AN ASSOCIATION BETWEEN AIR-POLLUTION AND MORTALITY IN 6 UNITED-STATES CITIES
AN ASSOCIATION BETWEEN AIR-POLLUTION AND MORTALITY IN 6 UNITED-STATES CITIES
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DOI：
10.1056/nejm199312093292401
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发表时间：
1993-12-09
影响因子：
158.5
通讯作者：
SPEIZER, FE
中科院分区：
文献类型：
--
作者：
DOCKERY, DW;POPE, CA;SPEIZER, FE
背景。最近的研究报道了颗粒空气污染与每日死亡率之间的关联。基于人群的，对美国大都市地区的横断面研究也发现了颗粒空气污染和年死亡率之间的关联，但这些研究受到了批评，部分原因是它们没有直接控制吸烟和其他健康风险。方法。在这项前瞻性队列研究中，我们估计了空气污染对死亡率的影响，同时控制了个体危险因素。生存分析，包括COX比例危害回归模型，并从美国六个城市的8111名成年人的14至16岁死亡率随访中进行了数据。死亡率与吸烟最密切相关。调整了吸烟和其他危险因素后，我们观察到空气污染与死亡率之间具有统计学意义和牢固的关联。与最低污染相比，城市中污染最多的调整死亡率比率为1.26（95％的置信区间，1.08至1.47）。空气污染与肺癌和心肺疾病的死亡呈正相关，但与其他原因的死亡无关。死亡率与包括硫酸盐在内的精细颗粒物的空气污染最密切相关。尽管无法确定的其他危险因素的其他影响，但这些结果表明，良好的空气污染或与细颗粒物相关的更复杂的污染混合物在某些美国城市中导致过度死亡率。
Background. Recent studies have reported associations between particulate air pollution and daily mortality rates. Population-based, cross-sectional studies of metropolitan areas in the United States have also found associations between particulate air pollution and annual mortality rates, but these studies have been criticized, in part because they did not directly control for cigarette smoking and other health risks.Methods. In this prospective cohort study, we estimated the effects of air pollution on mortality, while controlling for individual risk factors. Survival analysis, including Cox proportional-hazards regression modeling, was conducted with data from a 14-to-16-year mortality follow-up of 8111 adults in six U.S. cities.Results. Mortality rates were most strongly associated with cigarette smoking. After adjusting for smoking and other risk factors, we observed statistically significant and robust associations between air pollution and mortality. The adjusted mortality-rate ratio for the most polluted of the cities as compared with the least polluted was 1.26 (95 percent confidence interval, 1.08 to 1.47). Air pollution was positively associated with death from lung cancer and cardiopulmonary disease but not with death from other causes considered together. Mortality was most strongly associated with air pollution with fine particulates, including sulfates.Conclusions. Although the effects of other, unmeasured risk factors cannot be excluded with certainty, these results suggest that fine-particulate air pollution, or a more complex pollution mixture associated with fine particulate matter, contributes to excess mortality in certain U.S. cities.