Kang Suna, Hong Yun Soo, Park Jihwan, Kang Danbee, Kim Hyunsoo, Lee Jin, Kim Woojin, Kang Sung-Won, Guallar Eliseo, Cho Juhee, Park Hye Yun
Korea Environment Institute, Sicheong-daero, Sejong, South Korea.
Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
Ther Adv Chronic Dis. 2023 Jun 6;14:20406223231176175. doi: 10.1177/20406223231176175. eCollection 2023.
Evidence on whether long-term exposure to air pollution increases the mortality risk in patients with chronic obstructive pulmonary disease (COPD) is limited.
We aimed to investigate the associations of long-term exposure to particulate matter with diameter <10 µm (PM) and nitrogen dioxide (NO) with overall and disease-specific mortality in COPD patients.
We conducted a nationwide retrospective cohort study of 121,423 adults ⩾40 years diagnosed with COPD during 1 January to 31 December 2009.
Exposure to PM and NO was estimated for residential location using the ordinary kriging method. We estimated the risk of overall mortality associated with 1-, 3-, and 5-years average concentrations of PM and NO using Cox proportional hazards models and disease-specific mortality using the Fine and Gray method adjusted for age, sex, income, body mass index, smoking, comorbidities, and exacerbation history.
The adjusted hazard ratios (HRs) for overall mortality associated with a 10 µg/m increase in 1-year PM and NO exposures were 1.004 [95% confidence interval (CI) = 0.985, 1.023] and 0.993 (95% CI = 0.984, 1.002), respectively. The results were similar for 3- and 5-year exposures. For a 10-µg/m increase in 1-year PM and NO exposures, the adjusted HRs for chronic lower airway disease mortality were 1.068 (95% CI = 1.024, 1.113) and 1.029 (95% CI = 1.009, 1.050), respectively. In stratified analyses, exposures to PM and NO were associated with overall mortality in patients who were underweight and had a history of severe exacerbation.
In this large population-based study of patients with COPD, long-term PM and NO exposures were not associated with overall mortality but were associated with chronic lower airway disease mortality. PM and NO exposures were both associated with an increased risk of overall mortality, and with overall mortality in underweight individuals and those with a history of severe exacerbation.
关于长期暴露于空气污染是否会增加慢性阻塞性肺疾病（COPD）患者的死亡风险，相关证据有限。
我们旨在研究长期暴露于直径<10微米的颗粒物（PM）和二氧化氮（NO）与COPD患者的全因死亡率和疾病特异性死亡率之间的关联。
我们对2009年1月1日至12月31日期间确诊为COPD的121423名40岁及以上成年人进行了一项全国性回顾性队列研究。
使用普通克里格法估计居住地点的PM和NO暴露情况。我们使用Cox比例风险模型估计与PM和NO的1年、3年和5年平均浓度相关的全因死亡风险，并使用针对年龄、性别、收入、体重指数、吸烟、合并症和加重病史进行调整的Fine和Gray方法估计疾病特异性死亡率。
与1年PM和NO暴露每增加10微克/立方米相关的全因死亡调整风险比（HR）分别为1.004 [95%置信区间（CI）= 0.985，1.023]和0.993（95% CI = 0.984，1.002）。3年和5年暴露的结果相似。与1年PM和NO暴露每增加10微克/立方米相关的慢性下呼吸道疾病死亡调整HR分别为1.068（95% CI = 1.024，1.113）和1.029（95% CI = 1.009，1.050）。在分层分析中，PM和NO暴露与体重过轻且有严重加重病史的患者的全因死亡相关。
在这项基于大量COPD患者的研究中，长期暴露于PM和NO与全因死亡无关，但与慢性下呼吸道疾病死亡有关。PM和NO暴露均与全因死亡风险增加以及体重过轻个体和有严重加重病史个体的全因死亡有关。
