School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai 200032, China.
Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK.
Environ Sci Technol. 2022 Sep 20;56(18):13200-13211. doi: 10.1021/acs.est.2c03084. Epub 2022 Aug 31.
Few cohort studies explored the long-term effects of ambient fine particulate matter (PM) on incidence of cardiovascular diseases (CVDs), especially in countries with higher levels of air pollution. We aimed to evaluate the association between long-term exposure to PM and incidence of CVD in China. We performed a prospective cohort study in ten regions that recruited 512,689 adults during 2004-2008, with follow-up until 2017. Annual PM concentrations were estimated using a satellite-based model with national coverage and 1 x 1 km spatial resolution. Time-varying Cox proportional hazard regression models were used to estimate hazard ratios (HRs) for all-cause and cause-specific CVDs associated with PM, adjusting for conventional covariates. During 5.08 million person-years of follow-up, 148,030 incident cases of CVD were identified. Long-term exposure to PM showed positive and linear association with incidence of CVD, without a threshold below any concentration. The adjusted HRs per 10 μg/m increase in PM was 1.04 (95%CI: 1.02, 1.07) for total CVD. The risk estimates differed between certain population subgroups, with greater HRs in men, in household with higher income, and in people using unclean heating fuels. This prospective study of large Chinese population provided essential epidemiological evidence for CVD incident risk associated with PM.
在中国，很少有队列研究探讨环境细颗粒物（PM）对心血管疾病（CVD）发病率的长期影响，尤其是在空气污染水平较高的国家。我们旨在评估长期暴露于 PM 与 CVD 发病风险之间的关联。我们在中国十个地区开展了一项前瞻性队列研究，该研究在 2004 年至 2008 年间招募了 512689 名成年人，随访至 2017 年。使用具有全国覆盖范围和 1x1 公里空间分辨率的卫星模型来估算每年的 PM 浓度。采用时变 Cox 比例风险回归模型来估计与 PM 相关的全因和特定病因 CVD 的风险比（HR），调整了常规协变量。在 508 万人年的随访期间，共发现 148030 例 CVD 事件。长期暴露于 PM 与 CVD 发病率呈正相关且呈线性关系，任何浓度都没有阈值。PM 每增加 10μg/m，总 CVD 的调整后 HR 为 1.04（95%CI：1.02，1.07）。某些人群亚组的风险估计值不同，男性、家庭收入较高以及使用不洁取暖燃料的人群的 HR 更高。这项对中国大人群的前瞻性研究为 PM 与 CVD 发病风险相关提供了重要的流行病学证据。
