Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China.
Department of Statistics, Guangzhou Health Technology Identification and Human Resources Assessment Center, Guangzhou, Guangdong, China.
J Epidemiol Community Health. 2022 Dec;76(12):984-990. doi: 10.1136/jech-2022-219676. Epub 2022 Oct 5.
Despite ambient air pollution being associated with various adverse cardiovascular outcomes, the acute effects of ambient air pollution on hospital readmissions for heart failure (HF) among post-discharge patients with hypertension remain less understood.
We conducted a time-stratified case-crossover study among 3660 subjects 60 years or older who were admitted to hospital for HF after discharge for hypertension in Guangzhou, China during 2016-2019. For each subject, individualised residential exposures to ambient particulate matter with an aerodynamic diameter ≤1 µm (PM), ≤2.5 µm (PM), ≤10 µm (PM), sulfur dioxide (SO), nitrogen dioxide (NO), carbon monoxide (CO) and ozone were extracted from our validated grid dataset.
An IQR increase of lag 04-day exposure to PM (IQR: 11.6 μg/m), PM (IQR 21.9 μg/m), PM (IQR 35.0 μg/m), SO (IQR 4.4 μg/m), NO (IQR 23.3 μg/m) and CO (IQR 0.25 mg/m) was significantly associated with a 9.77% (95% CI 2.21% to 17.89%), 8.74% (95% CI 1.05% to 17.00%), 13.93% (95% CI 5.36% to 23.20%), 10.81% (95% CI 1.82% to 20.60%), 14.97% (95% CI 8.05% to 22.34%) and 7.37% (95% CI 0.98% to 14.16%) increase in odds of HF readmissions, respectively. With adjustment for other pollutants, the association for NO exposure remained stable, while the associations for PM, PM, PM, SO and CO exposures became insignificant. Overall, an estimated 19.86% of HF readmissions were attributable to NO exposure, while reducing NO exposure to the WHO and China air quality standards would avoid 12.87% and 0.54% of readmissions, respectively. No susceptible populations were observed by sex, age or season.
Short-term exposure to ambient NO was significantly associated with an increased odds of HF readmissions among post-discharge patients with hypertension in older Chinese adults.
尽管环境空气污染与各种不良心血管结局有关，但环境空气污染对高血压出院后心力衰竭（HF）患者住院再入院的急性影响仍知之甚少。
我们在中国广州进行了一项时间分层病例交叉研究，纳入了 2016 年至 2019 年期间因高血压出院后因 HF 住院的 3660 名 60 岁及以上的患者。对于每个患者，从我们经过验证的网格数据集中提取个人居住环境中空气动力学直径≤1μm（PM）、≤2.5μm（PM）、≤10μm（PM）、二氧化硫（SO）、二氧化氮（NO）、一氧化碳（CO）和臭氧的暴露量。
滞后 04 天暴露于 PM（IQR：11.6μg/m）、PM（IQR 21.9μg/m）、PM（IQR 35.0μg/m）、SO（IQR 4.4μg/m）、NO（IQR 23.3μg/m）和 CO（IQR 0.25mg/m）的 IQR 增加与 HF 再入院的几率增加 9.77%（95%CI 2.21%至 17.89%）、8.74%（95%CI 1.05%至 17.00%）、13.93%（95%CI 5.36%至 23.20%）、10.81%（95%CI 1.82%至 20.60%）、14.97%（95%CI 8.05%至 22.34%）和 7.37%（95%CI 0.98%至 14.16%）分别。在调整其他污染物后，NO 暴露的相关性仍然稳定，而 PM、PM、PM、SO 和 CO 暴露的相关性变得不显著。总的来说，估计有 19.86%的 HF 再入院归因于 NO 暴露，而将 NO 暴露降低到世界卫生组织和中国空气质量标准将分别避免 12.87%和 0.54%的再入院。未观察到性别、年龄或季节的易感人群。
在中国老年高血压出院后 HF 患者中，短期暴露于环境 NO 与 HF 再入院的几率增加显著相关。
