室外细颗粒物空气污染与心血管疾病的关联：中国城乡前瞻性流行病学研究（PURE-中国）的结果
Associations of outdoor fine particulate air pollution and cardiovascular disease: Results from the Prospective Urban and Rural Epidemiology Study in China (PURE-China).
作者信息
Xia Yanjie, Liu Zhiguang, Hu Bo, Rangarajan Sumathy, Ah Tse Lap, Li Yang, Wang Junying, Hu Lihua, Wang Yang, Xiang Quanyong, Lin Yang, Han Guoliang, Yusuf Salim, Li Wei
机构信息
Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
出版信息
Environ Int. 2023 Apr;174:107829. doi: 10.1016/j.envint.2023.107829. Epub 2023 Feb 15.
BACKGROUND
Evidence on whether an excess risk of incidence and mortality of cardiovascular disease (CVD) among people exposed to a high level of ambient PM in low- and middle-income countries (LMICs) is lacking. This study aimed to investigate the associations between long-term exposure to ambient fine particulate matter<2.5 µm (PM) concentrations and the risk of incidence and mortality of CVD in a large cohort study from 115 communities.
METHODS
In this cohort study, we followed 42 160 adults aged 35-75 years at baseline who enrolled in the Prospective Urban and Rural Epidemiology Study conducted in China (PURE-China) between 2005 and 2009 with ambient PM estimates, and followed up until August 2021. Cox proportional hazards frailty models were used to estimate the associations between long-term mean outdoor PM concentrations and CVD events, CVD mortality, and all-cause mortality.
FINDINGS
During a median follow-up period of 11.8 years, we documented 2 190 deaths, including 732 CVD deaths. There were 4 559 (10.8 %) of 42 160 participants who experienced incident total CVD, among them there were 861 myocardial infarctions (MI) and 2 338 S. The 3-year median concentration of ambient PM before the cohort commencement was 52.7 µg/m (interquartile range [IQR] 30.3-74.6). In full adjusted model, a 10 µg/m increase in PM was associated with a hazard ratio (HR) of 1.12 (95 % CI 1.11-1.14) for major CVD and 1.03 (95 % CI 1.01-1.05) for all-cause mortality. Besides, long-term PM concentrations had a significantly positive gradient association with total CVD and a similar pattern of associations with other CVD outcomes was observed.
INTERPRETATION
This study demonstrated that long-term ambient PM concentrations is positively associated with increased risks of CVD in adults aged 35-70 years from China. This finding reinforces the need for policymakers to adopt more effective strategies to improve air quality.
背景
在低收入和中等收入国家（LMICs），暴露于高水平环境细颗粒物（PM）的人群中心血管疾病（CVD）发病率和死亡率是否存在额外风险，目前缺乏相关证据。本研究旨在通过一项来自115个社区的大型队列研究，调查长期暴露于环境细颗粒物<2.5微米（PM）浓度与CVD发病率和死亡率风险之间的关联。
方法
在这项队列研究中，我们对42160名年龄在35 - 75岁的成年人进行了随访，这些人在2005年至2009年期间参加了中国进行的城乡前瞻性流行病学研究（PURE - China），并对其环境PM进行了估计，随访至2021年8月。采用Cox比例风险脆弱模型来估计长期平均室外PM浓度与CVD事件、CVD死亡率和全因死亡率之间的关联。
结果
在中位随访期11.8年期间，我们记录了2190例死亡，其中包括732例CVD死亡。在42160名参与者中，有4559例（10.8%）发生了CVD事件，其中有861例心肌梗死（MI）和2338例中风。队列开始前3年环境PM的中位浓度为52.7微克/立方米（四分位间距[IQR]30.3 - 74.6）。在完全调整模型中，PM每增加10微克/立方米，主要CVD的风险比（HR）为1.12（95%CI 1.11 - 1.14），全因死亡率的HR为1.03（95%CI 1.01 - 1.05）。此外，长期PM浓度与总CVD呈显著正梯度关联，并且观察到与其他CVD结局有类似的关联模式。
解读
本研究表明，中国35 - 70岁成年人长期暴露于环境PM浓度与CVD风险增加呈正相关。这一发现强化了政策制定者采取更有效策略改善空气质量的必要性。
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