[JAMA最新论文]:空气污染短期暴露与老年人死亡率的相关性 | 中国病理生理学会危重病医学专业委员会
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Original Investigation

December 26, 2017

Association of Short-term Exposure to Air Pollution With Mortality in Older Adults

Qian Di, Lingzhen Dai, Yun Wang, et al.

JAMA. 2017;318(24):2446-2456. doi:10.1001/jama.2017.17923


Importance 背景

The US Environmental Protection Agency is required to reexamine its National Ambient Air Quality Standards (NAAQS) every 5 years, but evidence of mortality risk is lacking at air pollution levels below the current daily NAAQS in unmonitored areas and for sensitive subgroups.


Objective 目的

To estimate the association between short-term exposures to ambient fine particulate matter (PM2.5) and ozone, and at levels below the current daily NAAQS, and mortality in the continental United States.

评估美国大陆低于现行每日NAAQS的室外细颗粒物 (PM2.5) 及臭氧的短期暴露与死亡率的相关性。

Design, Setting, and Participants 设计,场景及研究对象

Case-crossover design and conditional logistic regression to estimate the association between short-term exposures to PM2.5 and ozone (mean of daily exposure on the same day of death and 1 day prior) and mortality in 2-pollutant models. The study included the entire Medicare population from January 1, 2000, to December 31, 2012, residing in 39 182 zip codes.

通过病例交叉试验设计以及条件logistic回归分析,采用两种污染物模型,评估PM2.5 及臭氧短期暴露(死亡当天及前一天的平均日暴露量)与死亡率的相关性。研究纳入了2000年1月1日至2012年12月31日的居住在39182个邮政编码所在地的全部Medicare人群。

Exposures 暴露

Daily PM2.5 and ozone levels in a 1-km × 1-km grid were estimated using published and validated air pollution prediction models based on land use, chemical transport modeling, and satellite remote sensing data. From these gridded exposures, daily exposures were calculated for every zip code in the United States. Warm-season ozone was defined as ozone levels for the months April to September of each year.

根据发表且经过验证的空气污染预测模型(基于土地使用,化学物品运输模型,卫星遥感数据建立)估测1-km x 1-km网格的每日PM2.5 和臭氧水平。根据上述网格的暴露情况,计算美国每个邮政编码所在地每日暴露情况。暖季臭氧定义为每年4月至9月间的臭氧水平。

Main Outcomes and Measures 主要预后指标

All-cause mortality in the entire Medicare population from 2000 to 2012.


Results 结果

During the study period, there were 22 433 862 million case days and 76 143 209 control days. Of all case and control days, 93.6% had PM2.5 levels below 25 μg/m3, during which 95.2% of deaths occurred (21 353 817 of 22 433 862), and 91.1% of days had ozone levels below 60 parts per billion, during which 93.4% of deaths occurred (20 955 387 of 22 433 862). The baseline daily mortality rates were 137.33 and 129.44 (per 1 million persons at risk per day) for the entire year and for the warm season, respectively. Each short-term increase of 10 μg/m3in PM2.5 (adjusted by ozone) and 10 parts per billion (10−9) in warm-season ozone (adjusted by PM2.5) were statistically significantly associated with a relative increase of 1.05% (95% CI, 0.95%-1.15%) and 0.51% (95% CI, 0.41%-0.61%) in daily mortality rate, respectively. Absolute risk differences in daily mortality rate were 1.42 (95% CI, 1.29-1.56) and 0.66 (95% CI, 0.53-0.78) per 1 million persons at risk per day. There was no evidence of a threshold in the exposure-response relationship.

研究期间共计22433862百万病例日及76143209对照日。在所有病例日及对照日中,93.6%的 PM2.5 水平低于 25 μg/m3,95.2% 的死亡(21353817/22433862)发生在此期间;91.1% 的日子臭氧水平低于 60 parts per billion,93.4% 的死亡(20955387/22433862)发生在此期间。全年及暖季每日基线死亡率分别为137.33和129.44(每百万风险人口每日)。PM2.5 水平短期增加10 μg/m3(根据臭氧水平校正后)以及暖季臭氧水平短期增加 10 parts per billion (10−9) (根据PM2.5校正后)伴随每日死亡率分别增加 1.05% (95% CI, 0.95%-1.15%) 和 0.51% (95% CI, 0.41%-0.61%)。每日死亡率绝对差异为1.42 (95% CI, 1.29-1.56) 和 0.66 (95% CI, 0.53-0.78) 每百万风险人口每日。没有证据表明暴露反应关系存在阈值。

Conclusions and Relevance 结论与意义

In the US Medicare population from 2000 to 2012, short-term exposures to PM2.5 and warm-season ozone were significantly associated with increased risk of mortality. This risk occurred at levels below current national air quality standards, suggesting that these standards may need to be reevaluated.

2000-2012年间,美国Medicare人群中PM2.5 及暖季臭氧短期暴露伴随死亡风险增加。这一风险发生在低于现行国家空气质量标准以下,提示这些标准需要重新审定。



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