Shamsa El Hussain, Song Zhenfeng, Kim Hyunbae, Shamsa Falah, Hazlett Linda D, Zhang Kezhong
Center for Molecular Medicine & Genetics, The Wayne State University School of Medicine, Detroit, MI, United States of America.
Cancer Coalition of Georgia, Atlanta, GA, United States of America.
PLOS Glob Public Health. 2022 Aug 5;2(8):e0000707. doi: 10.1371/journal.pgph.0000707. eCollection 2022.
Air pollutants, particularly airborne particulate matter with aerodynamic diameter < 2.5μm (PM2.5), have been linked to the increase in mortality and morbidity associated with cardiovascular and metabolic diseases. In this study, we investigated the dose-risk relationships between PM2.5 concentrations and occurrences of cardiovascular and metabolic diseases as well as the confounding socioeconomic factors in Michigan, USA, where PM2.5 levels are generally considered acceptable. Multivariate linear regression analyses were performed to investigate the relationship between health outcome and annual ground-level PM2.5 concentrations of 82 counties in Michigan. The analyses revelated significant linear dose-response associations between PM2.5 concentrations and cardiovascular disease (CVD) hospitalization. A 10 μg/m3 increase in PM2.5 exposure was found to be associated with a 3.0% increase in total CVD, 0.45% increase in Stroke, and a 0.3% increase in Hypertension hospitalization rates in Medicare beneficiaries. While the hospitalization rates of Total Stroke, Hemorrhagic Stroke, and Hypertension in urbanized counties were significantly higher than those of rural counties, the death rates of coronary heart disease and ischemic stroke in urbanized counties were significantly lower than those of rural counties. These results were correlated with the facts that PM2.5 levels in urbanized counties were significantly higher than that in rural counties and that the percentage of the population with health insurance and the median household income in rural counties were significantly lower. While obesity prevalence showed evidence of a weak positive correlation (ρ = 0.20, p-value = 0.078) with PM2.5 levels, there was no significant dose-response association between county diabetes prevalence rates and PM2.5 exposure in Michigan. In summary, this study revealed strong dose-response associations between PM2.5 concentrations and CVD incidence in Michigan, USA. The socioeconomic factors, such as access to healthcare resources and median household income, represent important confounding factors that could override the impact of PM2.5 exposure on CVD mortality.
空气污染物，尤其是空气动力学直径小于2.5微米的空气颗粒物（PM2.5），与心血管疾病和代谢性疾病相关的死亡率和发病率增加有关。在本研究中，我们调查了美国密歇根州PM2.5浓度与心血管疾病和代谢性疾病发生率之间的剂量-风险关系，以及混杂的社会经济因素，该州的PM2.5水平通常被认为是可接受的。进行了多变量线性回归分析，以研究密歇根州82个县的健康结果与年度地面PM2.5浓度之间的关系。分析揭示了PM2.5浓度与心血管疾病（CVD）住院之间存在显著的线性剂量反应关联。发现PM2.5暴露每增加10微克/立方米，医疗保险受益人的总CVD增加3.0%，中风增加0.45%，高血压住院率增加0.3%。虽然城市化县的总中风、出血性中风和高血压住院率显著高于农村县，但城市化县的冠心病和缺血性中风死亡率显著低于农村县。这些结果与以下事实相关：城市化县的PM2.5水平显著高于农村县，农村县的医疗保险人口百分比和家庭收入中位数显著较低。虽然肥胖患病率与PM2.5水平呈弱正相关（ρ = 0.20，p值 = 0.078），但密歇根州各县糖尿病患病率与PM2.5暴露之间没有显著的剂量反应关联。总之，本研究揭示了美国密歇根州PM2.5浓度与CVD发病率之间存在强烈的剂量反应关联。社会经济因素，如获得医疗资源的机会和家庭收入中位数，是重要的混杂因素，可能会掩盖PM2.5暴露对CVD死亡率的影响。
