Institute of Health and Environment and Graduate School of Public Health, Seoul National University, Room 708, Building 220, Gwanak-Ro Gwanak-Gu, Seoul, 08826, Republic of Korea.
Department of Biostatistics and Epidemiology, School of Public Health, Seoul National University, Seoul, Republic of Korea.
BMC Nephrol. 2024 Feb 28;25(1):74. doi: 10.1186/s12882-024-03500-6.
Epidemiologic studies on the effects of long-term exposure to ozone (O) have shown inconclusive results. It is unclear whether to O has an effect on chronic kidney disease (CKD). We investigated the effects of O on mortality and renal outcome in CKD.
We included 61,073 participants and applied Cox proportional hazards models to examine the effects of ozone on the risk of end-stage renal disease (ESRD) and mortality in a two-pollutants model adjusted for socioeconomic status. We calculated the concentration of ozone exposure one year before enrollment and used inverse distance weighting (IDW) for interpolation, where the exposure was evenly distributed.
In the single pollutant model, O was significantly associated with an increased risk of ESRD and all-cause mortality. Based on the O concentration from IDW interpolation, this moving O average was significantly associated with an increased risk of ESRD and all-cause mortality. In a two-pollutants model, even after we adjusted for other measured pollutants, nitrogen dioxide did not attenuate the result for O. The hazard ratio (HR) value for the district-level assessment is 1.025 with a 95% confidence interval (CI) of 1.014-1.035, while for the point-level assessment, the HR value is 1.04 with a 95% CI of 1.035-1.045. The impact of ozone on ESRD, hazard ratio (HR) values are, 1.049(95%CI: 1.044-1.054) at the district unit and 1.04 (95%CI: 1.031-1.05) at the individual address of the exposure assessment. The ozone hazard ratio for all-cause mortality was 1.012 (95% confidence interval: 1.008-1.017) for administrative districts and 1.04 (95% confidence interval: 1.031-1.05) for individual addresses.
This study suggests that long-term ambient O increases the risk of ESRD and mortality in CKD. The strategy to decrease O emissions will substantially benefit health and the environment.
长期暴露于臭氧（O）的流行病学研究结果尚无定论。臭氧是否会对慢性肾脏病（CKD）产生影响尚不清楚。我们研究了臭氧对 CKD 患者死亡率和肾脏预后的影响。
我们纳入了 61073 名参与者，并应用 Cox 比例风险模型，在调整社会经济状况的双污染物模型中，研究臭氧对终末期肾病（ESRD）风险和死亡率的影响。我们计算了入组前一年臭氧暴露的浓度，并使用反距离权重（IDW）进行插值，其中暴露是均匀分布的。
在单污染物模型中，O 与 ESRD 和全因死亡率的风险增加显著相关。基于 IDW 插值的 O 浓度，这种移动 O 平均值与 ESRD 和全因死亡率的风险增加显著相关。在双污染物模型中，即使我们调整了其他测量的污染物，二氧化氮也没有减弱 O 的结果。区县级评估的危害比（HR）值为 1.025，95%置信区间（CI）为 1.014-1.035，而点位评估的 HR 值为 1.04，95%CI 为 1.035-1.045。臭氧对 ESRD 的影响，HR 值为区县级评估 1.049（95%CI：1.044-1.054），个体暴露评估点位为 1.04（95%CI：1.031-1.05）。全因死亡率的臭氧危害比为区县级评估 1.012（95%置信区间：1.008-1.017），个体暴露评估点位为 1.04（95%置信区间：1.031-1.05）。
本研究表明，长期环境 O 增加了 CKD 患者发生 ESRD 和死亡的风险。减少 O 排放的策略将极大地有益于健康和环境。
