Inappropriate use of daily mortality analyses to estimate longer-term mortality effects of air pollution
Inappropriate use of daily mortality analyses to estimate longer-term mortality effects of air pollution
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DOI：
10.1093/ije/27.3.450
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发表时间：
1998-06-01
影响因子：
7.7
通讯作者：
Cohen, AJ
中科院分区：
文献类型：
--
作者：
McMichael, AJ;Anderson, HR;Cohen, AJ
背景 为了避免空气污染和死亡率的多人群相关性研究的常见问题，并且为了方便起见，单一人群内的每日时间序列死亡率研究最近在空气污染流行病学中变得流行。此类研究描述了死亡的短期分布与空气污染水平的短期波动之间的关系。这些急性效应研究中基于回归的风险系数已被广泛用于估计具有特定平均空气污染水平的人群中的超额年度死亡率。这样的计算是不恰当的。由于每日时间序列数据无法提供与每日过量死亡相关的寿命缩短程度的简单直接信息（其中许多被认为是由于晚期疾病，特别是心血管疾病的恶化），因此此类数据无法有助于估计空气污染对慢性病发病率和长期死亡率的影响。然而，正是这一类影响对公共健康最为重要。 结论 此类影响最好通过长期队列研究来估计，这些研究结合了对当地（或个人）接触空气污染物和潜在混杂因素的深入了解。经过适当评估的时间序列研究可以确定空气污染瞬时峰值水平是否存在急性毒性效应；因此，它们可用于监测急性毒性和识别最有毒的污染物。然而，为了量化空气污染对健康的长期影响，我们不能使用急性效应数据。
Background To avoid the usual problems of multi-population correlation studies of air pollution and mortality, and for reasons of convenience, daily time-series mortality studies within single populations have recently become popular in air pollution epidemiology. Such studies describe how the short-term distribution of deaths relates to short-term fluctuations in air pollution levels. The regression-based risk coefficients from these acute-effects studies have been widely used to estimate the excess annual mortality within a population with a specified average level of air pollution. Such calculations are inappropriate. Since daily time-series data provide no simple direct information about the degree of Life-shortening associated with the excess daily deaths (many of which are thought to be due to exacerbation of well-advanced disease, especially cardiovascular disease), such data cannot contribute to the estimation of the effects of air pollution upon chronic disease incidence and long-term death rates. Yet it is that category of effect that is of most pubic health importance.Conclusion Such effects are best estimated from long-term cohort studies that Incorporate good knowledge of local (or personal) exposure to air pollutants and of potential confounders. Time-series studies, properly evaluated, can identify the existence of acute toxic effects of transient peak levels of air pollution; they are thus useful for monitoring acute toxicity and for identifying the most noxious pollutants. However, to quantify the long-term health impacts of air pollution we cannot use acute-effects data.