Estimating the exposure-response function between long-term ozone exposure and under-5 mortality in 55 low-income and middle-income countries: a retrospective, multicentre, epidemiological study
Estimating the exposure-response function between long-term ozone exposure and under-5 mortality in 55 low-income and middle-income countries: a retrospective, multicentre, epidemiological study
复制标题
估计 55 个低收入和中等收入国家长期臭氧暴露与 5 岁以下儿童死亡率之间的暴露-反应函数：一项回顾性、多中心、流行病学研究
DOI：
10.1016/s2542-5196(23)00165-1
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Xue T
中科院分区：
文献类型：
--
作者：
Xue T
2021年，世卫组织提出了长期暴露于环境臭氧的新目标浓度限值。然而，臭氧对弱势儿童的有害影响尚未得到充分研究。我们的目的是评估长期臭氧暴露与5岁以下儿童死亡率之间的关系（以下称5岁以下儿童死亡率），并估计97个低收入和中等收入国家的这一死亡率负担。我们评估了来自55个LMIC的2457个采样层的120多万5岁以下儿童的生存状况与生命过程中平均高峰期臭氧浓度之间的关系，使用固定效应考克斯模型。通过整合暴露层内变化的边际效应，建立了非线性的风险-响应函数。我们外推从55 LMIC获得的功能，估计在5岁以下的死亡率负担归因于臭氧暴露在97 LMIC，其中超过95%的全球死亡在这个年龄组occurs.FindingsThe固定效应模型显示臭氧和5岁以下的死亡率之间的强有力的关联。根据完全调整的线性模型，生命周期平均高峰期臭氧浓度增加10 ppb与5岁以下儿童死亡风险增加6.4%（95%CI 2.4 - 10.7）相关。非线性的累积-响应函数显示出具有阈值的次线性曲率，表明臭氧暴露的影响在低于世卫组织建议的第一阶段中期目标（100微克/立方米）的浓度下不显著。使用该函数，我们估计，2010年，长期臭氧暴露导致97个LMIC中153361名5岁以下儿童死亡（95%CI17077 - 276768; 2.3%[0.3 - 4.1]），相当于这些国家所有与臭氧相关的成人死亡（269785）的56.8%。 从2003年到2017年，臭氧相关的5岁以下儿童死亡率负担在97个低收入国家中的大多数国家都有所下降。解释长期暴露于高于世卫组织第一阶段中期目标的臭氧浓度是5岁以下儿童死亡率的一个风险因素，臭氧暴露对低收入国家这一年龄组的死亡率有很大影响。应加大力度控制大气臭氧污染，因为这将带来积极的健康效益。基金由中华人民共和国科学技术部和中国国家自然科学基金会资助。
BackgroundIn 2021, WHO suggested new target concentration limits for long-term exposure to ambient ozone. However, the harmful effects of ozone on vulnerable children have not been sufficiently studied. We aimed to evaluate the association between long-term ozone exposure and mortality in children younger than 5 years (hereafter denoted under-5 mortality) in low-income and middle-income countries (LMICs) and to estimate this mortality burden for 97 LMICs.MethodsBy combining information from 128 Demographic and Health Surveys, we evaluated the association between the survival status of more than 1·2 million children younger than 5 years from 2457 sampling strata in 55 LMICs and the average peak-season ozone concentration during the life course, using a fixed-effects Cox model. A non-linear exposure–response function was developed by integrating the marginal effects of within-strata variation in exposure. We extrapolated the function obtained from the 55 LMICs to estimate the under-5 mortality burden attributable to ozone exposure in 97 LMICs, in which more than 95% of global deaths in this age group occur.FindingsThe fixed-effects model showed a robust association between ozone and under-5 mortality. According to the fully adjusted linear model, an increment of 10 ppb in the life-course average peak-season ozone concentration was associated with a 6·4% (95% CI 2·4–10·7) increase in the risk of under-5 mortality. The non-linear exposure–response function showed a sublinear curvature with a threshold, suggesting that the effect of ozone exposure was non-significant at concentrations lower than the first-stage interim target (100 μg/m3) recommended by WHO. Using this function, we estimate that, in 2010, long-term ozone exposure contributed to 153 361 (95% CI 17 077–276 768; 2·3% [0·3–4·1]) deaths of children younger than 5 years in 97 LMICs, which is equivalent to 56·8% of all ozone-related deaths in adults (269 785) in these countries. From 2003 to 2017, the ozone-related under-5 mortality burden decreased in most of the 97 LMICs.InterpretationLong-term exposure to ozone concentrations higher than the WHO first-stage interim target is a risk factor for under-5 mortality, and ozone exposure contributes substantially to mortality in this age group in LMICs. Increased efforts should be made to control ambient ozone pollution as this will lead to positive health benefits.FundingMinistry of Science and Technology of the People's Republic of China and China National Natural Science Foundation.