长期暴露于空气污染、道路交通噪声和绿化环境与女性心肌梗死发病率的关系。

Long-term exposure to air pollution, road traffic noise and greenness, and incidence of myocardial infarction in women.

机构信息

Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 77 Stockholm, Sweden.

出版信息

Environ Int. 2024 Aug;190:108878. doi: 10.1016/j.envint.2024.108878. Epub 2024 Jul 6.

DOI:10.1016/j.envint.2024.108878

PMID:38991262

Abstract

BACKGROUND

Emerging evidence shows that long-term exposure to air pollution, road traffic noise, and greenness can each be associated with cardiovascular disease, but only few studies combined these exposures. In this study, we assessed associations of multiple environmental exposures and incidence of myocardial infarction using annual time-varying predictors.

MATERIALS AND METHODS

In a population-based cohort of 20,407 women in Sweden, we estimated a five-year moving average of residential exposure to air pollution (PM, PM and NO), road traffic noise (L), and greenness (normalized difference vegetation index, NDVI in 500 m buffers), from 1998 to 2017 based on annually varying exposures and address history. We used adjusted time-varying Cox proportional hazards regressions to estimate hazard ratios (HR) and 95 % confidence intervals (95 % CI) of myocardial infarction per interquartile range (IQR). Furthermore, we investigated interactions between the exposures and explored potential vulnerable subgroups.

RESULTS

In multi-exposure models, long-term exposure to greenness was inversely associated with incidence of myocardial infarction (HR 0.89; 95 % CI 0.80, 0.99 per IQR NDVI increase). Stronger associations were observed in some subgroups, e.g. among women with low attained education and in overweight (BMI ≥ 25 kg/m) compared to their counterparts. For air pollution, we observed a tendency of an increased risk of myocardial infarction in relation to PM (HR 1.07; 95 % CI 0.93, 1.23) and the association appeared stronger in women with low attained education (HR 1.30; 95 % CI 1.06, 1.58). No associations were observed for PM, NO or road traffic noise. Furthermore, there were no clear interaction patterns between the exposures.

CONCLUSION

Over a 20-year follow-up period, in multi-exposure models, we found an inverse association between residential greenness and risk of myocardial infarction among women. Furthermore, we observed an increased risk of myocardial infarction in relation to PM among women with low attained education. Road traffic noise was not associated with myocardial infarction.

摘要

背景

新出现的证据表明，长期暴露于空气污染、道路交通噪声和绿化环境中都可能与心血管疾病相关，但只有少数研究将这些暴露因素综合考虑。在本研究中，我们使用年度时变预测因子评估了多种环境暴露因素与心肌梗死发病的相关性。

材料和方法

在瑞典的一个基于人群的 20407 名女性队列中，我们根据 1998 年至 2017 年每年变化的暴露情况和地址记录，估计了居住环境中空气污染（PM、PM 和 NO）、道路交通噪声（L）和绿化环境（500 米缓冲区归一化差异植被指数，NDVI）的五年移动平均值。我们使用调整后的时变 Cox 比例风险回归来估计每四分位间距（IQR）心肌梗死的风险比（HR）和 95%置信区间（95%CI）。此外，我们还研究了暴露因素之间的相互作用，并探索了潜在的脆弱亚组。

结果

在多暴露模型中，长期暴露于绿化环境与心肌梗死发病呈负相关（每增加一个 IQR 的 NDVI，HR 为 0.89；95%CI 为 0.80，0.99）。在一些亚组中观察到更强的关联，例如，在受教育程度较低和超重（BMI≥25kg/m）的女性中，与对照组相比，这种关联更强。对于空气污染，我们观察到 PM 与心肌梗死风险增加有关（HR 为 1.07；95%CI 为 0.93，1.23），这种关联在受教育程度较低的女性中更为明显（HR 为 1.30；95%CI 为 1.06，1.58）。PM、NO 或道路交通噪声与心肌梗死无关。此外，这些暴露因素之间没有明显的交互作用模式。