Yang Hong-Ho, Grimm David, Velasquez Esther, Hwang Peter H
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.
Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA.
Int Forum Allergy Rhinol. 2025 Mar;15(3):258-266. doi: 10.1002/alr.23477. Epub 2024 Oct 30.
Emerging evidence has underscored the harmful effects of air pollution on the upper airway. We investigated the relationship between ambient particulate matter (PM) level and the frequency of outpatient visits for chronic rhinosinusitis (CRS).
We conducted an ecological cohort study of US adults enrolled in The Merative MarketScan outpatient database from 2007 to 2020. For each geographical subunit (core-based statistical area [CBSA]), we calculated the annual rate of CRS-related outpatient visits per 1000 well-patient checkup visits (CRS-OV). Using data from the Environmental Protection Agency's Air Quality System, we mapped the rolling statistical average of daily PM and PM over the preceding year onto each CBSA × year combination. We employed multivariable negative binomial regression modeling to estimate the association between PM levels and subsequent CRS-OV.
Across 3933 observations (CBSA × year combinations), encompassing ∼4 billion visits, the median CRS-OV was 164 (interquartile range 110-267). The mean PM level was 8.9 µg/m (SD 2.6) and the mean PM level was 20.2 µg/m (SD 7.2). Adjusting for patient demographics and respiratory comorbidities, a compounded rise in subsequent CRS-OV was observed with increasing PM levels. Each µg/m rise in PM independently predicted a 10% increase in CRS-OV (adjusted incidence rate ratio [aIRR]) 1.10, 95% confidence interval [CI] 1.08-1.13) and each µg/m rise in PM independently predicted a 3% increase in CRS-OV (aIRR 1.03, 95% CI 1.02-1.04).
Elevated ambient PM and PM levels are associated with a subsequent compounded increase in the frequency of CRS-OV, with PM predicting a more pronounced rise compared to PM.
新出现的证据强调了空气污染对上呼吸道的有害影响。我们调查了环境颗粒物（PM）水平与慢性鼻-鼻窦炎（CRS）门诊就诊频率之间的关系。
我们对2007年至2020年纳入默克多市场扫描门诊数据库的美国成年人进行了一项生态队列研究。对于每个地理子单元（基于核心的统计区域[CBSA]），我们计算了每1000次健康体检中CRS相关门诊就诊的年率（CRS-OV）。利用美国环境保护局空气质量系统的数据，我们将前一年每日PM和PM的滚动统计平均值映射到每个CBSA×年份组合上。我们采用多变量负二项回归模型来估计PM水平与随后的CRS-OV之间的关联。
在3933个观察值（CBSA×年份组合）中，涵盖约40亿次就诊，CRS-OV的中位数为164（四分位间距110-267）。PM的平均水平为8.9µg/m（标准差2.6），PM的平均水平为20.2µg/m（标准差7.2）。在调整了患者人口统计学和呼吸道合并症后，随着PM水平的升高，观察到随后的CRS-OV呈复合上升。PM每升高1µg/m独立预测CRS-OV增加10%（调整后的发病率比[aIRR]为1.10，95%置信区间[CI]为1.08-1.13），PM每升高1µg/m独立预测CRS-OV增加3%（aIRR为1.03，95%CI为1.02-1.04）。
环境PM和PM水平升高与随后CRS-OV频率的复合增加相关，与PM相比，PM预测的上升更为明显。
