PM2.5 and Mortality in 207 US Cities: Modification by Temperature and City Characteristics.
PM2.5 and Mortality in 207 US Cities: Modification by Temperature and City Characteristics.
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DOI：
10.1097/ede.0000000000000422
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发表时间：
2016-03
期刊：
影响因子：
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通讯作者：
Zanobetti A
中科院分区：
文献类型：
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作者：
Kioumourtzoglou MA;Schwartz J;James P;Dominici F;Zanobetti A
据报道，长期接触PM2.5与死亡率之间的估计影响在空间上有所不同。我们评估了社区层面的变量，包括社会经济状况(SES)指标和温度，是否改变了这种联系。我们使用了来自美国207个城市的3500万联邦医疗保险参保者的数据(2000-2010)。对于每个城市，我们计算了PM2.5的年平均值，这些平均值是在周边中央监测点测量的。我们使用了一种因果建模方法的变体，并拟合了特定于城市的COX模型，然后使用随机效应元回归将其汇集在一起。在第二阶段，我们评估了温度和城市层面的变量，包括吸烟率和肥胖率、贫困、教育和环保程度，是否改变了PM2.5与死亡率的长期关联。我们发现长期PM2.5与生存之间存在关联(HR=1.2；95%可信区间：PM2.5年平均浓度每增加10微克/立方米，其可信区间为1.1-1.3)。我们观察到美国东南部、南部和西北部的估计值较高(HR=1.9；95%CI：1.7-2.2，1.4；95%CI：1.2-1.7和1.4；95%CI：1.1-1.9)。我们观察到，在较温暖的城市中，长期接触PM2.5与死亡率之间存在较高的相关性。此外，我们观察到随着肥胖率的增加，居民和贫困家庭的百分比，黑人居民和没有高中学历的人口的百分比，以及家庭收入中位数和白人居民百分比的增加，估计数字也在增加。据我们所知，这是第一项评估温度和社区水平特征对PM2.5长期生存关联的影响的研究。我们的发现表明，生活在高温和低SES的城市与更高的效果估计相关。
The reported estimated effects between long-term PM2.5 exposures and mortality vary spatially. We assessed whether community-level variables, including socioeconomic status (SES) indicators and temperature, modify this association. We used data from >35 million Medicare enrollees from 207 U.S. cities (2000–2010). For each city, we calculated annual PM2.5 averages, measured at ambient central monitoring sites. We used a variation of a causal modeling approach and fitted city-specific Cox models, which we then pooled using a random effects meta-regression. In this second stage, we assessed whether temperature and city-level variables, including smoking and obesity rates, poverty, education and greenness, modify the long-term PM2.5–mortality association. We found an association between long-term PM2.5 and survival (HR = 1.2; 95%CI: 1.1–1.3 per 10 µg/m3 increase in the annual PM2.5 average concentrations). We observed elevated estimates in the Southeastern, South and Northwestern U.S. (HR = 1.9; 95%CI: 1.7–2.2, 1.4; 95%CI: 1.2–1.7 and 1.4; 95%CI: 1.1–1.9 respectively). We observed a higher association between long-term PM2.5 exposure and mortality in warmer cities. Furthermore, we observed increasing estimates with increasing obesity rates, %residents and families in poverty, %black residents and %population without a high school degree, and lower effects with increasing median household income and %white residents. To our knowledge, this is the first study to assess modification by temperature and community-level characteristics on the long-term PM2.5–survival association. Our findings suggest that living in cities with high temperatures and low SES is associated with higher effect estimates.