Chen Juan, Liu Huimeng, Li Ge, Bai Lijun, Jiang Yunxing, Wang Jinxi, Wei Chen, Li Yinxiang, Lei Jian, Deng Furong, Zhang Luxia, Guo Xinbiao, Wu Shaowei
Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China.
Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, Shaanxi 710061, China.
Environ Health (Wash). 2024 May 6;2(8):553-562. doi: 10.1021/envhealth.4c00004. eCollection 2024 Aug 16.
Incident chronic kidney disease (CKD) may be accelerated (could be indicated by repeated admissions to the hospital) by environmental triggers such as ambient particulate matter (PM). Additionally, hospital admission is a sensitive proxy reflecting the disease burden. However, the association of PM exposure with hospital admissions for CKD is still unknown, let alone the excess risks (ERs) in hospital admissions for CKD due to high PM level exposure. In this study, a two-stage time-stratified case-crossover study was conducted to investigate the association of ambient air PM exposure with hospital admission for CKD in 282 Chinese cities of prefecture-level or above during 2013-2017. City-specific associations of single and cumulative 0-3 days lagged exposure to fine particulate matter (PM) and inhalable particles (PM) with hospital admissions for total CKD and its subtypes were evaluated by the conditional logistic regression model, then were pooled using the random-effect model. A total of 3,490,416 hospital admissions for CKD were identified. We found that per interquartile range (IQR) increment in PM at lag02 and per IQR increment in PM at lag03 were associated with increases of 2.36% (95%CI: 1.58%, 3.14%) and 2.87% (95% CI:1.91%, 3.85%) in hospital admissions for total CKD, respectively. Compared to control concentrations (PM: 35 μg/m; PM: 50 μg/m), the largest ERs in hospital admissions for total CKD were 2.63% (95% CI: 2.15%-3.11%) and 4.45% (95% CI: 3.85%-5.06%) in association with exposure to heavily excessive PM (≥75 μg/m) and PM (≥150 μg/m), respectively. Moreover, the attributable fractions (AFs) for CKD admissions were 2.83% for PM and 3.46% for PM during the study period. These findings suggested that exposure to PM and PM is associated with substantially increased risk and burden of CKD admissions.
突发性慢性肾脏病（CKD）可能会因环境诱因（如环境颗粒物（PM））而加速发展（可通过反复住院来表明）。此外，住院是反映疾病负担的一个敏感指标。然而，PM暴露与CKD住院之间的关联仍不清楚，更不用说因高PM水平暴露导致的CKD住院超额风险（ERs）了。在本研究中，进行了一项两阶段时间分层病例交叉研究，以调查2013 - 2017年期间中国282个地级及以上城市环境空气中PM暴露与CKD住院之间的关联。通过条件逻辑回归模型评估特定城市中0 - 3天滞后的细颗粒物（PM）和可吸入颗粒物（PM）单次及累积暴露与总CKD及其亚型住院之间的关联，然后使用随机效应模型进行汇总。共确定了3490416例CKD住院病例。我们发现，滞后0 - 2天的PM每增加一个四分位数间距（IQR）以及滞后0 - 3天的PM每增加一个IQR，分别与总CKD住院病例增加2.36%（95%置信区间：1.58%，3.14%）和2.87%（95%置信区间：1.91%，3.85%）相关。与对照浓度（PM：35μg/m³；PM：50μg/m³）相比，总CKD住院病例中与暴露于严重超标PM（≥75μg/m³）和PM（≥150μg/m³）相关的最大ERs分别为为暴露于严重超标PM（≥75μg/m³）和PM（≥150μg/m³），分别为2.63%（95%置信区间：2.15% - 3.11%）和4.45%（95%置信区间：3.85% - 5.06%）。此外，在研究期间，CKD住院病例中PM的归因分数（AFs）为2.83%，PM为3.46%。这些发现表明，暴露于PM和PM与CKD住院风险和负担的大幅增加相关。
