily medical management of hemodialysis patients.
背景
长期暴露于空气中的颗粒物污染物会导致血液透析患者死亡率上升，但缺乏短期暴露于环境颗粒物中导致死亡风险的证据。本研究旨在评估短期暴露于不同浓度环境颗粒物与血液透析患者死亡率之间的关联。
方法
我们进行了一项时间分层病例交叉研究，以评估短期暴露于细颗粒物（PM）和可吸入颗粒物（PM）与血液透析患者死亡率之间的关联。该研究纳入了自2013年以来来自41个城市279家医院的18114例血液透析死亡病例。根据每个病例的透析中心地址，采用反向距离加权模型计算每日颗粒物暴露量。采用条件逻辑回归来量化暴露-反应关联。敏感性分析主要探讨颗粒物的滞后效应。
结果
在研究期间，共有18114个病例日和61726个对照日。在所有病例日和对照日中，PM和PM的平均水平分别为43.98μg/m和70.86μg/m。PM和PM每短期增加10μg/m，分别与血液透析患者每日死亡率相对增加1.07%（95%置信区间[CI]：0.99%-1.15%）和0.89%（95%CI：0.84%-0.94%）具有统计学显著关联。暴露-反应关系中没有阈值证据。死亡当天和前一天（滞后01天）的每日暴露平均值是最合理的暴露时间窗。
结论
本研究证实，短期暴露于颗粒物会导致血液透析患者死亡率增加。政策制定者和公共卫生从业者有明确且紧迫的机会通过空气质量控制政策来关爱血液透析人群，并将空气质量纳入血液透析患者的日常医疗管理中。
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