U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States.
Gillings Global School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Front Public Health. 2024 May 21;12:1367416. doi: 10.3389/fpubh.2024.1367416. eCollection 2024.
Sudden death accounts for approximately 10% of deaths among working-age adults and is associated with poor air quality. Objectives: To identify high-risk groups and potential modifiers and mediators of risk, we explored previously established associations between fine particulate matter (PM) and sudden death stratified by potential risk factors.
Sudden death victims in Wake County, NC, from 1 March 2013 to 28 February 2015 were identified by screening Emergency Medical Systems reports and adjudicated ( = 399). Daily PM concentrations for Wake County from the Air Quality Data Mart were linked to event and control periods. Potential modifiers included greenspace metrics, clinical conditions, left ventricular hypertrophy (LVH), and neutrophil-to-lymphocyte ratio (NLR). Using a case-crossover design, conditional logistic regression estimated the OR (95%CI) for sudden death for a 5 μg/m increase in PM with a 1-day lag, adjusted for temperature and humidity, across risk factor strata.
Individuals having LVH or an NLR above 2.5 had PM associations of greater magnitude than those without [with LVH OR: 1.90 (1.04, 3.50); NLR > 2.5: 1.25 (0.89, 1.76)]. PM was generally less impactful for individuals living in areas with higher levels of greenspace.
LVH and inflammation may be the final step in the causal pathway whereby poor air quality and traditional risk factors trigger arrhythmia or myocardial ischemia and sudden death. The combination of statistical evidence with clinical knowledge can inform medical providers of underlying risks for their patients generally, while our findings here may help guide interventions to mitigate the incidence of sudden death.
青壮年人群中约有 10%的死亡是由于突然死亡，而这与空气质量差有关。目的：为了确定高危人群以及风险的潜在修饰因子和调节因子，我们探讨了在潜在危险因素分层的情况下，细颗粒物（PM）与突然死亡之间已建立的关联。
通过筛选紧急医疗系统报告并进行裁决，确定了北卡罗来纳州威克县 2013 年 3 月 1 日至 2015 年 2 月 28 日期间的突然死亡受害者（ = 399）。从空气质量数据集市中获取威克县的每日 PM 浓度数据，并将其与事件和对照期相联系。潜在修饰因子包括绿地指标、临床状况、左心室肥厚（LVH）和中性粒细胞与淋巴细胞比值（NLR）。使用病例交叉设计，条件逻辑回归估计了在考虑温度和湿度的情况下，PM 每增加 5μg/m，滞后 1 天时，突然死亡的比值比（95%CI）在危险因素分层中的风险。
患有 LVH 或 NLR 高于 2.5 的个体的 PM 关联强度大于没有这些疾病的个体[LVH：1.90（1.04，3.50）；NLR > 2.5：1.25（0.89，1.76）]。对于居住在绿地水平较高地区的个体，PM 的影响通常较小。
LVH 和炎症可能是空气质量差和传统危险因素引发心律失常或心肌缺血和突然死亡这一因果途径的最后一步。统计证据与临床知识的结合可以使医疗服务提供者了解其患者的潜在风险，而我们在这里的发现可能有助于指导干预措施，以降低突然死亡的发生率。
