Spatial Association Between Ambient Fine Particulate Matter and Incident Hypertension
Spatial Association Between Ambient Fine Particulate Matter and Incident Hypertension
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DOI：
10.1161/circulationaha.113.003532
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发表时间：
2014-02-04
期刊：
影响因子：
37.8
通讯作者：
Copes, Ray
中科院分区：
文献类型：
--
作者：
Chen, Hong;Burnett, Richard T.;Copes, Ray
背景
实验室研究表明，暴露于细颗粒物（直径2.5μm）（PM2.5）可引发一系列病理生理反应，可能导致高血压的发生。然而，有关PM2.5与高血压的流行病学证据却很稀少。因此，我们开展了一项基于人群的队列研究，以确定暴露于环境PM2.5是否与高血压发病相关。
方法与结果
我们组建了一个来自加拿大安大略省的35303名非高血压成年人的队列，这些人在1996年至2005年间参与了4项基于人群的健康调查中的1项，并随访至2010年12月31日。高血压发病诊断是从安大略高血压数据库中确定的，该数据库是安大略省经确诊的高血压患者的有效登记处（敏感性 = 72%，特异性 = 95%）。参与者邮政编码居住地的长期PM2.5暴露量估计值来自卫星观测。我们使用了考克斯比例风险模型，并对各种个体和环境风险因素进行了调整，包括体重指数、吸烟、体力活动以及社区层面的失业率。我们进行了各种敏感性分析以评估效应估计值的稳健性，例如研究几个暴露时间窗口以及控制高血压风险随时间的潜在变化。在1996年至2010年间，我们确定了8649例高血压发病病例和2296例死亡病例。PM2.5每增加10μg/m³，高血压发病的调整后风险比为1.13（95%置信区间，1.05 - 1.22）。在所有敏感性分析中，估计的相关性具有可比性。
结论
这项研究支持PM2.5与高血压发病之间存在关联。
Background Laboratory studies suggest that exposure to fine particulate matter (2.5 m in diameter) (PM2.5) can trigger a combination of pathophysiological responses that may induce the development of hypertension. However, epidemiological evidence relating PM2.5 and hypertension is sparse. We thus conducted a population-based cohort study to determine whether exposure to ambient PM2.5 is associated with incident hypertension.Methods and Results We assembled a cohort of 35 303 nonhypertensive adults from Ontario, Canada, who responded to 1 of 4 population-based health surveys between 1996 and 2005 and were followed up until December 31, 2010. Incident diagnoses of hypertension were ascertained from the Ontario Hypertension Database, a validated registry of persons diagnosed with hypertension in Ontario (sensitivity=72%, specificity=95%). Estimates of long-term exposure to PM2.5 at participants' postal-code residences were derived from satellite observations. We used Cox proportional hazards models, adjusting for various individual and contextual risk factors including body mass index, smoking, physical activity, and neighbourhood-level unemployment rates. We conducted various sensitivity analyses to assess the robustness of the effect estimate, such as investigating several time windows of exposure and controlling for potential changes in the risk of hypertension over time. Between 1996 and 2010, we identified 8649 incident cases of hypertension and 2296 deaths. For every 10-mu g/m(3) increase of PM2.5, the adjusted hazard ratio of incident hypertension was 1.13 (95% confidence interval, 1.05-1.22). Estimated associations were comparable among all sensitivity analyses.Conclusions This study supports an association between PM2.5 and incident hypertension.