Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China.
Centre for Global Health, Zhejiang University, Hangzhou, China.
Environ Health Perspect. 2023 Jul;131(7):77010. doi: 10.1289/EHP12215. Epub 2023 Jul 28.
Previous studies indicated that air pollution plausibly increases the risk of adverse outcomes in inflammatory bowel disease (IBD) via proinflammatory mechanisms. However, there is scant epidemiological data and insufficient prospective evidence assessing associations between ambient air pollution and clinical outcomes of IBD.
We aimed to investigate the associations between ambient air pollution and clinical outcomes among individuals with IBD.
Leveraging data from the UK Biobank, we included 4,708 individuals with IBD recruited in the period 2006-2010 in this study. A land use regression model was used to assess annual mean concentrations of ambient air pollutants nitrogen including oxides (), nitrogen dioxide (), and particulate matter (PM) with aerodynamic diameter () and PM with aerodynamic diameter (). Individuals with IBD were followed up for incident clinical outcomes of enterotomy, gastrointestinal cancer, and all-cause mortality, ascertained via death registry, inpatient, primary care, and cancer registry data. Cox proportional hazard model was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the magnitude of the associations.
During a mean follow-up of 12.0 y, 265 enterotomy events, 124 incident gastrointestinal cancer, and 420 death events were documented among individuals with IBD. We found that each interquartile range (IQR) increase in exposure to was associated with increased risk of enterotomy (; 95% CI: 1.00, 1.34, ), whereas an IQR increase in exposure to (; 95% CI: 1.01, 1.20, ), (; 95% CI: 1.03, 1.29, ), (; 95% CI: 1.03, 1.30, ), and (; 95% CI: 1.02, 1.28, ) was associated with increased risk of all-cause mortality among individuals with IBD. We did not observe any significant associations between air pollutants and gastrointestinal cancer in the primary analyses. Consistent results were observed in subgroup and sensitivity analyses.
Ambient pollution exposure was associated with an increased risk of enterotomy and all-cause mortality among individuals with IBD, highlighting the important role of environmental health in improving the prognosis of IBD. https://doi.org/10.1289/EHP12215.
先前的研究表明，空气污染可能通过促炎机制增加炎症性肠病（IBD）不良结局的风险。然而，目前评估环境空气污染与 IBD 临床结局之间关联的流行病学数据很少，前瞻性证据也不足。
我们旨在研究环境空气污染与 IBD 个体临床结局之间的关联。
本研究利用英国生物银行的数据，纳入了 2006 年至 2010 年期间招募的 4708 名 IBD 患者。采用基于土地利用的回归模型评估环境空气污染物年平均浓度，包括氮氧化物（）、二氧化氮（）和空气动力学直径为 （）的颗粒物（PM）以及空气动力学直径为 （）的颗粒物（PM）。通过死亡登记、住院、初级保健和癌症登记数据，对 IBD 患者的肠切开术、胃肠道癌症和全因死亡率等新发生的临床结局进行随访。采用 Cox 比例风险模型估计关联程度的危害比（HR）及其 95%置信区间（CI）。
在平均 12.0 年的随访期间，IBD 患者中记录了 265 例肠切开术事件、124 例新发胃肠道癌和 420 例死亡事件。我们发现，与暴露于 相关的每个四分位间距（IQR）增加与肠切开术风险增加相关（；95%CI：1.00，1.34），而与暴露于 相关的 IQR 增加（；95%CI：1.01，1.20），（；95%CI：1.03，1.29），（；95%CI：1.03，1.30）和（；95%CI：1.02，1.28）与 IBD 患者的全因死亡率风险增加相关。我们在主要分析中没有观察到空气污染物与胃肠道癌之间存在任何显著关联。在亚组和敏感性分析中观察到了一致的结果。
环境污染物暴露与 IBD 患者肠切开术和全因死亡率风险增加相关，突出了环境卫生在改善 IBD 预后方面的重要作用。https://doi.org/10.1289/EHP12215.
