School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China; Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
EBioMedicine. 2024 Sep;107:105270. doi: 10.1016/j.ebiom.2024.105270. Epub 2024 Aug 12.
Short-term exposure to particulate matter air pollution has been associated with the exacerbations of COPD, but its association with COPD mortality was not fully elucidated. We aimed to assess the association between short-term particulate matter exposure and the risk of COPD mortality in China using individual-level data.
We derived 2.26 million COPD deaths from a national death registry database in Chinese mainland between 2013 and 2019. Exposures to fine particulate matter (PM) and coarse particulate matter (PM) were assessed by satellite-based models of a 1 × 1 km resolution and assigned to each individual based on residential address. The associations of PM and PM with COPD mortality were examined using a time-stratified case-crossover design and conditional logistic regressions with distributed lag models. We further conducted stratified analyses by age, sex, education level, and season.
Short-term exposures to both PM and PM were associated with increased risks of COPD mortality. These associations appeared and peaked on the concurrent day, attenuated and became nonsignificant after 5 or 7 days, respectively. The exposure-response curves were approximately linear without discernible thresholds. An interquartile range increase in PM and PM concentrations was associated with 4.23% (95% CI: 3.75%, 4.72%) and 2.67% (95% CI: 2.18%, 3.16%) higher risks of COPD mortality over lag 0-7 d, respectively. The associations of PM and PM attenuated slightly but were still significant in the mutual-adjustment models. A larger association of PM was observed in the warm season.
This individual-level, nationwide, case-crossover study suggests that short-term exposure to PM and PM might act as one of the environmental risk factors for COPD mortality.
This study is supported by the National Key Research and Development Program of China (2023YFC3708304 and 2022YFC3702701), the National Natural Science Foundation of China (82304090 and 82030103), the 3-year Action Plan for Strengthening the Construction of the Public Health System in Shanghai (GWVI-11.2-YQ31), and the Science and Technology Commission of Shanghai Municipality (21TQ015).
短期暴露于颗粒物空气污染与 COPD 加重有关，但与 COPD 死亡率的关联尚未完全阐明。我们旨在使用中国大陆的个人水平数据评估短期颗粒物暴露与 COPD 死亡率风险之间的关系。
我们从中国大陆国家死亡登记数据库中得出了 226 万例 COPD 死亡。通过分辨率为 1×1km 的卫星模型评估细颗粒物（PM）和粗颗粒物（PM）暴露情况，并根据居住地址将其分配给每个个体。使用时间分层病例交叉设计和条件逻辑回归与分布式滞后模型检查 PM 和 PM 与 COPD 死亡率的关联。我们还按年龄、性别、教育水平和季节进行了分层分析。
短期暴露于 PM 和 PM 均与 COPD 死亡率增加有关。这些关联在当日出现并达到峰值，分别在 5 或 7 天后减弱且变得无统计学意义。暴露反应曲线近似线性，没有明显的阈值。PM 和 PM 浓度的四分位间距增加分别与滞后 0-7d 期间 COPD 死亡率增加 4.23%（95%CI：3.75%，4.72%）和 2.67%（95%CI：2.18%，3.16%）相关。在相互调整模型中，PM 和 PM 的关联略有减弱，但仍有统计学意义。在温暖季节观察到 PM 的关联更大。
这项基于个体、全国性、病例交叉研究表明，短期暴露于 PM 和 PM 可能是 COPD 死亡率的环境危险因素之一。
本研究得到了中国国家重点研发计划（2023YFC3708304 和 2022YFC3702701）、国家自然科学基金（82304090 和 82030103）、上海市公共卫生体系建设三年行动计划（GWVI-11.2-YQ31）和上海市科学技术委员会（21TQ015）的支持。
