Abstract：
Ambient PM2.5 is a ubiquitous air pollutant with demonstrated adverse health impacts in population. Hemodialysis patients are a highly vulnerable population and may be particularly susceptible to the effects of PM2.5 exposure. This study examines associations between short-term PM2.5 exposure and cardiovascular disease (CVD) and mortality among patients receiving maintenance in-center hemodialysis.
Using the United State Renal Data System (USRDS) registry, we enumerated a cohort of all US adult kidney failure patients who initiated in-center hemodialysis between 1/1/2011 and 12/31/2016. Daily ambient PM2.5 exposure estimates were assigned to cohort members based on the ZIP code of the dialysis clinic. CVD incidence and mortality were ascertained through 2016 based on USRDS records. Discrete time hazards regression was used to estimate the association between lagged PM2.5 exposure and CVD incidence, CVD-specific mortality, and all-cause mortality 1 t adjusting for temperature, humidity, day of the week, season, age at baseline, race, employment status, and geographic region. Effect measure modification was assessed for age, sex, race, and comorbidities.
Among 314,079 hemodialysis patients, a 10 µg/m3 increase in the average lag 0-1 daily PM2.5 exposure was associated with CVD incidence (HR: 1.03 (95% CI: 1.02, 1.04)), CVD mortality (1.05 (95% CI: 1.03, 1.08)), and all-cause mortality (1.04 (95% CI: 1.03, 1.06)). The association was larger for people who initiated dialysis at an older age, while minimal evidence of effect modification was observed across levels of sex, race, or baseline comorbidities.
Short-term ambient PM2.5 exposure was positively associated with incident CVD events and mortality among patients receiving in-center hemodialysis. Older patients appeared to be more susceptible to PM2.5-associated CVD events than younger hemodialysis patients.
Using the United State Renal Data System (USRDS) registry, we enumerated a cohort of all US adult kidney failure patients who initiated in-center hemodialysis between 1/1/2011 and 12/31/2016. Daily ambient PM2.5 exposure estimates were assigned to cohort members based on the ZIP code of the dialysis clinic. CVD incidence and mortality were ascertained through 2016 based on USRDS records. Discrete time hazards regression was used to estimate the association between lagged PM2.5 exposure and CVD incidence, CVD-specific mortality, and all-cause mortality 1 t adjusting for temperature, humidity, day of the week, season, age at baseline, race, employment status, and geographic region. Effect measure modification was assessed for age, sex, race, and comorbidities.
Among 314,079 hemodialysis patients, a 10 µg/m3 increase in the average lag 0-1 daily PM2.5 exposure was associated with CVD incidence (HR: 1.03 (95% CI: 1.02, 1.04)), CVD mortality (1.05 (95% CI: 1.03, 1.08)), and all-cause mortality (1.04 (95% CI: 1.03, 1.06)). The association was larger for people who initiated dialysis at an older age, while minimal evidence of effect modification was observed across levels of sex, race, or baseline comorbidities.
Short-term ambient PM2.5 exposure was positively associated with incident CVD events and mortality among patients receiving in-center hemodialysis. Older patients appeared to be more susceptible to PM2.5-associated CVD events than younger hemodialysis patients.
摘要：
环境PM2.5是一种普遍存在的空气污染物，对人群的健康产生不利影响。血液透析患者是高度脆弱的人群，可能特别容易受到PM2.5暴露的影响。这项研究调查了短期PM2.5暴露与心血管疾病（CVD）和死亡率之间的关系接受维持在中心血液透析的患者。
使用美国肾脏数据系统（USRDS）注册表，我们列举了在2011年1月1日至2016年12月31日期间开始中心血液透析的所有美国成人肾衰竭患者的队列.根据透析诊所的邮政编码，将每日环境PM2.5暴露估计值分配给队列成员。根据USRDS记录确定到2016年的CVD发病率和死亡率。使用离散时间风险回归来估计滞后PM2.5暴露与CVD发生率之间的关系，CVD特异性死亡率，和全因死亡率1t调整温度，湿度,湿度星期几,季节,基线年龄，种族,就业状况,和地理区域。效果测量修改被评估为年龄，性别,种族,和合并症。
在314,079名血液透析患者中，10µg/m3的平均滞后0-1日PM2.5暴露量增加与CVD发病率相关(HR:1.03(95%CI:1.02,1.04)),CVD死亡率（1.05（95%CI：1.03，1.08）），和全因死亡率（1.04（95%CI：1.03，1.06））。对于年龄较大的人来说，这种关联更大，虽然在性别层面上观察到最小的效应改变证据，种族,或基线合并症。
在接受中心血液透析的患者中，短期环境PM2.5暴露与CVD事件和死亡率呈正相关。与年轻的血液透析患者相比，老年患者似乎更容易发生PM2.5相关的CVD事件。
使用美国肾脏数据系统（USRDS）注册表，我们列举了在2011年1月1日至2016年12月31日期间开始中心血液透析的所有美国成人肾衰竭患者的队列.根据透析诊所的邮政编码，将每日环境PM2.5暴露估计值分配给队列成员。根据USRDS记录确定到2016年的CVD发病率和死亡率。使用离散时间风险回归来估计滞后PM2.5暴露与CVD发生率之间的关系，CVD特异性死亡率，和全因死亡率1t调整温度，湿度,湿度星期几,季节,基线年龄，种族,就业状况,和地理区域。效果测量修改被评估为年龄，性别,种族,和合并症。
在314,079名血液透析患者中，10µg/m3的平均滞后0-1日PM2.5暴露量增加与CVD发病率相关(HR:1.03(95%CI:1.02,1.04)),CVD死亡率（1.05（95%CI：1.03，1.08）），和全因死亡率（1.04（95%CI：1.03，1.06））。对于年龄较大的人来说，这种关联更大，虽然在性别层面上观察到最小的效应改变证据，种族,或基线合并症。
在接受中心血液透析的患者中，短期环境PM2.5暴露与CVD事件和死亡率呈正相关。与年轻的血液透析患者相比，老年患者似乎更容易发生PM2.5相关的CVD事件。
