背景:空气污染是心血管疾病(CVD)的公认危险因素。温度也与CVD有关,主要关注急性效应。尽管空气污染和温度有着密切的关系,它们的健康影响经常单独检查,有可能忽视它们的协同效应。此外,较少研究对多个共同暴露进行混合分析,对于调整它们之间的混杂效应以及评估累积效应和个体效应至关重要。
方法:我们获得了美国14个州居民的住院记录,2000-2016年,来自卫生成本和利用项目州住院数据库。我们使用了分组加权分位数和回归,一种新的混合物分析方法,同时评估对四种分组混合物的年度暴露的累积和个体关联:空气污染物(元素碳,铵,硝酸盐,有机碳,硫酸盐,二氧化氮,臭氧),整个研究期间夏季和冬季温度平均值及其长期平均值之间的差异(即,夏季和冬季温度平均异常),整个研究期间夏季和冬季温度标准偏差(SD)与其长期平均值之间的差异(即,夏季和冬季温度SD异常),空气污染物与夏季和冬季温度平均异常之间的相互作用项。结果是四种流行的CVD亚型的住院率:缺血性心脏病,脑血管疾病,心力衰竭,和心律不齐。
结果:长期暴露于空气污染物混合物与所有CVD亚型的住院率增加有关,心力衰竭是最易感的亚型。硫酸盐,硝酸盐,二氧化氮,和有机碳构成最高的风险。空气污染物和温度平均异常之间的相互作用项的混合与所有CVD亚型的住院率增加有关。
结论:我们的发现确定了目标排放控制的关键污染物,并表明异常温度变化通过与空气污染相互作用而长期影响心血管健康。不是直接的。
BACKGROUND: Air pollution is a recognized risk factor for cardiovascular disease (CVD). Temperature is also linked to CVD, with a primary focus on acute effects. Despite the close relationship between air pollution and temperature, their health effects are often examined separately, potentially overlooking their synergistic effects. Moreover, fewer studies have performed mixture analysis for multiple co-exposures, essential for adjusting confounding effects among them and assessing both cumulative and individual effects.
METHODS: We obtained hospitalization records for residents of 14 U.S. states, spanning 2000-2016, from the Health Cost and Utilization Project State Inpatient Databases. We used a grouped weighted quantile sum regression, a novel approach for mixture analysis, to simultaneously evaluate cumulative and individual associations of annual exposures to four grouped mixtures: air pollutants (elemental carbon, ammonium, nitrate, organic carbon, sulfate, nitrogen dioxide, ozone), differences between summer and winter temperature means and their long-term averages during the entire study period (i.e., summer and winter temperature mean anomalies), differences between summer and winter temperature standard deviations (SD) and their long-term averages during the entire study period (i.e., summer and winter temperature SD anomalies), and interaction terms between air pollutants and summer and winter temperature mean anomalies. The outcomes are hospitalization rates for four prevalent CVD subtypes: ischemic heart disease, cerebrovascular disease, heart failure, and arrhythmia.
RESULTS: Chronic exposure to air pollutant mixtures was associated with increased hospitalization rates for all CVD subtypes, with heart failure being the most susceptible subtype. Sulfate, nitrate, nitrogen dioxide, and organic carbon posed the highest risks. Mixtures of the interaction terms between air pollutants and temperature mean anomalies were associated with increased hospitalization rates for all CVD subtypes.
CONCLUSIONS: Our findings identified critical pollutants for targeted emission controls and suggested that abnormal temperature changes chronically affected cardiovascular health by interacting with air pollution, not directly.