长期暴露于环境空气中的污染物与英国生物库中肺炎风险增加之间的关系。
Long-term Exposure to Ambient Air Pollutants and Increased Risk of Pneumonia in the UK Biobank.
机构信息
Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Center for Statistics in Medicine, NDORMS, University of Oxford, The Botnar Research Centre, Oxford, England.
出版信息
Chest. 2023 Jul;164(1):39-52. doi: 10.1016/j.chest.2023.02.018. Epub 2023 Feb 18.
BACKGROUND
Short-term exposure to air pollution has been linked to pneumonia risk. However, evidence on the long-term effects of air pollution on pneumonia morbidity is scarce and inconsistent. We investigated the associations of long-term air pollutant exposure with pneumonia and explored the potential interactions with smoking.
RESEARCH QUESTION
Is long-term exposure to ambient air pollution associated with the risk of pneumonia, and does smoking modify the associations?
STUDY DESIGN AND METHODS
We analyzed data in 445,473 participants without pneumonia within 1 year before baseline from the UK Biobank. Annual average concentrations of particulate matter (particulate matter with a diameter < 2.5 μm [PM] and particulate matter with a diameter < 10 μm [PM]), nitrogen dioxide (NO), and nitrogen oxides (NO) were estimated using land-use regression models. Cox proportional hazards models were used to assess the associations between air pollutants and pneumonia incidence. Potential interactions between air pollution and smoking were examined on both additive and multiplicative scales.
RESULTS
The hazard ratios of pneumonia for each interquartile range increase in PM, PM, NO, and NO concentrations were 1.06 (95% CI, 1.04-1.08), 1.10 (95% CI, 1.08-1.12), 1.12 (95% CI, 1.10-1.15), and 1.06 (95% CI, 1.04-1.07), respectively. There were significant additive and multiplicative interactions between air pollution and smoking. Compared with individuals who had never smoked with low air pollution exposure, individuals who had ever smoked with high air pollution exposure had the highest pneumonia risk (PM: hazard ratio [HR], 1.78; 95% CI, 1.67-1.90; PM: HR, 1.94; 95% CI, 1.82-2.06; NO: HR, 2.06; 95% CI, 1.93-2.21; NO: HR, 1.88; 95% CI, 1.76-2.00). The associations between air pollutants and pneumonia risk persisted in participants exposed to air pollutants concentrations meeting the European Union limits.
INTERPRETATION
Long-term exposure to air pollutants was associated with an increased risk of pneumonia, especially in individuals who smoke.
背景
短期暴露于空气污染与肺炎风险有关。然而，关于空气污染对肺炎发病率的长期影响的证据很少且不一致。我们调查了长期空气污染物暴露与肺炎的关联，并探讨了吸烟对这些关联的潜在影响。
研究问题
长期暴露于环境空气中的污染物是否与肺炎风险相关，吸烟是否会改变这种关联？
研究设计和方法
我们分析了英国生物库中 445473 名在基线前 1 年内无肺炎的参与者的数据。使用基于土地利用的回归模型来估计每年的平均颗粒物（直径小于 2.5μm[PM]和直径小于 10μm[PM]的颗粒物）、二氧化氮（NO）和氮氧化物（NO）浓度。使用 Cox 比例风险模型评估了空气污染与肺炎发病率之间的关联。在加性和乘法尺度上检查了空气污染和吸烟之间的潜在相互作用。
结果
PM、PM、NO 和 NO 浓度每增加一个四分位间距，肺炎的危险比分别为 1.06（95%CI，1.04-1.08）、1.10（95%CI，1.08-1.12）、1.12（95%CI，1.10-1.15）和 1.06（95%CI，1.04-1.07）。空气污染和吸烟之间存在显著的加性和乘法相互作用。与低空气污染暴露且从未吸烟的个体相比，高空气污染暴露且有吸烟史的个体肺炎风险最高（PM：危险比[HR]，1.78；95%CI，1.67-1.90；PM：HR，1.94；95%CI，1.82-2.06；NO：HR，2.06；95%CI，1.93-2.21；NO：HR，1.88；95%CI，1.76-2.00）。在暴露于符合欧盟标准的空气污染物浓度的参与者中，空气污染物与肺炎风险之间的关联仍然存在。
解释
长期暴露于空气污染物与肺炎风险增加有关，尤其是在吸烟的人群中。
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