Particulate matter and daily mortality - A case-crossover analysis of individual effect modifiers
Particulate matter and daily mortality - A case-crossover analysis of individual effect modifiers
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DOI：
10.1097/ede.0b013e3181761f8a
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发表时间：
2008-07-01
期刊：
影响因子：
5.4
通讯作者：
Perucci, Carlo A.
中科院分区：
文献类型：
--
作者：
Forastiere, Francesco;Stafoggia, Massimo;Perucci, Carlo A.
背景：多项时间序列研究已经确定了颗粒物 (PM10) 与死亡率之间的关系。我们采用病例交叉设计来评估个体社会人口特征和慢性或急性医疗状况是否会改变 PM10 与死亡率的关联。方法：我们选择了 1997 年至 2004 年间意大利 9 个城市的成年（35 岁以上）居民中发生的所有自然死亡（321,024 名受试者）。我们获得了有关社会人口统计学变量、死亡地点和慢性病（前 2 年入院情况）的个人信息。期）。对于院内死亡，我们收集了死亡时治疗病房和急性医疗状况的信息。在病例交叉分析中，我们根据时间、人口变化和气象条件进行了调整。结果：PM10 与 65 岁及以上受试者的死亡率相关（每 10 μg/m(3) 增加 0.75% [95% 置信区间 = 0.42% 至 1.09%]），其中对 85 岁及以上人群的影响更为明显。最富裕人群的影响较弱。这种效应对于院外和院内死亡均存在，特别是在普通内科和其他不太专业的病房接受治疗的患者中。 PM10 对糖尿病患者（1.03% [0.28% 至 1.79%]）和慢性阻塞性肺疾病患者（0.84% [0.17% 至 1.52%]）的影响更强。估计影响最大的急性病症是肺循环急性损伤（4.56% [0.75% 至 8.51%]）和心力衰竭（1.67% [0.30% 至 3.04%]）。结论：包括高龄、医院病房类型以及慢性和急性健康状况在内的几个因素会改变 PM10 相关的死亡风险。肺循环改变和心力衰竭是重要的效应调节因素，表明心脏代偿失调是 PM10 致命效应的可能机制。
Background: Several time-series studies have established the relationship between particulate matter (PM10) and mortality. We adopted a case-crossover design to evaluate whether individual socio-demographic characteristics and chronic or acute medical conditions modify the PM10-mortality association.Methods: We selected all natural deaths (321,024 subjects) occurring among adult (aged 35+ years) residents of 9 Italian cities between 1997 and 2004. We had access to individual information on socio-demographic variables, location of death, and chronic conditions (hospital admissions in the preceding 2-year period). For in-hospital deaths, we collected information on treatment wards at time of death and acute medical conditions. In a case-crossover analysis we adjusted for time, population changes, and meteorological conditions.Results: PM10 was associated with mortality among subjects age 65 years and older (0.75% increase per 10 mu g/m(3) [95% confidence interval = 0.42% to 1.09%]), with a more pronounced effect among people age 85 and older. A weaker effect was found among the most affluent people. The effect was present for both out-of-hospital and in-hospital deaths, especially among those treated in general medicine and other less specialized wards. PM10 effects were stronger among people with diabetes (1.03% [0.28% to 1.79%]) and chronic obstructive pulmonary disease (0.84% [0.17% to 1.52%]). The acute conditions with the largest effect estimates were acute impairment of pulmonary circulation (4.56% [0.75% to 8.51%]) and heart failure (1.67% [0.30% to 3.04%]).Conclusions: Several factors, including advanced age, type of hospital ward, and chronic and acute health conditions, modify the PM10-related risk of death. Altered pulmonary circulation and heart failure are important effect modifiers, suggesting that cardiac decompensation is a possible mechanism of the fatal PM10 effect.