Long-term air pollution exposure and cardio- respiratory mortality: a review.
Long-term air pollution exposure and cardio- respiratory mortality: a review.
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DOI：
10.1186/1476-069x-12-43
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发表时间：
2013-05-28
期刊：
影响因子：
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通讯作者：
Kaufman JD
中科院分区：
文献类型：
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作者：
Hoek G;Krishnan RM;Beelen R;Peters A;Ostro B;Brunekreef B;Kaufman JD
目前，环境空气污染的浓度与一系列不利的健康影响有关，特别是心血管和呼吸系统疾病造成的死亡率和发病率。本文综述了长期暴露于细颗粒物、粗颗粒物、二氧化氮（NO2）和元素碳对全因死亡率、心血管疾病和呼吸系统疾病的影响。我们还总结了研究中潜在易感亚组的发现。我们通过检索Medline和Scopus数据库以及2013年1月之前的综述确定了研究，如果相同暴露指标的研究超过5项，则进行荟萃分析。有大量关于长期空气污染暴露的新研究，涵盖更广泛的地理区域，包括亚洲。这些最近的研究支持了先前关于PM2.5的队列研究中发现的相关性。以PM2.5暴露量每增加10 μg/m3的超额风险表示的汇总效应估计值，全因死亡率为6%（95% CI 4，8%），心血管死亡率为11%（95% CI 5，16%）。与非恶性呼吸道疾病相比，长期暴露于PM2.5与心血管疾病（特别是缺血性心脏病）死亡率的相关性更大（汇总估计值3%（95%CI-6，13%））。研究发现PM2.5效应估计值存在显著异质性，可能与颗粒成分差异、室内颗粒渗透、人群特征以及暴露评估和混杂因素控制的方法学差异有关。全因死亡率与元素碳（每1 μg/m3的合并估计值为6%（95% CI 5.7%））和NO2（每10 μg/m3的合并估计值为5%（95% CI 3.8%））显著相关，这两种标记物均为燃烧源。几乎没有证据表明长期粗颗粒物暴露与死亡率之间存在关联，这可能是由于研究数量少和暴露评估的局限性。在所有研究中，几乎没有证据表明女性与男性之间的联系更强。在教育程度较低和肥胖的受试者中，发现与细颗粒物相关的死亡率效应估计值较大，尽管在最近的研究中，与教育相关的差异证据已被削弱。
Current day concentrations of ambient air pollution have been associated with a range of adverse health effects, particularly mortality and morbidity due to cardiovascular and respiratory diseases. In this review, we summarize the evidence from epidemiological studies on long-term exposure to fine and coarse particles, nitrogen dioxide (NO2) and elemental carbon on mortality from all-causes, cardiovascular disease and respiratory disease. We also summarize the findings on potentially susceptible subgroups across studies. We identified studies through a search in the databases Medline and Scopus and previous reviews until January 2013 and performed a meta-analysis if more than five studies were available for the same exposure metric. There is a significant number of new studies on long-term air pollution exposure, covering a wider geographic area, including Asia. These recent studies support associations found in previous cohort studies on PM2.5. The pooled effect estimate expressed as excess risk per 10 μg/m3 increase in PM2.5 exposure was 6% (95% CI 4, 8%) for all-cause and 11% (95% CI 5, 16%) for cardiovascular mortality. Long-term exposure to PM2.5 was more associated with mortality from cardiovascular disease (particularly ischemic heart disease) than from non-malignant respiratory diseases (pooled estimate 3% (95% CI −6, 13%)). Significant heterogeneity in PM2.5 effect estimates was found across studies, likely related to differences in particle composition, infiltration of particles indoors, population characteristics and methodological differences in exposure assessment and confounder control. All-cause mortality was significantly associated with elemental carbon (pooled estimate per 1 μg/m3 6% (95% CI 5, 7%)) and NO2 (pooled estimate per 10 μg/m3 5% (95% CI 3, 8%)), both markers of combustion sources. There was little evidence for an association between long term coarse particulate matter exposure and mortality, possibly due to the small number of studies and limitations in exposure assessment. Across studies, there was little evidence for a stronger association among women compared to men. In subjects with lower education and obese subjects a larger effect estimate for mortality related to fine PM was found, though the evidence for differences related to education has been weakened in more recent studies.