长期暴露于空气污染、绿化水平与温度与非致死性心肌梗死存活后。
Long-term exposure to air pollution, greenness and temperature and survival after a nonfatal myocardial infarction.
机构信息
Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA.
出版信息
Environ Pollut. 2024 Aug 15;355:124236. doi: 10.1016/j.envpol.2024.124236. Epub 2024 May 25.
BACKGROUND
Little is known about the impact of environmental exposures on mortality risk after a myocardial infarction (MI).
OBJECTIVE
The goal of this study was to evaluate associations of long-term temperature, air pollution and greenness exposures with mortality among survivors of an MI.
METHODS
We used data from the US-based Nurses' Health Study to construct an open cohort of survivors of a nonfatal MI 1990-2017. Participants entered the cohort when they had a nonfatal MI, and were followed until death, loss to follow-up, end of follow-up, or they reached 80 years old, whichever came earliest. We assessed residential 12-month moving average fine particulate matter (PM) and nitrogen dioxide (NO), satellite-based annual average greenness (in a circular 1230 m buffer), summer average temperature and winter average temperature. We used Cox proportional hazard models adjusted for potential confounders to assess hazard ratios (HR and 95% confidence intervals). We also assessed potential effect modification.
RESULTS
Among 2262 survivors of a nonfatal MI, we observed 892 deaths during 19,216 person years of follow-up. In single-exposure models, we observed a HR (95%CI) of 1.20 (1.04, 1.37) per 10 ppb NO increase and suggestive positive associations were observed for PM, lower greenness, warmer summer average temperature and colder winter average temperature. In multi-exposure models, associations of summer and winter average temperature remained stable, while associations of NO, PM and greenness attenuated. The strength of some associations was modified by other exposures. For example, associations of greenness (HR = 0.88 (0.78, 0.98) per 0.1) were more pronounced for participants in areas with a lower winter average temperature.
CONCLUSION
We observed associations of air pollution, greenness and temperature with mortality among MI survivors. Some associations were confounded or modified by other exposures, indicating that it is important to explore the combined impact of environmental exposures.
背景
人们对环境暴露对心肌梗死（MI）后死亡风险的影响知之甚少。
目的
本研究旨在评估长期温度、空气污染和绿化暴露与 MI 幸存者死亡率之间的关联。
方法
我们使用美国护士健康研究的数据构建了一个 1990-2017 年非致命性 MI 幸存者的开放队列。参与者在发生非致命性 MI 时进入队列，并随访至死亡、失访、随访结束或达到 80 岁，以最早者为准。我们评估了住宅 12 个月移动平均细颗粒物（PM）和二氧化氮（NO）、基于卫星的年度平均绿化（在一个 1230 m 的圆形缓冲区）、夏季平均温度和冬季平均温度。我们使用 Cox 比例风险模型调整潜在混杂因素来评估危险比（HR 和 95%置信区间）。我们还评估了潜在的效应修饰。
结果
在 2262 名非致命性 MI 幸存者中，我们观察到在 19216 人年的随访期间有 892 人死亡。在单暴露模型中，我们观察到每增加 10 ppb 的 NO 浓度，HR（95%CI）为 1.20（1.04，1.37），并且观察到 PM、较低的绿化水平、较高的夏季平均温度和较低的冬季平均温度呈阳性相关。在多暴露模型中，夏季和冬季平均温度的关联仍然稳定，而 NO、PM 和绿化的关联则减弱。一些关联的强度受到其他暴露的修饰。例如，在冬季平均温度较低的地区，绿化与死亡率之间的关联（每增加 0.1，HR=0.88（0.78，0.98））更为明显。
结论
我们观察到空气污染、绿化和温度与 MI 幸存者死亡率之间存在关联。一些关联受到其他暴露的混杂或修饰，表明探索环境暴露的综合影响很重要。
Zotero 插件