Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Building 2, 4th Floor, Boston, MA, 02115, USA.
Rutgers University Institute for Health, Healthcare Policy, and Aging Research, The State University of New Jersey, 112 Paterson Street, New Brunswick, NJ, 08901, USA.
Environ Res. 2024 Jun 15;251(Pt 1):118628. doi: 10.1016/j.envres.2024.118628. Epub 2024 Mar 7.
Despite biological plausibility, very few epidemiologic studies have investigated the risks of clinically significant bleeding events due to particulate air pollution.
To measure the independent and synergistic effects of PM exposure and anticoagulant use on serious bleeding events.
Retrospective cohort study (2008-2016).
Nationwide Medicare population.
A 50% random sample of Medicare Part D-eligible Fee-for-Service beneficiaries at high risk for cardiovascular and thromboembolic events.
Fine particulate matter (PM) and anticoagulant drugs (apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin).
The outcomes were acute hospitalizations for gastrointestinal bleeding, intracranial bleeding, or epistaxis. Hazard ratios and 95% CIs for PM exposure were estimated by fitting inverse probability weighted marginal structural Cox proportional hazards models. The relative excess risk due to interaction was used to assess additive-scale interaction between PM exposure and anticoagulant use.
The study cohort included 1.86 million high-risk older adults (mean age 77, 60% male, 87% White, 8% Black, 30% anticoagulant users, mean PM exposure 8.81 μg/m). A 10 μg/m increase in PM was associated with a 48% (95% CI: 45%-52%), 58% (95% CI: 49%-68%) and 55% (95% CI: 37%-76%) increased risk of gastrointestinal bleeding, intracranial bleeding, and epistaxis, respectively. Significant additive interaction between PM exposure and anticoagulant use was observed for gastrointestinal and intracranial bleeding.
Among older adults at high risk for cardiovascular and thromboembolic events, increasing PM exposure was significantly associated with increased risk of gastrointestinal bleeding, intracranial bleeding, and epistaxis. In addition, PM exposure and anticoagulant use may act together to increase risks of severe gastrointestinal and intracranial bleeding. Thus, clinicians may recommend that high-risk individuals limit their outdoor air pollution exposure during periods of increased PM concentrations. Our findings may inform environmental policies to protect the health of vulnerable populations.
尽管具有生物学合理性，但很少有流行病学研究调查过因颗粒物空气污染而导致临床显著出血事件的风险。
测量 PM 暴露和抗凝剂使用对严重出血事件的独立和协同作用。
回顾性队列研究（2008-2016 年）。
全国医疗保险人群。
心血管和血栓栓塞事件高危的医疗保险部分 D 合格的按服务收费受益人的 50%随机样本。
细颗粒物（PM）和抗凝药物（阿哌沙班、达比加群、依度沙班、利伐沙班或华法林）。
结果是急性胃肠道出血、颅内出血或鼻出血住院。通过拟合逆概率加权边际结构 Cox 比例风险模型，估计 PM 暴露的风险比和 95%CI。相对超额风险由于相互作用被用来评估 PM 暴露和抗凝剂使用之间的加性规模相互作用。
研究队列包括 186 万高危老年人（平均年龄 77 岁，60%为男性，87%为白人，8%为黑人，30%为抗凝剂使用者，平均 PM 暴露 8.81μg/m）。PM 增加 10μg/m 与胃肠道出血、颅内出血和鼻出血的风险分别增加 48%（95%CI：45%-52%）、58%（95%CI：49%-68%）和 55%（95%CI：37%-76%）相关。PM 暴露和抗凝剂使用之间存在显著的相加性相互作用，与胃肠道和颅内出血有关。
在心血管和血栓栓塞事件高危的老年人中，PM 暴露增加与胃肠道出血、颅内出血和鼻出血风险增加显著相关。此外，PM 暴露和抗凝剂使用可能共同作用，增加严重胃肠道和颅内出血的风险。因此，临床医生可能会建议高危个体在 PM 浓度增加期间限制其户外空气污染暴露。我们的研究结果可能为保护弱势群体健康的环境政策提供信息。
