大气污染短期暴露对心血管和呼吸疾病死亡率的时间变化特征：22 年间 380 个城市的综合分析

Temporal variations in the short-term effects of ambient air pollution on cardiovascular and respiratory mortality: a pooled analysis of 380 urban areas over a 22-year period.

机构信息

Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany; Department of Environmental Health, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Munich Heart Alliance, German Center for Cardiovascular Research, Munich, Germany.

出版信息

Lancet Planet Health. 2024 Sep;8(9):e657-e665. doi: 10.1016/S2542-5196(24)00168-2.

DOI:10.1016/S2542-5196(24)00168-2

PMID:39243781

Abstract

BACKGROUND

Ambient air pollution, including particulate matter (such as PM and PM) and nitrogen dioxide (NO), has been linked to increases in mortality. Whether populations' vulnerability to these pollutants has changed over time is unclear, and studies on this topic do not include multicountry analysis. We evaluated whether changes in exposure to air pollutants were associated with changes in mortality effect estimates over time.

METHODS

We extracted cause-specific mortality and air pollution data collected between 1995 and 2016 from the Multi-Country Multi-City (MCC) Collaborative Research Network database. We applied a two-stage approach to analyse the short-term effects of NO, PM, and PM on cause-specific mortality using city-specific time series regression analyses and multilevel random-effects meta-analysis. We assessed changes over time using a longitudinal meta-regression with time as a linear fixed term and explored potential sources of heterogeneity and two-pollutant models.

FINDINGS

Over 21·6 million cardiovascular and 7·7 million respiratory deaths in 380 cities across 24 countries over the study period were included in the analysis. All three air pollutants showed decreasing concentrations over time. The pooled results suggested no significant temporal change in the effect estimates per unit exposure of PM, PM, or NO and mortality. However, the risk of cardiovascular mortality increased from 0·37% (95% CI -0·05 to 0·80) in 1998 to 0·85% (0·55 to 1·16) in 2012 with a 10 μg/m increase in PM. Two-pollutant models generally showed similar results to single-pollutant models for PM fractions and indicated temporal differences for NO.

INTERPRETATION

Although air pollution levels decreased during the study period, the effect sizes per unit increase in air pollution concentration have not changed. This observation might be due to the composition, toxicity, and sources of air pollution, as well as other factors, such as socioeconomic determinants or changes in population distribution and susceptibility.

FUNDING

None.

摘要

背景

包括颗粒物（如 PM 和 PM）和二氧化氮（NO）在内的大气污染与死亡率的上升有关。目前尚不清楚人群对这些污染物的易感性是否随时间发生了变化，而且关于这一主题的研究并未包含多国分析。我们评估了暴露于空气污染物的变化是否与死亡率效应估计值随时间的变化有关。

方法

我们从多国多城市（MCC）协作研究网络数据库中提取了 1995 年至 2016 年期间收集的特定原因死亡率和空气污染数据。我们采用两阶段方法，通过城市特定的时间序列回归分析和多层次随机效应荟萃分析，分析了 NO、PM 和 PM 对特定原因死亡率的短期影响。我们使用纵向荟萃回归分析评估了随时间的变化，将时间作为线性固定项，并探讨了潜在的异质性来源和双污染物模型。

结果

在研究期间，来自 24 个国家的 380 个城市的 2160 多万例心血管死亡和 770 多万例呼吸死亡被纳入分析。所有三种空气污染物的浓度随时间呈下降趋势。汇总结果表明，每单位暴露 PM、PM 或 NO 和死亡率的效应估计值没有随时间发生显著变化。然而，心血管死亡率的风险从 1998 年的 0.37%（95%CI -0.05 至 0.80）增加到 2012 年的 0.85%（0.55 至 1.16），PM 浓度每增加 10 μg/m。双污染物模型通常为 PM 分数的单污染物模型提供了类似的结果，并表明 NO 存在时间差异。