A Case-Crossover Analysis of Out-of-Hospital Cardiac Arrest and Air Pollution
A Case-Crossover Analysis of Out-of-Hospital Cardiac Arrest and Air Pollution
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DOI：
10.1161/circulationaha.113.000027
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发表时间：
2013-03-19
期刊：
影响因子：
37.8
通讯作者：
Persse, David
中科院分区：
文献类型：
--
作者：
Ensor, Katherine B.;Raun, Loren H.;Persse, David
背景：文献中越来越多地发现暴露于空气污染与总体心血管发病率和死亡率之间存在关联的证据。然而，关于急性空气污染暴露与院外心脏骤停风险之间关系的研究结果在细颗粒物方面并不一致，而且，尽管病理生理学证据表明院外心脏骤停与臭氧之间存在似是而非的联系，但尚未有任何报道。在美国，每年大约有30万人经历OHCA，其中90%的人死亡。了解这种联系为保护公众健康提供了重要信息。方法与结果：采用时间分层病例交叉设计，对2004年至2011年在德克萨斯州休斯顿发生的11677例急诊医疗服务记录的OHCA事件，评估发病前数小时和数天OHCA与空气污染浓度之间的关系。空气污染浓度是通过广泛的区域监测网络获得的。发病前2天细颗粒物浓度平均增加6 μ g/m(3)与OHCA风险增加相关（1.046；95%可信区间为1.012-1.082）。在8小时的平均每日最大值中，臭氧增加20 ppb与事件当天OHCA的风险增加相关（1.039；95%可信区间，1.005-1.073）。在之前的1至3小时内，臭氧每增加20 ppb， OHCA的风险就会增加（1.044；95%可信区间为1.004-1.085）。男性、黑人或65岁以上人群的相对风险估计更高。结论：研究结果证实了OHCA与细颗粒物之间的联系，并提供了与臭氧之间类似联系的证据。(循环。2013;127:1192 - 1199)。
Background-Evidence of an association between the exposure to air pollution and overall cardiovascular morbidity and mortality is increasingly found in the literature. However, results from studies of the association between acute air pollution exposure and risk of out-of-hospital cardiac arrest (OHCA) are inconsistent for fine particulate matter, and, although pathophysiological evidence indicates a plausible link between OHCA and ozone, none has been reported. Approximately 300 000 persons in the United States experience an OHCA each year, of which >90% die. Understanding the association provides important information to protect public health.Methods and Results-The association between OHCA and air pollution concentrations hours and days before onset was assessed by using a time-stratified case-crossover design using 11 677 emergency medical service-logged OHCA events between 2004 and 2011 in Houston, Texas. Air pollution concentrations were obtained from an extensive area monitor network. An average increase of 6 mu g/m(3) in fine particulate matter 2 days before onset was associated with an increased risk of OHCA (1.046; 95% confidence interval, 1.012-1.082). A 20-ppb ozone increase for the 8-hour average daily maximum was associated with an increased risk of OHCA on the day of the event (1.039; 95% confidence interval, 1.005-1.073). Each 20-ppb increase in ozone in the previous 1 to 3 hours was associated with an increased risk of OHCA (1.044; 95% confidence interval, 1.004-1.085). Relative risk estimates were higher for men, blacks, or those aged >65 years.Conclusions-The findings confirm the link between OHCA and fine particulate matter and introduce evidence of a similar link with ozone. (Circulation. 2013;127:1192-1199.)