背景:贫血是一种具有多种病因的公共卫生重要性的疾病。以前的文献表明室内空气污染(IAP)对血红蛋白水平的作用,但由于后勤限制,这方面的研究较少。发展中国家人口比例很高,包括印度,仍然依赖于不清洁的燃料,这加剧了IAP。目的是研究按性别划分的印度老年成年人(≥45岁)中贫血与IAP之间的关系。
方法:我们的研究分析了印度纵向老龄化研究的全国代表性数据集(LASI2017-18,Wave-1)。我们已经记录了贫血(结果变量)与IAP(解释变量)的关联。为了减少人口统计学和社会经济的混杂效应;健康相关和行为协变量;进行了倾向评分匹配(PSM)。进行嵌套多水平回归建模。州和联邦领土被交叉分类为低,根据贫血和IAP暴露,中度和高度。P值<0.05被认为具有统计学意义。使用SATA版本17进行分析。
结果:超过一半(52.52%)的参与者暴露于IAP(男性(53.55%)>女性(51.63%))。在使用不清洁/固体燃料的参与者中,贫血的几率显着高出1.19倍(AOR1.19(1.09-1.31))。在暴露于污染源的参与者中,调整后的赔率明显更高(AOR1.30;1.18-1.43),和家庭室内吸烟(AOR1.17(1.07-1.29)。暴露于IAP的参与者患贫血的几率显著较高(AOR1.26;1.15-1.38),男性(AOR1.36;1.15-1.61)高于女性(AOR1.21;1.08-1.35)。授权行动小组(EAG)像北方邦这样的国家,恰蒂斯加尔邦,中央邦,比哈尔邦同时患有高度贫血和IAP暴露。
结论:本研究通过具有全国代表性的大型数据集,在印度老年人中建立了贫血与室内空气污染的正相关关系。男性的关联较高。建议进一步研究以了解详细的因果关系并建立时间性。现在是在全国范围内实施积极干预以减少固体/不清洁燃料使用的时候了,脆弱的通风,室内吸烟,IAP和与之相关的健康危害以及对EAG州的更集中的行动。
BACKGROUND: Anaemia is a disease of public health importance with multi-causal pathways. Previous literature suggests the role of indoor air pollution (IAP) on haemoglobin levels, but this has been studied less due to logistic constraints. A high proportion of the population in developing countries, including India, still depends on unclean fuel, which exacerbates IAP. The objective was to study the association between anaemia and IAP among the older Indian adult population (≥ 45 years) as per gender.
METHODS: Our study analysed the nationally representative dataset of the Longitudinal Ageing Study in India (LASI 2017-18, Wave-1). We have documented the association of anaemia (outcome variable) with IAP (explanatory variable). To reduce the confounding effects of demographic and socioeconomic; health related and behavioural covariates; propensity score matching (PSM) was conducted. Nested multilevel regression
modelling was conducted. States and union territories were categorised cross tabulated as low, middle and high as per anaemia and IAP exposure. P value < 0.05 was considered statistically significant. SATA version 17 was used for analysis.
RESULTS: More than half (52.52%) of the participants were exposed to IAP (male (53.55%) > female (51.63%)). The odds of having anaemia was significantly 1.19 times higher (AOR 1.19 (1.09-1.31)) among participants using unclean/ solid fuel. The adjusted odds were significantly higher among participants exposed to pollution-generating sources (AOR 1.30; 1.18-1.43), and household indoor smoking (AOR 1.17 (1.07-1.29). The odds of having anaemia were significantly higher (AOR 1.26; 1.15-1.38) among participants exposed to IAP, which was higher in males (AOR 1.36; 1.15-1.61) than females (AOR 1.21; 1.08-1.35). Empowered Action Group (EAG) states like Uttar Pradesh, Chhattisgarh, Madhya Pradesh, Bihar had both high anaemia and IAP exposure.
CONCLUSIONS: This study established the positive association of anaemia with indoor air pollution among older Indian adults through a nationally representative large dataset. The association was higher among men. Further research is recommended to understand detailed causation and to establish temporality. It is a high time to implement positive intervention nationally to decrease solid/ unclean fuel usage, vulnerable ventilation, indoor smoking, IAP and health hazards associated with these with more focused actions towards EAG states.