长期粗颗粒物暴露与医疗补助儿童的哮喘相关
2017/12/20
摘要
基本原理：短期及长期细颗粒物（PM2.5）污染与哮喘的发展、发病率相关，但长期粗颗粒物（PM10-2.5）暴露对呼吸系统健康的影响尚没有相关的研究。
目的：了解长时间粗颗粒物、细颗粒物暴露与儿童哮喘流行、发病之间的关系。
方法：用合并了PM2.5和PM10监测数据和地理特征的半参数回归模型，来预测邮政编码制表区级、2009年到2010年间的PM2.5和PM10-2.5暴露的2年平均值。数据来自5-20岁，在2009-2010期间医疗补助登记的7,810,025名儿童。用对数线性回归模型预测颗粒物水平，来估测颗粒物暴露与哮喘流行、发病间的关系。评估经过以下调整：种族、性别、年龄、区域水平、城区、贫穷、教育及未检测的空间混淆。
检测与主要结果：经细颗粒物暴露调整，粗颗粒暴露与哮喘流行（RR（粗颗粒物水平增加1µg/m3）：1.006，95%CI: 1.001-1.011）、住院治疗（RR: 1.023, 95%CI: 1.003-1.042）和急诊就诊（RR: 1.017, 95%CI: 1.001-1.033）增加有关。与粗颗粒物暴露相比，细颗粒物暴露及哮喘流行、发病之间的关联性更强。经不同水平的空间混淆调整后，检测结果仍然升高。
结论：医疗补助登记的儿童中，更高水平粗颗粒物暴露与哮喘流行、发病相关。结果提示，粗颗粒物需要监测，长期平均粗颗粒物污染水平范围需要再审议。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(Am J Respir Crit Care Med. 2017 Dec 15.)
Long-term Coarse PM Exposure is Associated with Asthma Among Children in Medicaid
Keet CA, Keller JP, Peng RD.
Abstract
RATIONALE:Short and long-term fine particulate matter (PM2.5) pollution is associated with asthma development and morbidity, but there is little data on the effects of long-term exposure to coarse PM (PM10-2.5) on respiratory health.
OBJECTIVES:To understand the relationship between long-term fine and coarse PM exposure and asthma prevalence and morbidity among children.
METHODS:A semi-parametric regression model that incorporated PM2.5 and PM10 monitor data and geographic characteristics was developed to predict two-year average PM2.5 and PM10-2.5exposure during the period 2009-2010 at the zip-code tabulation area level. Data from 7,810,025children aged 5-20 years enrolled in Medicaid from 2009-2010 were used in a log-linear regression model with predicted PM levels to estimate the association between PM exposure and asthma prevalence and morbidity, adjusting for race/ethnicity, sex, age, area-level urbanicity, poverty, education, and unmeasured spatial confounding.
MEASUREMENTS AND MAIN RESULTS:Exposure to coarse PM was associated with increased asthma diagnosis prevalence (RR for 1µg/m3 increase in coarse PM level: 1.006, 95%CI: 1.001-1.011), hospitalizations (RR: 1.023, 95%CI: 1.003-1.042), and emergency department (ED) visits (RR: 1.017, 95%CI: 1.001-1.033) when adjusting for fine PM. Fine PM exposure was more strongly associated with increased asthma prevalence and morbidity than coarse PM. The estimates remained elevated across different levels of spatial confounding adjustment.
CONCLUSIONS:Among children enrolled in Medicaid, exposure to higher average coarse PM levels is associated with increased asthma prevalence and morbidity. These results suggest the need for direct monitoring of coarse PM and reconsideration of limits on long-term average coarse PM pollution levels.
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哮喘患者健康相关生活质量：2005与2015两个队列的比较
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对宠物的敏感和接触：对美国人群哮喘发病率的影响
