Exposure to Particulate Matter Air Pollution and Anosmia.
Exposure to Particulate Matter Air Pollution and Anosmia.
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DOI：
10.1001/jamanetworkopen.2021.11606
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发表时间：
2021-05-03
影响因子：
13.8
通讯作者：
Ramanathan M Jr
中科院分区：
文献类型：
--
作者：
Zhang Z;Rowan NR;Pinto JM;London NR;Lane AP;Biswal S;Ramanathan M Jr
这项病例对照研究调查了长期接触空气动力学直径不超过2.5μm的颗粒物与嗅觉障碍的关系。长期接触空气污染物、空气动力学直径不超过2.5μm(PM2.5)的环境颗粒物(PM)和嗅觉障碍(即嗅觉障碍)之间有什么联系？在这项病例对照研究中，每隔5年测量2690名患者的PM2.5暴露水平，PM2.5暴露水平与嗅觉障碍之间存在剂量-反应关系，尽管控制了已知与嗅觉相关的合并症，这种关系仍然存在。这些发现表明，累积接触细颗粒物与嗅觉障碍的风险增加有关。嗅觉缺失，即嗅觉丧失，对患者的安全、幸福和生活质量具有深远的影响，它是患者虚弱和死亡率的预测指标。暴露在空气污染中可能是对嗅觉的侮辱，导致嗅觉障碍的发展。探讨长期接触空气动力学直径不超过2.5μm的颗粒物(PM)与嗅觉障碍的关系。这项病例对照研究考察了2013年1月1日至2016年12月31日期间在马里兰州巴尔的摩一家学术医疗中心就诊的个人。病例参与者被委员会认证的耳鼻喉科医生诊断为嗅觉障碍。对照参与者使用最近邻匹配策略选择年龄、性别、种族/民族和诊断日期。数据分析从2020年9月至2021年3月进行。环境PM2.5水平。量化被诊断为嗅觉缺乏症患者与匹配的对照组参与者的环境PM2.5暴露水平的新方法。共有2690名患者被确认，平均年龄(SD)为55.3(16.6)岁。病例组包括538名嗅觉障碍患者(20%)，对照组包括2152名匹配的对照组参与者(80%)。病例组和对照组中的大多数人是女性，白人患者，超重(BMI 25至30)，不吸烟(女性：339[63.0%]和1355[63.0%]；白人患者：318[59.1%]和1343[62.4%]；超重：179[33.3%]和653[30.3%]；不吸烟：328[61.0%]和1248[58.0%])。在12个月、24个月、36个月和60个月的时间点，嗅觉缺乏症患者暴露于PM2.5的平均(SD)值显著高于健康对照组：10.2(1.6)μg/m~3对9.9(1.9)μg/m~3；10.5(1.7)μg/m~3对10.2(1.9)μg/m~3；10.8(1.8)μg/m~3对10.4(2.0)μg/m~3；和11.0(1.8)μg/m~3对10.7(2.1)μg/m~3。在调整了年龄、性别、种族/民族、体重指数、饮酒或吸烟以及医疗合并症后的多因素分析中，PM2.5暴露水平升高与无嗅觉的风险相关(12mo：优势比[OR]，1.73；95%CI，1.28-2.33；24mo：OR，1.30-2.29；36mo：OR，1.69；95%CI，1.30-2.19；60mo：OR，1.59；95%CI，1.22-2.08)。样条线分析表明，长期暴露在PM2.5中与发生嗅觉障碍的几率之间的关系是非线性的。例如，在暴露于PM2.5的12个月中，6.0微克/立方米发生嗅觉障碍的几率为0.79(95%CI，0.64-0.97)；10.0微克/立方米，OR 1.42(95%可信区间，1.10-1.82)；15.0微克/立方米，OR 2.03(95%可信区间，1.15-3.58)。在这项研究中，长期暴露在空气中的PM2.5与嗅觉障碍有关。环境PM2.5是嗅觉丧失的一个潜在的普遍和可改变的危险因素。
This case-control study investigated the association between long-term exposure to particulate matter with an aerodynamic diameter of no more than 2.5 μm with anosmia. What is the association of long-term exposure to the air pollutant, ambient particulate matter (PM) with an aerodynamic diameter of no more than 2.5 μm (PM2.5), and anosmia, ie, the inability to smell? In this case-control study that measured PM2.5 exposure levels among 2690 patients at intervals for 5 years, there was a dose-response association between PM2.5 exposure levels and anosmia that persisted despite controlling for comorbidities known to be associated with olfaction. These findings suggest that cumulative exposure to fine PM is associated with an increased risk of anosmia. Anosmia, the loss of the sense of smell, has profound implications for patient safety, well-being, and quality of life, and it is a predictor of patient frailty and mortality. Exposure to air pollution may be an olfactory insult that contributes to the development of anosmia. To investigate the association between long-term exposure to particulate matter (PM) with an aerodynamic diameter of no more than 2.5 μm (PM2.5) with anosmia. This case-control study examined individuals who presented from January 1, 2013, through December 31, 2016, at an academic medical center in Baltimore, Maryland. Case participants were diagnosed with anosmia by board-certified otolaryngologists. Control participants were selected using the nearest neighbor matching strategy for age, sex, race/ethnicity, and date of diagnosis. Data analysis was conducted from September 2020 to March 2021. Ambient PM2.5 levels. Novel method to quantify ambient PM2.5 exposure levels in patients diagnosed with anosmia compared with matched control participants. A total of 2690 patients were identified with a mean (SD) age of 55.3 (16.6) years. The case group included 538 patients with anosmia (20%), and the control group included 2152 matched control participants (80%). Most of the individuals in the case and control groups were women, White patients, had overweight (BMI 25 to <30), and did not smoke (women: 339 [63.0%] and 1355 [63.0%]; White patients: 318 [59.1%] and 1343 [62.4%]; had overweight: 179 [33.3%] and 653 [30.3%]; and did not smoke: 328 [61.0%] and 1248 [58.0%]). Mean (SD) exposure to PM2.5 was significantly higher in patients with anosmia compared with healthy control participants at 12-, 24-, 36-, 60-month time points: 10.2 (1.6) μg/m3 vs 9.9 (1.9) μg/m3; 10.5 (1.7) μg/m3 vs 10.2 (1.9) μg/m3; 10.8 (1.8) μg/m3 vs 10.4 (2.0) μg/m3; and 11.0 (1.8) μg/m3 vs 10.7 (2.1) μg/m3, respectively. There was an association between elevated PM2.5 exposure level and odds of anosmia in multivariate analyses that adjusted for age, sex, race/ethnicity, body mass index, alcohol or tobacco use, and medical comorbidities (12 mo: odds ratio [OR], 1.73; 95% CI, 1.28-2.33; 24 mo: OR, 1.72; 95% CI, 1.30-2.29; 36 mo: OR, 1.69; 95% CI, 1.30-2.19; and 60 mo: OR, 1.59; 95% CI, 1.22-2.08). The association between long-term exposure to PM2.5 and the odds of developing anosmia was nonlinear, as indicated by spline analysis. For example, for 12 months of exposure to PM2.5, the odds of developing anosmia at 6.0 µg/m3 was OR 0.79 (95% CI, 0.64-0.97); at 10.0 µg/m3, OR 1.42 (95% CI, 1.10-1.82); at 15.0 µg/m3, OR 2.03 (95% CI, 1.15-3.58). In this study, long-term airborne exposure to PM2.5 was associated with anosmia. Ambient PM2.5 represents a potentially ubiquitous and modifiable risk factor for the loss of sense of smell.
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