Air Pollution and Mortality in the Medicare Population.
Air Pollution and Mortality in the Medicare Population.
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DOI：
10.1056/nejmoa1702747
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发表时间：
2017-06-29
期刊：
影响因子：
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通讯作者：
Schwartz JD
中科院分区：
文献类型：
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作者：
Di Q;Wang Y;Zanobetti A;Wang Y;Koutrakis P;Choirat C;Dominici F;Schwartz JD
研究表明，长期暴露于空气污染会增加死亡率。然而，空气污染水平低于最新国家环境空气质量标准的证据有限。以前的研究主要涉及城市人口，没有统计能力来估计代表性不足的群体的健康影响。我们构建了一个开放队列，其中包括2000年至2012年美国大陆所有医疗保险受益人（60，925，443人），随访时间为460，310，521人年。细颗粒物（质量中值空气动力学直径小于2.5 μm [PM2.5]的颗粒）和臭氧的年平均值根据每个登记者的居住地邮政编码使用先前验证的预测模型进行估计。我们使用两种污染物的考克斯比例风险模型，控制人口统计学特征，医疗补助资格和地区水平的协变量，估计与暴露于PM2.5增加10 μg/m3和臭氧增加10 ppb相关的死亡风险。PM2.5每立方米增加10微克和臭氧每立方米增加10 ppb分别与全因死亡率增加7.3%（95%置信区间[CI]，7.1至7.5）和1.1%（95% CI，1.0至1.2）相关。当分析仅限于暴露于PM2.5小于12 μg/m3和臭氧小于50 ppb的人-年时，PM2.5和臭氧的相同增加分别与死亡风险增加13.6%（95%CI，13.1至14.1）和1.0%（95%CI，0.9至1.1）相关。对于PM2.5，男性，黑人和有医疗补助资格的人的死亡风险高于其他人群。在整个医疗保险人群中，有明显的证据表明，暴露于PM2.5和臭氧浓度低于现行国家标准时会产生不良影响。这种影响在自我认定的少数民族和低收入人群中最为明显。（由健康影响研究所和其他机构支持。
Studies have shown that long-term exposure to air pollution increases mortality. However, evidence is limited for air-pollution levels below the most recent National Ambient Air Quality Standards. Previous studies involved predominantly urban populations and did not have the statistical power to estimate the health effects in underrepresented groups. We constructed an open cohort of all Medicare beneficiaries (60,925,443 persons) in the continental United States from the years 2000 through 2012, with 460,310,521 person-years of follow-up. Annual averages of fine particulate matter (particles with a mass median aerodynamic diameter of less than 2.5 μm [PM2.5]) and ozone were estimated according to the ZIP Code of residence for each enrollee with the use of previously validated prediction models. We estimated the risk of death associated with exposure to increases of 10 μg per cubic meter for PM2.5 and 10 parts per billion (ppb) for ozone using a two-pollutant Cox proportional-hazards model that controlled for demographic characteristics, Medicaid eligibility, and area-level covariates. Increases of 10 μg per cubic meter in PM2.5 and of 10 ppb in ozone were associated with increases in all-cause mortality of 7.3% (95% confidence interval [CI], 7.1 to 7.5) and 1.1% (95% CI, 1.0 to 1.2), respectively. When the analysis was restricted to person-years with exposure to PM2.5 of less than 12 μg per cubic meter and ozone of less than 50 ppb, the same increases in PM2.5 and ozone were associated with increases in the risk of death of 13.6% (95% CI, 13.1 to 14.1) and 1.0% (95% CI, 0.9 to 1.1), respectively. For PM2.5, the risk of death among men, blacks, and people with Medicaid eligibility was higher than that in the rest of the population. In the entire Medicare population, there was significant evidence of adverse effects related to exposure to PM2.5 and ozone at concentrations below current national standards. This effect was most pronounced among self-identified racial minorities and people with low income. (Supported by the Health Effects Institute and others.)