Nationwide Study of Short-term Exposure to Fine Particulate Matter and Cardiovascular Hospitalizations Among Medicaid Enrollees.
Nationwide Study of Short-term Exposure to Fine Particulate Matter and Cardiovascular Hospitalizations Among Medicaid Enrollees.
复制标题
DOI：
10.1097/ede.0000000000001265
复制
发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Kioumourtzoglou MA
中科院分区：
文献类型：
--
作者：
deSouza P;Braun D;Parks RM;Schwartz J;Dominici F;Kioumourtzoglou MA
细颗粒物 (PM2.5) 一直与心血管疾病 (CVD) 相关。尽管研究报告了收入的变化，但据我们所知，迄今为止还没有研究检验过医疗补助成年人之间的这种关系，该补助为低收入和/或残疾美国人提供健康保险。我们使用时间分层病例交叉设计估计了美国大陆成年医疗补助参与者（2000-2012 年）的短期 PM2.5 暴露（住院当天和前一天的 PM2.5 平均值）与 CVD 入院率之间的关联。我们在低于世界卫生组织每日指导值 25 μg/m3 的 PM2.5 浓度下重复了这一分析。我们比较了 ≥65 岁医疗补助与非医疗补助资格医疗保险参保者（≥65 岁）的 PM2.5 - CVD 关联。利用 3,666,657 名接受医疗补助的成年人因 CVD 住院的信息，我们发现 PM2.5 每增加 10 μg/m3，CVD 入院率就会增加 0.9%（95%CI：0.6，1.1%）。在 PM2.5 水平较低时，这种关联性更强（1.3%；95%CI：0.9，1.6%）。在 65 岁以上的医疗补助参保者中，相关性为 0.9% (95%CI: 0.6, 1.3%)，而在 65 岁以上的非医疗补助资格医疗保险参保者中，相关性为 0.8% (95%CI: 0.6, 0.9%)。我们发现强有力的证据表明，在成年医疗补助参与者的弱势群体中，短期 PM2.5 与 CVD 住院之间存在关联。重要的是，即使 PM2.5 水平低于现行国家标准，这种关联仍然存在。
Fine particulate matter (PM2.5) has been consistently linked to cardiovascular disease (CVD). Although studies have reported modification by income, to our knowledge no study to date has examined this relationship among adults in Medicaid, which provides health coverage to low-income and/or disabled Americans. We estimated the association between short-term PM2.5 exposure (average of PM2.5 on the day of hospitalization and the preceding day) and CVD admissions rates among adult Medicaid enrollees in the continental US (2000–2012) using a time-stratified case–crossover design. We repeated this analysis at PM2.5 concentrations below the World Health Organization daily guideline of 25 μg/m3. We compared the PM2.5 – CVD association in the Medicaid ≥65 years old vs. non-Medicaid-eligible Medicare enrollees (≥65 years old). Using information on 3,666,657 CVD hospitalizations among Medicaid adults we observed a 0.9% (95%CI: 0.6, 1.1%) increase in CVD admission rates per 10 μg/m3 PM2.5 increase. The association was stronger at low PM2.5 levels (1.3%; 95%CI: 0.9, 1.6%). Among Medicaid enrollees ≥65 years old, the association was 0.9% (95%CI: 0.6, 1.3%) vs. 0.8% (95%CI: 0.6, 0.9%) among non-Medicaid-eligible Medicare enrollees ≥65 years old. We found robust evidence of an association between short-term PM2.5 and CVD hospitalizations among the vulnerable subpopulation of adult Medicaid enrollees. Importantly, this association persisted even at PM2.5 levels below the current national standards.