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短期暴露于室外二氧化氮与呼吸性死亡率及高危人群:一项全国性时间分层病例交叉研究

Short-term exposure to outdoor nitrogen dioxide and respiratory mortality, with high-risk populations: a nationwide time-stratified case-crossover study.

作者信息

Yun Hyewon, Ahn Seoyeong, Oh Jieun, Kang Cinoo, Kim Ayoung, Kwon Dohoon, Ahn Sojin, Park Jiwoo, Park Jinah, Kim Ejin, Kim Ho, Lee Whanhee

机构信息

Graduate School of Data Science, Pusan National University, Busan, South Korea.

Department of Information Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Yangsan, South Korea.

出版信息

BMC Public Health. 2024 Dec 18;24(1):3484. doi: 10.1186/s12889-024-21048-w.

Abstract

Numerous existing studies reported the negative impacts of outdoor nitrogen dioxide (NO) on respiratory mortality. However, the evidence of related high-risk populations was considerably limited, especially associated with ages, causes of death, and district-level characteristics. In addition, most earlier studies were based on monitored areas, thus previous risk estimates of NO could be biased to provide nationwide risk estimates and high-risk populations. Therefore, this study performed a nationwide time-stratified case-crossover study to evaluate the association between short-term ambient NO and respiratory mortality in South Korea (2015-2019). A machine learning-ensemble daily NO prediction model was used to cover unmonitored areas. To examine high-risk populations, we assessed NO risk estimates by age group, sex, cause of mortality, and district-level characteristics. In the total population, NO was weakly associated with increased mortality risk due to respiratory disease (OR [odds ratio]: 1.011, 95% CI [confidence interval]: 0.995-1.027), and the association became evident only in individuals aged 80 y or older (1.022, 1.000-1.044), especially related to pneumonia. Further, in people aged 60-69 years, NO was marginally associated with mortality for chronic lower respiratory diseases. Lower district-level socioeconomic status and medical services were marginally related to higher respiratory mortality risks related to NO. The excess respiratory mortality fractions and YLL (year of life lost) attributable to NO were 4.13% and 93,851.63 years, and around 70% of the excess deaths were due to noncompliance with the World Health Organization air quality guidelines (daily average NO > 25 µg/m). This study provides evidence for high-risk populations and the appropriateness of target-specific action plans against NO. In addition, based on the excess death estimates, we suggest stricter NO standards are required.

摘要

众多现有研究报告了室外二氧化氮(NO)对呼吸系统死亡率的负面影响。然而,相关高危人群的证据相当有限,尤其是与年龄、死因和地区层面特征相关的证据。此外,大多数早期研究基于监测区域,因此之前对NO的风险估计可能存在偏差,无法提供全国范围的风险估计和高危人群信息。因此,本研究进行了一项全国性的时间分层病例交叉研究,以评估韩国(2015 - 2019年)短期环境NO与呼吸系统死亡率之间的关联。使用机器学习集成的每日NO预测模型来覆盖未监测区域。为了研究高危人群,我们按年龄组、性别、死亡原因和地区层面特征评估了NO风险估计值。在总人口中,NO与呼吸系统疾病导致的死亡风险增加呈弱关联(比值比[OR]:1.011,95%置信区间[CI]:0.995 - 1.027),且这种关联仅在80岁及以上个体中明显(1.022,1.000 - 1.044),尤其与肺炎相关。此外,在60 - 69岁人群中,NO与慢性下呼吸道疾病死亡率存在微弱关联。地区层面较低的社会经济地位和医疗服务与NO相关的较高呼吸系统死亡风险存在微弱关联。归因于NO的呼吸系统超额死亡分数和寿命损失年数(YLL)分别为4.13%和93,851.63年,约70%的超额死亡是由于未达到世界卫生组织空气质量指南(每日平均NO>25μg/m³)。本研究为高危人群提供了证据,以及针对NO的特定目标行动计划的适宜性。此外,基于超额死亡估计,我们建议需要更严格的NO标准。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e90a/11658215/b1bce1b0e0cb/12889_2024_21048_Fig1_HTML.jpg

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