长期暴露于空气污染与心血管疾病死亡率：对22个欧洲队列的分析

Long-term exposure to air pollution and cardiovascular mortality: an analysis of 22 European cohorts.

作者信息

Beelen Rob, Stafoggia Massimo, Raaschou-Nielsen Ole, Andersen Zorana Jovanovic, Xun Wei W, Katsouyanni Klea, Dimakopoulou Konstantina, Brunekreef Bert, Weinmayr Gudrun, Hoffmann Barbara, Wolf Kathrin, Samoli Evangelia, Houthuijs Danny, Nieuwenhuijsen Mark, Oudin Anna, Forsberg Bertil, Olsson David, Salomaa Veikko, Lanki Timo, Yli-Tuomi Tarja, Oftedal Bente, Aamodt Geir, Nafstad Per, De Faire Ulf, Pedersen Nancy L, Östenson Claes-Göran, Fratiglioni Laura, Penell Johanna, Korek Michal, Pyko Andrei, Eriksen Kirsten Thorup, Tjønneland Anne, Becker Thomas, Eeftens Marloes, Bots Michiel, Meliefste Kees, Wang Meng, Bueno-de-Mesquita Bas, Sugiri Dorothea, Krämer Ursula, Heinrich Joachim, de Hoogh Kees, Key Timothy, Peters Annette, Cyrys Josef, Concin Hans, Nagel Gabriele, Ineichen Alex, Schaffner Emmanuel, Probst-Hensch Nicole, Dratva Julia, Ducret-Stich Regina, Vilier Alice, Clavel-Chapelon Françoise, Stempfelet Morgane, Grioni Sara, Krogh Vittorio, Tsai Ming-Yi, Marcon Alessandro, Ricceri Fulvio, Sacerdote Carlotta, Galassi Claudia, Migliore Enrica, Ranzi Andrea, Cesaroni Giulia, Badaloni Chiara, Forastiere Francesco, Tamayo Ibon, Amiano Pilar, Dorronsoro Miren, Katsoulis Michail, Trichopoulou Antonia, Vineis Paolo, Hoek Gerard

机构信息

From the aInstitute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands; bDepartment of Epidemiology, Lazio Regional Health Service, Rome, Italy; cDanish Cancer Society Research Center, Copenhagen, Denmark; dCenter for Epidemiology and Screening, Department of Public Health, University of Copenhagen, CSS, København K, Denmark; eMRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, London, United Kingdom; fUniversity College London, CeLSIUS, London, United Kingdom; gDepartment of Hygiene, Epidemiology, and Medical Statistics, Medical School, University of Athens, Athens, Greece; hJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; iInstitute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; jIUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany, and Medical Faculty, University of Düsseldorf, Düsseldorf, Germany; kInstitute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; lNational Institute for Public Health and the Environment, Bilthoven, The Netherlands; mCentre for Research in Environmental Epidemiology (CREAL), Barcelona, and Parc de Recerca Biomèdica de Barcelona-PRBB (office 183.05) C. Doctor Aiguader, Barcelona, Spain; nConsortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Melchor Fernández Almagro 3-5, Madrid, Spain; oDivision of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; pNational Institute for Health and Welfare, Kuopio, Finland; qNorwegian Institute of Public Health, Oslo, Norway; rInstitute of Health and Society, University of Oslo, Oslo, Norway; sInstitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; tDepartm

出版信息

Epidemiology. 2014 May;25(3):368-78. doi: 10.1097/EDE.0000000000000076.

DOI:10.1097/EDE.0000000000000076

PMID:24589872

Abstract

BACKGROUND

Air pollution has been associated with cardiovascular mortality, but it remains unclear as to whether specific pollutants are related to specific cardiovascular causes of death. Within the multicenter European Study of Cohorts for Air Pollution Effects (ESCAPE), we investigated the associations of long-term exposure to several air pollutants with all cardiovascular disease (CVD) mortality, as well as with specific cardiovascular causes of death.

METHODS

Data from 22 European cohort studies were used. Using a standardized protocol, study area-specific air pollution exposure at the residential address was characterized as annual average concentrations of the following: nitrogen oxides (NO2 and NOx); particles with diameters of less than 2.5 μm (PM2.5), less than 10 μm (PM10), and 10 μm to 2.5 μm (PMcoarse); PM2.5 absorbance estimated by land-use regression models; and traffic indicators. We applied cohort-specific Cox proportional hazards models using a standardized protocol. Random-effects meta-analysis was used to obtain pooled effect estimates.

RESULTS

The total study population consisted of 367,383 participants, with 9994 deaths from CVD (including 4,992 from ischemic heart disease, 2264 from myocardial infarction, and 2484 from cerebrovascular disease). All hazard ratios were approximately 1.0, except for particle mass and cerebrovascular disease mortality; for PM2.5, the hazard ratio was 1.21 (95% confidence interval = 0.87-1.69) per 5 μg/m and for PM10, 1.22 (0.91-1.63) per 10 μg/m.

CONCLUSION

In a joint analysis of data from 22 European cohorts, most hazard ratios for the association of air pollutants with mortality from overall CVD and with specific CVDs were approximately 1.0, with the exception of particulate mass and cerebrovascular disease mortality for which there was suggestive evidence for an association.

摘要

背景

空气污染与心血管疾病死亡率相关，但具体污染物是否与特定的心血管疾病死亡原因有关仍不清楚。在多中心欧洲空气污染影响队列研究（ESCAPE）中，我们调查了长期暴露于几种空气污染物与所有心血管疾病（CVD）死亡率以及特定心血管疾病死亡原因之间的关联。

方法

使用了来自22项欧洲队列研究的数据。采用标准化方案，将居住地址特定研究区域的空气污染暴露特征化为以下各项的年平均浓度：氮氧化物（二氧化氮和氮氧化物）；直径小于2.5μm的颗粒物（PM2.5）、小于10μm的颗粒物（PM10）以及10μm至2.5μm的颗粒物（粗颗粒物）；通过土地利用回归模型估算的PM2.5吸光度；以及交通指标。我们采用标准化方案应用队列特异性Cox比例风险模型。使用随机效应荟萃分析来获得合并效应估计值。

结果

总研究人群包括367383名参与者，其中9994人死于心血管疾病（包括4992人死于缺血性心脏病、2264人死于心肌梗死和2484人死于脑血管疾病）。除颗粒物质量与脑血管疾病死亡率外，所有风险比均约为1.0；对于PM2.5，每5μg/m³的风险比为1.21（95%置信区间=0.87-1.69），对于PM10，每10μg/m³的风险比为1.22（0.91-1.63）。