Short-Term Effects of Air Pollution in a Cohort of Patients With Chronic Obstructive Pulmonary Disease
Short-Term Effects of Air Pollution in a Cohort of Patients With Chronic Obstructive Pulmonary Disease
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DOI：
10.1097/ede.0b013e31826767c2
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发表时间：
2012-11-01
期刊：
影响因子：
5.4
通讯作者：
Forastiere, Francesco
中科院分区：
文献类型：
--
作者：
Faustini, Annunziata;Stafoggia, Massimo;Forastiere, Francesco
背景资料：虽然空气污染物对呼吸系统的损害已被认识到，但对慢性阻塞性呼吸道疾病（COPD）患者对空气污染的易感性的研究却产生了相互矛盾的结果。我们研究了颗粒物（PM10，PM2.5），二氧化氮（NO2）和臭氧（O-3）对COPD队列中心脏和呼吸系统死亡率的短期影响。我们评估了年龄、性别和既往疾病作为效应modifiers.Methods：使用医院数据（1998-2009年）和药物数据（2005-2009年），我们招募了145，681名年龄在35岁以上的罗马居民COPD受试者，并从2005年至2009年对他们进行了随访。还研究了无COPD的对照组（1，710，557例受试者）。我们分析了所有自然原因导致的死亡（国际疾病分类-第九次修订代码1-799）。采用Poisson回归和病例交叉方法进行统计分析。结果：PM10、PM2.5和NO2（0- 5天滞后）与每日死亡率相关，在COPD患者中影响更大。COPD患者与PM10（每四分位数范围[IQR] = 16 μ g/m3）相关的死亡率（3.5% [95%置信区间= -0.1%至7.2%]）是其他受试者（0.7% [-0.8%至2.2%]）的5倍。在COPD受试者中，PM 2.5（IQR = 11 μ g/m3）（11.6% [2.0%-22.2%]）和NO2（IQR = 24 μ g/m3）（19.6% [3.5%-38.2%]）对呼吸死亡率的影响尤其显著。年龄较大，男性，预先存在的心脏传导障碍，脑血管疾病与COPD subjects.Conclusions更强的影响：COPD患者更容易受到空气污染物，尤其是PM10和NO2。这些结果表明，需要为易感群体制定更多的保护性空气污染标准。
Background: Although damage to the respiratory system from air pollutants has been recognized, research on susceptibility to air pollution in patients with chronic obstructive respiratory disease (COPD) has produced contradictory results. We studied the short-term effects of particulate matter (PM10, PM2.5), nitrogen dioxide (NO2), and ozone (O-3) on cardiac and respiratory mortality in a COPD cohort. We assessed age, sex, and previous diseases as effect modifiers.Methods: Using hospital data (1998-2009) and pharmaceutical data (2005-2009), we enrolled 145,681 COPD subjects, aged 35+ years and residents of Rome, and followed them from 2005 to 2009. A comparison group of people without COPD (1,710,557 subjects) was also studied. We analyzed deaths due to all natural causes (International Classification of Diseases - Ninth Revision codes 1-799). Statistical analyses were carried out using Poisson regression and a case-crossover approach.Results: PM10, PM2.5, and NO2 (0- to 5-day lag) were associated with daily mortality, with stronger effects in people with COPD. The mortality associated with PM10 (per interquartile range [IQR] = 16 mu g/m(3)) was five times more in COPD patients (3.5% [95% confidence interval = -0.1% to 7.2%]) than in other subjects (0.7% [-0.8% to 2.2%]). Effects on respiratory mortality among COPD subjects were particularly elevated from PM 2.5 (IQR = 11 mu g/m3) (11.6% [2.0% to 22.2%]) and NO2 (IQR = 24 mu g/m(3)) (19.6% [3.5% to 38.2%]). Older age, male sex, preexisting heart conduction disorders, and cerebrovascular diseases were associated with stronger effects in COPD subjects.Conclusions: COPD patients are more susceptible to air pollutants, especially PM10 and NO2. These results suggest a need for more protective air pollution standards for susceptible groups.