Chan Elizabeth A W, Fann Neal, Kelly James T
Office of Air Quality Planning and Standards, U.S. Environmental Protection Agency (EPA), Research Triangle Park, NC, USA.
Atmos Environ (1994). 2023 Dec;315:1-9. doi: 10.1016/j.atmosenv.2023.120131.
Epidemiologic studies have consistently observed associations between fine particulate matter (PM) exposure and premature mortality. These studies use air quality concentration information from a combination of sources to estimate pollutant exposures and then assess how mortality varies as a result of differing exposures. Health impact assessments then typically use a single log-linear hazard ratio (HR) per health outcome to estimate counts of avoided human health effects resulting from air quality improvements. This paper estimates the total PM-attributable premature mortality burden using a variety of methods for estimating exposures and quantifying PM-attributable deaths in 2011 and 2028. We use: 1) several exposure models that apply a wide range of methods, and 2) a variety of HRs from the epidemiologic literature that relate long-term PM exposures to mortality among the U.S. population. We then further evaluate the variability of aggregated national premature mortality estimates to stratification by race and/or ethnicity or exposure level (e.g., below the current annual PM National Ambient Air Quality Standards). We find that unstratified annual adult mortality burden incidence estimates vary more (e.g., ~3-fold) by HR than by exposure model (e.g., <10%). In addition, future mortality burden estimates stratified by race/ethnicity are larger than the unstratified estimates of the entire population, and studies that stratify PM-attributable mortality HRs by an exposure concentration threshold led to substantially higher estimates. These results are intended to provide transparency regarding the sensitivity of mortality estimates to upstream input choices.
流行病学研究一直观察到细颗粒物（PM）暴露与过早死亡之间存在关联。这些研究利用来自多种来源的空气质量浓度信息来估算污染物暴露量，然后评估死亡率如何因不同的暴露量而变化。健康影响评估通常随后针对每个健康结果使用单一的对数线性风险比（HR）来估算空气质量改善所避免的人类健康影响的数量。本文使用多种估算暴露量和量化2011年及2028年PM所致死亡人数的方法，估算了PM所致过早死亡的总负担。我们使用：1）几种应用广泛方法的暴露模型，以及2）来自流行病学文献的各种HR，这些HR将美国人群的长期PM暴露与死亡率联系起来。然后，我们进一步评估汇总的全国过早死亡估算值按种族和/或族裔或暴露水平（例如，低于当前年度PM国家环境空气质量标准）分层后的变异性。我们发现，未分层的年度成人死亡负担发生率估算值因HR的变化（例如，约3倍）大于因暴露模型的变化（例如，<10%）。此外，按种族/族裔分层的未来死亡负担估算值大于整个人口的未分层估算值，并且按暴露浓度阈值对PM所致死亡HR进行分层的研究导致估算值大幅提高。这些结果旨在提供关于死亡率估算值对上游输入选择敏感性的透明度。
