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期刊来源：BMJ

原文链接：https://doi.org/10.1136/bmj-2023-076939

摘要内容如下：

客观

评估长期暴露于细可吸入颗粒物（PM2.5）与主要心血管疾病（CVD）亚型首次住院风险之间的暴露-反应关系。

设计

基于人群的队列研究。

设置

毗邻的美国。

参与者

59761494 2000-16年期间年龄≥65岁的医疗保险付费服务受益人。校准的PM2.5预测与每个参与者的住宅邮政编码相关联，作为代理暴露测量。

主要结果指标

缺血性心脏病、脑血管疾病、心力衰竭、心肌病、心律失常、瓣膜性心脏病、胸和腹主动脉瘤或这些CVD亚型的复合疾病随访期间首次入院的风险。为暴露-反应估计开发了一个对混杂偏差和暴露测量误差引起的偏差具有鲁棒性的因果框架。

结果

三年平均PM2.5暴露与缺血性心脏病、脑血管疾病、心力衰竭、心肌病、心律失常、胸和腹主动脉瘤首次住院的相对风险增加相关。对于复合CVD，暴露-反应曲线显示与PM2.5相关的风险单调增加：与≤5µg/m3的暴露量（世界卫生组织空气质量指南）相比，暴露量在9和10µg/m3之间的相对风险为1.29（95%置信区间1.28至1.30），其中包括研究期间美国全国平均暴露量9.7µg/m3。在绝对尺度上，复合CVD的住院风险从暴露量≤5µg/m3时的2.59%增加到暴露量在9和10µg/m3之间时的3.35%。在接触PM2.5后，这种影响至少会持续三年。年龄、教育、医疗保健的可及性和社区贫困水平似乎改变了对PM2.5的易感性。

结论

这项研究的发现表明，PM2.5对整体心血管健康的慢性影响不存在安全阈值。通过遵守世界卫生组织的空气质量准则，可以获得实质性的好处。

英文原文如下：

Abstracts

OBJECTIVE  To estimate exposure-response associations between chronic exposure to fine particulate matter (PM2.5) and risks of the first hospital admission for major cardiovascular disease (CVD) subtypes.

DESIGN  Population based cohort study.

SETTING  Contiguous US.

PARTICIPANTS  59 761 494 Medicare fee-for-service beneficiaries aged ≥65 years during 2000-16. Calibrated PM2.5 predictions were linked to each participant's residential zip code as proxy exposure measurements.

MAIN OUTCOME MEASURES  Risk of the first hospital admission during follow-up for ischemic heart disease, cerebrovascular disease, heart failure, cardiomyopathy, arrhythmia, valvular heart disease, thoracic and abdominal aortic aneurysms, or a composite of these CVD subtypes. A causal framework robust against confounding bias and bias arising from errors in exposure measurements was developed for exposure-response estimations.

RESULTS  Three year average PM2.5 exposure was associated with increased relative risks of first hospital admissions for ischemic heart disease, cerebrovascular disease, heart failure, cardiomyopathy, arrhythmia, and thoracic and abdominal aortic aneurysms. For composite CVD, the exposure-response curve showed monotonically increased risk associated with PM2.5: compared with exposures ≤5 µg/m3 (the World Health Organization air quality guideline), the relative risk at exposures between 9 and 10 µg/m3, which encompassed the US national average of 9.7 µg/m3 during the study period, was 1.29 (95% confidence interval 1.28 to 1.30). On an absolute scale, the risk of hospital admission for composite CVD increased from 2.59% with exposures ≤5 µg/m3 to 3.35% at exposures between 9 and 10 µg/m3. The effects persisted for at least three years after exposure to PM2.5. Age, education, accessibility to healthcare, and neighborhood deprivation level appeared to modify susceptibility to PM2.5.

CONCLUSIONS  The findings of this study suggest that no safe threshold exists for the chronic effect of PM2.5 on overall cardiovascular health. Substantial benefits could be attained through adherence to the WHO air quality guideline.

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