Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.
Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China.
Environ Sci Pollut Res Int. 2023 Jul;30(31):76881-76890. doi: 10.1007/s11356-023-27813-5. Epub 2023 May 29.
Air pollution remains a major threat to cardiovascular health and most acute myocardial infarction (AMI) deaths occur at home. However, currently established knowledge on the deleterious effect of air pollution on AMI has been limited to routinely monitored air pollutants and overlooked the place of death. In this study, we examined the association between short-term residential exposure to China's routinely monitored and unmonitored air pollutants and the risk of AMI deaths at home. A time-stratified case-crossover analysis was undertaken to associate short-term residential exposure to air pollution with 0.1 million AMI deaths at home in Jiangsu Province (China) during 2016-2019. Individual-level residential exposure to five unmonitored and monitored air pollutants including PM (particulate matter with an aerodynamic diameter ≤ 1 μm) and PM (particulate matter with an aerodynamic diameter ≤ 2.5 μm), SO (sulfur dioxide), NO (nitrogen dioxide), and O (ozone) was estimated from satellite remote sensing and machine learning technique. We found that exposure to five air pollutants, even below the recently released stricter air quality standards of the World Health Organization (WHO), was all associated with increased odds of AMI deaths at home. The odds of AMI deaths increased by 20% (95% confidence interval: 8 to 33%), 22% (12 to 33%), 14% (2 to 27%), 13% (3 to 25%), and 7% (3 to 12%) for an interquartile range increase in PM, PM, SO, NO, and O, respectively. A greater magnitude of association between NO or O and AMI deaths was observed in females and in the warm season. The greatest association between PM and AMI deaths was found in individuals aged ≤ 64 years. This study for the first time suggests that residential exposure to routinely monitored and unmonitored air pollutants, even below the newest WHO air quality standards, is still associated with higher odds of AMI deaths at home. Future studies are warranted to understand the biological mechanisms behind the triggering of AMI deaths by air pollution exposure, to develop intervention strategies to reduce AMI deaths triggered by air pollution exposure, and to evaluate the cost-effectiveness, accessibility, and sustainability of these intervention strategies.
空气污染仍然是心血管健康的主要威胁，大多数急性心肌梗死 (AMI) 死亡发生在家庭中。然而，目前关于空气污染对 AMI 的有害影响的知识仅限于常规监测的空气污染物，而忽略了死亡地点。在这项研究中，我们研究了短期居住环境中接触中国常规监测和未监测的空气污染物与家庭内 AMI 死亡风险之间的关系。我们进行了时间分层病例交叉分析，将短期居住环境暴露于空气污染与 2016-2019 年江苏省（中国）100 万例家庭内 AMI 死亡相关联。使用卫星遥感和机器学习技术，从个体层面估算了 5 种未监测和监测的空气污染物（包括 PM（空气动力学直径≤1μm 的颗粒物）和 PM（空气动力学直径≤2.5μm 的颗粒物）、SO（二氧化硫）、NO（二氧化氮）和 O（臭氧））的个人居住环境暴露情况。我们发现，即使接触到低于世界卫生组织（WHO）最近发布的更严格空气质量标准的五种空气污染物，也都与家庭内 AMI 死亡风险增加有关。与 PM 浓度每增加一个四分位距，AMI 死亡的风险分别增加 20%（95%置信区间：8 至 33%）、22%（12 至 33%）、14%（2 至 27%）、13%（3 至 25%）和 7%（3 至 12%）；PM 浓度每增加一个四分位距，AMI 死亡的风险分别增加 20%（95%置信区间：8 至 33%）、22%（12 至 33%）、14%（2 至 27%）、13%（3 至 25%）和 7%（3 至 12%）；SO 浓度每增加一个四分位距，AMI 死亡的风险分别增加 22%（12 至 33%）、14%（2 至 27%）、13%（3 至 25%）、13%（3 至 25%）和 7%（3 至 12%）；NO 浓度每增加一个四分位距，AMI 死亡的风险分别增加 14%（2 至 27%）、13%（3 至 25%）、13%（3 至 25%）、7%（3 至 12%）和 3%（0 至 12%）；O 浓度每增加一个四分位距，AMI 死亡的风险分别增加 7%（3 至 12%）、3%（0 至 12%）、3%（0 至 12%）、3%（0 至 12%）和 1%（0 至 11%）。NO 或 O 与 AMI 死亡之间的关联在女性和温暖季节中更为显著。在≤64 岁的个体中，PM 与 AMI 死亡之间的关联最大。这项研究首次表明，即使接触到低于最新 WHO 空气质量标准的常规监测和未监测的空气污染物，仍与家庭内 AMI 死亡的风险增加有关。未来的研究需要进一步了解空气污染暴露引发 AMI 死亡的生物学机制，制定减少空气污染暴露引发 AMI 死亡的干预策略，并评估这些干预策略的成本效益、可及性和可持续性。
