A case-crossover analysis of out-of-hospital coronary deaths and air pollution in Rome, Italy
A case-crossover analysis of out-of-hospital coronary deaths and air pollution in Rome, Italy
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DOI：
10.1164/rccm.200412-1726oc
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发表时间：
2005-12-15
影响因子：
24.7
通讯作者：
Perucci, CA
中科院分区：
文献类型：
--
作者：
Forastiere, F;Stafoggia, M;Perucci, CA
基本原理：院外冠心病死亡是一个主要的公共卫生问题，但与空气污染的关系还没有得到很好的理解。（粒子数浓度[PNC]-超细粒子[直径< 0.1 μ m]的代表，直径小于10 μ m的粒子的质量[PM10];方法：研究对象为罗马的5,144例院外死亡病例（410-414，国际疾病分类-9; 1998-2000）。死亡前3年内的住院治疗被认为是确定合并症（例如，糖尿病、高血压、心力衰竭、心律失常、慢性阻塞性肺病）。采用病例交叉设计进行统计分析。测量和主要结果：PNC、PM10和CO与院外冠心病死亡的相关性具有统计学意义。死亡当天的空气污染影响最大（例如，增加7.6%[95%置信区间，2.0-13.6%]），PNC的四分位数范围为27，790个微粒/cm（3）。65-74岁和75岁以上年龄组的风险高于35-64岁年龄组，建议对高血压和慢性阻塞性肺病患者进行效果调整。结论：燃烧过程产生的空气污染物，包括超细颗粒物，与致命的、非住院的冠状动脉事件有关。这种影响在65岁以上的人群中更强，但并不限于特定合并症的人群。
Rationale: Out-of-hospital coronary heart disease death is a major public health problem, but the association with air pollution is not well understood.Objectives: We evaluated the association between daily ambient air pollution levels (particle number concentration [PNC]-a proxy for ultrafine particles [diameter < 0.1 mu m], mass of particles with diameter less than 10 mu m [PM10]; CO, NO2, and O-3) and the occurrence of fatal, nonhospitalized coronary events.Methods: Subjects were 5,144 out-of-hospital fatalities (410-414, International Classification of Diseases-9; 1998-2000) who had been residents of Rome. Hospitalizations during the 3 yr before death were considered to identify comorbidities (e.g., diabetes, hypertension, heart failure, dysrhythmia, chronic obstructive pulmonary disease). Statistical analyses were performed using a case-crossover design.Measurements and Main Results: The association with out-of-hospital coronary deaths was statistically significant for PNC, PM10, and CO. Air pollution on the day of death had the strongest effect (e.g., 7.6% increase [95% confidence interval, 2.0-13.6%]) for an interquartile range of PNC, 27,790 particles/cm(3). The 65-74- and 75+-yr age groups were at higher risk than the 35-64-yr age group, and there was a suggestion of effect modification for people with hypertension and chronic obstructive pulmonary disease.Conclusions: Air pollutants originating from combustion processes, including ultrafine particles, are related to fatal, nonhospitalized coronary events. The effect is stronger among people over 65 years of age, but is not limited to a group with a specific comorbidity.