Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN.
Pulmonary, Allergy, Critical Care and Sleep Medicine, Medical School, University of Minnesota, Minneapolis, MN; Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, MN; Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN.
Chest. 2024 Apr;165(4):825-835. doi: 10.1016/j.chest.2023.10.016. Epub 2023 Oct 18.
Air pollution contributes to premature mortality, but potential impacts differ in populations with existing disease, particularly for individuals with multiple risk factors. Although COPD increases vulnerability to air pollution, individuals with COPD and other individual risk factors are at the intersection of multiple risks and may be especially susceptible to the effect of acute outdoor air pollution.
What is the association between wintertime air pollution and mortality in patients with COPD and the modifying role of individual risk factors?
This study evaluated 19,243 deceased veterans with prior COPD diagnosis who had resided in 25 US metropolitan regions (2016-2019). Electronic health records included patient demographic characteristics; smoking status; and comorbidities such as asthma, coronary artery disease (CAD), obesity, and diabetes. Using geocoded addresses, individuals were assigned wintertime fine particulate matter (particulate matter smaller than 2.5 μg in diameter [PM]) and nitrogen dioxide air pollution exposures. Associations between acute air pollution and mortality were estimated by using a time-stratified case-crossover design with a conditional logistic model, and individual risk differences were assessed according to stratified analysis.
A 1.05 (95% CI, 1.02-1.09) mortality risk was estimated for each 10 μg/m increase in daily wintertime PM). Older patients and Black individuals displayed elevated risk. Obesity was a substantial air pollution-related mortality risk factor (OR, 1.11; 95% CI, 1.01-1.23), and the estimated risk for individuals with obesity plus CAD or obesity plus diabetes was 16% higher.
Wintertime PM exposure was associated with elevated mortality risk in people with COPD, but individuals with multiple comorbidities, notably obesity, had high vulnerability. Our study suggests that obesity, CAD, and diabetes are understudied modifiers of air pollution-related risks for people with existing COPD.
空气污染导致过早死亡，但在存在疾病的人群中，其潜在影响有所不同，尤其是在存在多种风险因素的个体中。虽然 COPD 增加了对空气污染的脆弱性，但患有 COPD 和其他个体风险因素的个体处于多种风险的交叉点，可能特别容易受到急性户外空气污染的影响。
冬季空气污染与 COPD 患者死亡率之间的关系是什么，个体风险因素的作用是什么？
本研究评估了 25 个美国大都市地区的 19243 名曾患有 COPD 的已故退伍军人（2016-2019 年）。电子健康记录包括患者的人口统计学特征；吸烟状况；以及哮喘、冠心病（CAD）、肥胖症和糖尿病等合并症。通过地理编码地址，为个体分配冬季细颗粒物（直径小于 2.5μm 的颗粒物[PM]）和二氧化氮空气污染暴露。使用时间分层病例交叉设计和条件逻辑模型估计急性空气污染与死亡率之间的关联，并根据分层分析评估个体风险差异。
估计每天冬季 PM 增加 10μg/m，死亡率风险增加 1.05（95%CI，1.02-1.09）。年龄较大的患者和黑人个体显示出更高的风险。肥胖症是一个与空气污染相关的重要死亡率风险因素（OR，1.11；95%CI，1.01-1.23），患有肥胖症加 CAD 或肥胖症加糖尿病的个体的风险增加了 16%。
冬季 PM 暴露与 COPD 患者的死亡率升高有关，但合并多种合并症（尤其是肥胖症）的个体易受影响。我们的研究表明，肥胖症、CAD 和糖尿病是 COPD 患者现有空气污染相关风险的研究不足的调节因素。
