Kim Chung Ho, Park Bomi, Baek Moon Seong
Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
Ecotoxicol Environ Saf. 2025 Mar 1;292:117978. doi: 10.1016/j.ecoenv.2025.117978. Epub 2025 Mar 4.
Chronic obstructive pulmonary disease (COPD) is a major global cause of morbidity and mortality; however, evidence on the effects of air pollutant mixtures on COPD remains limited. This study assessed the impact of long-term exposure to multiple pollutants on COPD prevalence and identified vulnerable subgroups. We analyzed Korea National Health and Nutrition Examination Survey (2010-2017) data linked to 5-year moving average concentrations of CO, NO₂, SO₂, O₃, PM₂.₅, and PM₁₀. Bayesian kernel machine regression (BKMR) estimated the combined effects of pollutants on COPD prevalence, with subgroup analyses performed according to sex, smoking status, and airflow limitation. Adjustments included age, sex, BMI, smoking status, and household income. Among 21,804 participants, 3515 had COPD. BKMR analysis showed that long-term exposure to a pollutant mixture was associated with increased COPD prevalence. O₃ and NO₂ were identified as the most influential pollutants (posterior inclusion probabilities > 0.50). Further analysis showed a significant increase in COPD risk with higher NO₂ and O₃ concentrations, particularly when other pollutants were at lower or median levels. Significant interactions were observed, particularly between SO₂ and CO, CO and O₃, and NO₂ and O₃. Subgroup analyses identified vulnerable populations, indicating stronger associations among females and never smokers and more pronounced effects in individuals with GOLD 2-4. These findings suggest that long-term exposure to multiple air pollutants could increase COPD risk, particularly for females, never smokers, and individuals with more severe COPD. Targeted interventions and policy measures are needed to reduce exposure, especially for these at-risk populations.
慢性阻塞性肺疾病（COPD）是全球发病和死亡的主要原因；然而，关于空气污染物混合物对COPD影响的证据仍然有限。本研究评估了长期暴露于多种污染物对COPD患病率的影响，并确定了易感亚组。我们分析了与一氧化碳（CO）、二氧化氮（NO₂）、二氧化硫（SO₂）、臭氧（O₃）、细颗粒物（PM₂.₅）和可吸入颗粒物（PM₁₀）的5年移动平均浓度相关的韩国国家健康与营养检查调查（2010 - 2017年）数据。贝叶斯核机器回归（BKMR）估计了污染物对COPD患病率的综合影响，并根据性别、吸烟状况和气流受限情况进行了亚组分析。调整因素包括年龄、性别、体重指数（BMI）、吸烟状况和家庭收入。在21,804名参与者中，3515人患有COPD。BKMR分析表明，长期暴露于污染物混合物与COPD患病率增加有关。O₃和NO₂被确定为最具影响力的污染物（后验包含概率>0.50）。进一步分析表明，随着NO₂和O₃浓度升高，COPD风险显著增加，尤其是当其他污染物处于较低或中等水平时。观察到显著的相互作用，特别是在SO₂与CO、CO与O₃以及NO₂与O₃之间。亚组分析确定了易感人群，表明女性和从不吸烟者之间的关联更强，且在慢性阻塞性肺疾病全球倡议（GOLD）2 - 4级个体中影响更为明显。这些发现表明，长期暴露于多种空气污染物可能会增加COPD风险，尤其是对女性、从不吸烟者以及患有更严重COPD的个体。需要采取有针对性的干预措施和政策措施来减少暴露，特别是针对这些高危人群。
