■社会经济上处于不利地位的亚群更容易受到细颗粒物(PM2.5)的影响。然而,由于先前的研究集中在个人层面的社会经济特征上,背景剥夺如何改变PM2.5暴露与心血管健康之间的关系尚不清楚.
■评估由不同社会经济特征定义的亚群之间PM2.5暴露与心血管疾病相关的差异。
■这项队列研究使用了2016至2022日历年来自“我们所有人”研究计划的电子健康记录(EHR)参与者的纵向数据。从2023年9月25日至2024年2月23日进行统计分析。
■根据参与者的住址,卫星衍生的5年平均PM2.5暴露在3位邮政编码级别。
■从EHRs获得急性心肌梗死(MI)和中风。使用分层Cox比例风险回归模型来估计PM2.5暴露与MI或中风之间的风险比(HR)。我们评估了由3个社会经济特征定义的亚群:情境剥夺(较少剥夺,更被剥夺),家庭年收入(≥5万美元,<5万美元),和种族和种族(非西班牙裔黑人,非西班牙裔白人)。我们计算了HR(RHR)的比率,以量化这些亚群之间的差异。
■共分析了210554名参与者(40%年龄>60岁;59.4%女性;16.7%西班牙裔,19.4%非西班牙裔黑人,56.1%非西班牙裔白人,7.9%其他[美洲印第安人,亚洲人,超过1个种族和种族]),其中发现了954例MI和1407例卒中病例.较高的PM2.5水平与较高的MI和卒中风险相关。然而,弱势群体(更贫困,年收入<5万美元,黑人种族)更容易受到高PM2.5水平的影响。由情境剥夺定义的群体之间的差异最为明显。例如,PM2.5从6μg/m3增加到10μg/m3,卒中的HR为1.13(95%CI,0.85-1.51),相对于2.57(95%CI,2.06-3.21),相对于2.46(95%CI,1.07-2.01),在每年50000美元或更多的人群中,相对于2.27(95%CI,1.73-2.97),在每年的人群中,相对于1.76美元情境剥夺的RHR最高(2.27;95%CI,1.59-3.24),与收入(1.55;95%CI,1.05-2.29)和种族和民族(1.62;95%CI,1.02-2.58)相比。
■在这项队列研究中,虽然个人种族、种族和收入在PM2.5与心血管风险的不利关系中仍然至关重要,情境剥夺是一个更强大的社会经济特征,可以改变PM2.5暴露的关联。
UNASSIGNED: Socioeconomically disadvantaged subpopulations are more vulnerable to fine particulate matter (PM2.5) exposure. However, as prior studies focused on individual-level socioeconomic characteristics, how contextual deprivation modifies the association of PM2.5 exposure with cardiovascular health remains unclear.
UNASSIGNED: To assess disparities in PM2.5 exposure association with cardiovascular disease among subpopulations defined by different socioeconomic characteristics.
UNASSIGNED: This cohort study used longitudinal data on participants with electronic health records (EHRs) from the All of Us Research Program between calendar years 2016 and 2022. Statistical analysis was performed from September 25, 2023, through February 23, 2024.
UNASSIGNED: Satellite-derived 5-year mean PM2.5 exposure at the 3-digit zip code level according to participants\' residential address.
UNASSIGNED: Incident myocardial infarction (MI) and stroke were obtained from the EHRs. Stratified Cox proportional hazards regression models were used to estimate the hazard ratio (HR) between PM2.5 exposure and incident MI or stroke. We evaluated subpopulations defined by 3 socioeconomic characteristics: contextual deprivation (less deprived, more deprived), annual household income (≥$50 000, <$50 000), and race and ethnicity (non-Hispanic Black, non-Hispanic White). We calculated the ratio of HRs (RHR) to quantify disparities between these subpopulations.
UNASSIGNED: A total of 210 554 participants were analyzed (40% age >60 years; 59.4% female; 16.7% Hispanic, 19.4% Non-Hispanic Black, 56.1% Non-Hispanic White, 7.9% other [American Indian, Asian, more than 1 race and ethnicity]), among whom 954 MI and 1407 stroke cases were identified. Higher PM2.5 levels were associated with higher MI and stroke risks. However, disadvantaged groups (more deprived, income <$50 000 per year, Black race) were more vulnerable to high PM2.5 levels. The disparities were most pronounced between groups defined by contextual deprivation. For instance, increasing PM2.5 from 6 to 10 μg/m3, the HR for stroke was 1.13 (95% CI, 0.85-1.51) in the less-deprived vs 2.57 (95% CI, 2.06-3.21) in the more-deprived cohort; 1.46 (95% CI, 1.07-2.01) in the $50 000 or more per year vs 2.27 (95% CI, 1.73-2.97) in the under $50 000 per year cohort; and 1.70 (95% CI, 1.35-2.16) in White individuals vs 2.76 (95% CI, 1.89-4.02) in Black individuals. The RHR was highest for contextual deprivation (2.27; 95% CI, 1.59-3.24), compared with income (1.55; 95% CI, 1.05-2.29) and race and ethnicity (1.62; 95% CI, 1.02-2.58).
UNASSIGNED: In this cohort study, while individual race and ethnicity and income remained crucial in the adverse association of PM2.5 with cardiovascular risks, contextual deprivation was a more robust socioeconomic characteristic modifying the association of PM2.5 exposure.