Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Chapel Hill, NC, USA; Oak Ridge Associated Universities, Oak Ridge, TN, USA.
School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
Environ Res. 2023 Jul 1;228:115839. doi: 10.1016/j.envres.2023.115839. Epub 2023 Apr 5.
Air pollution exposure is a significant risk factor for morbidity and mortality, especially for those with pre-existing chronic disease. Previous studies highlighted the risks that long-term particulate matter exposure has for readmissions. However, few studies have evaluated source and component specific associations particularly among vulnerable patient populations.
Use electronic health records from 5556 heart failure (HF) patients diagnosed between July 5, 2004 and December 31, 2010 that were part of the EPA CARES resource in conjunction with modeled source-specific fine particulate matter (PM) to estimate the association between exposure to source and component apportioned PM at the time of HF diagnosis and 30-day readmissions.
We used zero-inflated mixed effects Poisson models with a random intercept for zip code to model associations while adjusting for age at diagnosis, year of diagnosis, race, sex, smoking status, and neighborhood socioeconomic status. We undertook several sensitivity analyses to explore the impact of geocoding precision and other factors on associations and expressed associations per interquartile range increase in exposures.
We observed associations between 30-day readmissions and an interquartile range increase in gasoline- (16.9% increase; 95% confidence interval = 4.8%, 30.4%) and diesel-derived PM (9.9% increase; 95% confidence interval = 1.7%, 18.7%), and the secondary organic carbon component of PM (SOC; 20.4% increase; 95% confidence interval = 8.3%, 33.9%). Associations were stable in sensitivity analyses, and most consistently observed among Black study participants, those in lower income areas, and those diagnosed with HF at an earlier age. Concentration-response curves indicated a linear association for diesel and SOC. While there was some non-linearity in the gasoline concentration-response curve, only the linear component was associated with 30-day readmissions.
There appear to be source specific associations between PM and 30-day readmissions particularly for traffic-related sources, potentially indicating unique toxicity of some sources for readmission risks that should be further explored.
空气污染暴露是发病率和死亡率的一个重要危险因素，尤其是对那些患有先前存在的慢性疾病的人。先前的研究强调了长期颗粒物暴露对再入院的风险。然而，很少有研究评估特定来源和成分的关联，特别是在脆弱的患者群体中。
利用 2004 年 7 月 5 日至 2010 年 12 月 31 日期间诊断为心力衰竭（HF）的 5556 名患者的电子健康记录，这些患者是 EPA CARES 资源的一部分，并结合模型化的特定来源的细颗粒物（PM），来估计在 HF 诊断时暴露于来源和成分分配的 PM 与 30 天再入院之间的关联。
我们使用具有邮政编码随机截距的零膨胀混合效应泊松模型来模拟关联，同时调整年龄、诊断年份、种族、性别、吸烟状况和邻里社会经济地位。我们进行了几次敏感性分析，以探索地理编码精度和其他因素对关联的影响，并表示暴露于每增加一个四分位间距的关联。
我们观察到 30 天再入院与汽油衍生的 PM（16.9%的增加；95%置信区间=4.8%，30.4%）和柴油衍生的 PM（9.9%的增加；95%置信区间=1.7%，18.7%）之间存在关联，以及 PM 的二次有机碳成分（SOC；20.4%的增加；95%置信区间=8.3%，33.9%）。敏感性分析中观察到的关联是稳定的，并且在黑人研究参与者、收入较低地区的参与者以及年龄较早被诊断为 HF 的参与者中最为一致。浓度-反应曲线表明柴油和 SOC 之间存在线性关联。虽然汽油浓度-反应曲线存在一定的非线性，但只有线性成分与 30 天再入院有关。
似乎存在 PM 与 30 天再入院之间的特定来源关联，特别是对于与交通相关的来源，这可能表明某些来源对再入院风险具有独特的毒性，应该进一步探索。
