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美国空气污染和老年医疗保险人群死亡率的关系
Air Pollution and Mortality in the Medicare Population


Qian Di ... 呼吸系统疾病 • 2017.06.29
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空气污染对全因死亡率的影响:现状与挑战

 

关伟杰,钟南山* 

呼吸疾病国家重点实验室;国家呼吸疾病临床医学研究中心;广州呼吸疾病研究所;广州医科大学附属第一医院,广州医科大学

* 通讯作者


随着社会经济的发展,全球疾病谱发生了重大转变,但环境(特别是空气)污染对人群的不良影响在近10年才逐渐被重视。2015年全球疾病负担报告指出,大气PM2.5水平增高使全球死亡率从1990年的350万人增加至2015年的420万人1。自1990年起,我国空气污染物年均水平逐年增加,其对慢性呼吸道疾病、心血管疾病死亡率的贡献度也相应增加;室内空气污染对疾病的不良影响大于室外空气污染2。近年来,我国多个地区相继出现的重度空气污染(如大范围雾霾、沙尘暴)事件使公众“谈霾色变”,故全方位治理空气污染刻不容缓。

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摘要


背景

既往研究表明长期暴露于空气污染会增加死亡率。但低于美国最新的国家环境空气质量标准(National Ambient Air Quality Standard)的空气污染是否增加死亡率,目前来看证据有限。既往研究主要纳入的是城市地区人群,因而没有统计学功效来估计那些未被充分代表的人群的健康效应。

 

方法

我们建立了一个开放性队列,纳入了美国本土2000~2012年的所有美国老年医疗保险(Medicare)受益人(60,925,443人),并合计随访了460,310,521人-年。采用既往验证过的空气污染预测模型,根据每位入选者的居住地邮政编码估计了细颗粒物(总气体动力学中位数直径小于2.5 μm的颗粒物[PM2.5])和臭氧的年平均水平。我们采用双污染物Cox比例风险模型,并且控制人口统计学特征、医疗补助保险(Medicaid)资格和地区水平的协变量,估计了与PM2.5暴露增加10 μg/m3和臭氧暴露增加10个十亿分率(ppb)相关的死亡风险。

 

结果

PM2.5的暴露增加10 μg/m3和臭氧暴露增加10 ppb,分别与全因死亡率增加7.3%(95%置信区间[CI],7.1%~7.5%)和1.1%(95% CI,1.0%~1.2%)相关。当分析仅限于PM2.5暴露低于12 μg/m3和臭氧暴露低于50 ppb的人-年时,上述PM2.5和臭氧暴露增加分别与死亡风险增加13.6%(95% CI,13.1%~14.1%)和1.0%(95% CI,0.9%~1.1%)相关。对于PM2.5而言,男性、黑种人和有医疗补助保险资格的人的死亡风险要比其余人群高。

 

结论

在整个老年医疗保险人群中,在低于现行美国国家标准的空气污染浓度下,仍然有与PM2.5和臭氧暴露相关的不良健康效应。这一效应在自我认定的少数族裔和低收入人群中最明显(由美国健康影响研究所[Health Effects Institute]等资助)。





作者信息

Qian Di , M.S., Yan Wang, M.S., Antonella Zanobetti, Ph.D., Yun Wang, Ph.D., Petros Koutrakis, Ph.D., Christine Choirat, Ph.D., Francesca Dominici, Ph.D., and Joel D. Schwartz, Ph.D.
From the Departments of Environmental Health (Q.D., Yan Wang, A.Z., P.K., J.D.S.) and Biostatistics (Yun Wang, C.C., F.D.), Harvard T.H. Chan School of Public Health, Boston. Address reprint requests to Dr. Dominici at Harvard T.H. Chan School of Public Health, Biostatistics Department, Bldg. 2, 4th Flr., 655 Huntington Ave., Boston, MA 02115, or at fdominic@hsph.harvard.edu.

 

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