Wang Ying, Wei Jing, Zhang Yuqin, Guo Tong, Chen Shirui, Wu Wenjing, Chen Shimin, Li Ziqiang, Qu Yanji, Xiao Jianpeng, Deng Xinlei, Liu Yu, Du Zhicheng, Zhang Wangjian, Hao Yuantao
Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China.
Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, USA.
Environ Int. 2023 Jan;171:107726. doi: 10.1016/j.envint.2022.107726. Epub 2023 Jan 5.
The association between long-term particulate matter (PM) exposure and all-cause mortality has been well-documented. However, evidence is still limited from high-exposed cohorts, especially for PM which is smaller while more toxic than other commonly investigated particles. We aimed to examine the potential casual links of long-term PMs exposure with all-cause mortality in high-exposed areas.
A total of 580,757 participants in southern China were enrolled during 2009-2015 and followed up to 2020. The annual average concentration of PM, PM, and PM at 1 km spatial resolution was assessed for each residential address through validated spatiotemporal models. We used marginal structural Cox models to estimate the PM-mortality associations which were further stratified by sociodemographic, lifestyle factors and general exposure levels.
37,578 deaths were totally identified during averagely 8.0 years of follow-up. Increased exposure to all 3 PM size fractions were significantly associated with increased risk of all-cause mortality, with hazard ratios (HRs) of 1.042 (95 % confidence interval (CI): 1.037-1.046), 1.031 (95 % CI: 1.028-1.033), and 1.029 (95 % CI: 1.027-1.031) per 1 μg/m increase in PM, PM, and PM concentrations, respectively. We observed greater effect estimates among the elderly (age ≥ 65 years), unmarried participants, and those with low education attainment. Additionally, the effect of PM, PM, and PM tend to be higher in the low-exposure group than in the general population.
We provided comprehensive evidence for the potential causal links betweenlong-term PM exposureand all-cause mortality, and suggested stronger links for PMcompared to large particles and among certain vulnerable subgroups.
长期暴露于颗粒物（PM）与全因死亡率之间的关联已有充分记录。然而，来自高暴露队列的证据仍然有限，特别是对于比其他常见研究颗粒更小但毒性更大的PM。我们旨在研究高暴露地区长期暴露于PM与全因死亡率之间的潜在因果关系。
2009年至2015年期间，在中国南方共招募了580757名参与者，并随访至2020年。通过经过验证的时空模型，对每个居住地址在1公里空间分辨率下的PM、PM和PM的年平均浓度进行了评估。我们使用边际结构Cox模型来估计PM与死亡率的关联，并根据社会人口学、生活方式因素和一般暴露水平进行进一步分层。
在平均8.0年的随访期间，共确定了37578例死亡病例。所有3种PM粒径分数的暴露增加均与全因死亡率风险增加显著相关，PM、PM和PM浓度每增加1μg/m，危险比（HR）分别为1.042（95%置信区间（CI）：1.037-1.046）、1.031（95%CI：1.028-1.033）和1.029（95%CI：1.027-1.031）。我们在老年人（年龄≥65岁）、未婚参与者和低教育程度者中观察到更大的效应估计值。此外，PM、PM和PM在低暴露组中的效应往往高于一般人群。
我们为长期暴露于PM与全因死亡率之间的潜在因果关系提供了全面证据，并表明与大颗粒相比，PM与特定脆弱亚组之间的联系更强。
