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ASSESSING THE ACUTE AND CHRONIC CARDIO-RESPIRATORY HEALTH IMPACTS OF AMBIENT AIR POLLUTION IN CHINA

评估中国环境空气污染对心肺健康的急性和慢性影响

基本信息

批准号：
1808876
负责人：
金额：
--
依托单位：
University of Oxford
依托单位国家：
英国
项目类别：
Studentship
财政年份：
2016
资助国家：
英国
起止时间：
2016 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=studentship-1808876
关键词：
ASSESSING ACUTE CHRONIC CARDIO RESPIRATORY

项目摘要

BackgroundBoth the acute and chronic health impacts of ambient air pollution (AAP) are now consistently documented throughout epidemiological literature. However, the majority of evidence currently applies to developed regions where both health outcome data and pollutant data are more readily obtainable with greater degree of quality assurance. Thus, generic extrapolation of the health impacts from developed regions into low and/or middle income countries (LMIC's) including China is increasingly common within the evidence base. Such extrapolation of results often presents as the better option, with research in LMIC's themselves frequently restricted by methodological issues. These issues stem from their complex healthcare systems, lack of unified health data recording, and consistent exposure misclassification. Therefore, evidence on the health impacts of AAP exposure for populations within LMIC's exclusively remains anecdotal. Within China specifically, economic development has flourished at the inherent sacrifice of air quality, with AAP causing an estimated 1.6 million deaths annually (1). However, even within China there remains significant uncertainty in terms of the exact health impacts of AAP exposure on the population. Furthermore, the majority of high quality epidemiological studies are performed within the Chinese "mega-cities" with little consideration for the health effects in wider regions, despite the ubiquity of AAP exposure. This project therefore aims to accurately determine the acute and chronic health effects of AAP exposure within varying regions of China, using a methodology previously reserved almost exclusively for developed regions.MethodsThis project will utilise China Kadoorie Biobank (CKB), a cohort of 0.5 million participants covering 10 diverse regions of China. The availability of high quality standardised health data through health insurance data linkage will enable health outcomes to be accurately examined in relation to AAP exposure for individuals within the CKB. The acute health effects of AAP exposure will be examined in terms of both cardiovascular and respiratory hospital admissions, documented from five urban areas in China. This will involve single pollutant modelling for the primary air pollutants (PM2.5, PM10, SO2, NOx, O3) obtained from the Chinese National Air pollution monitoring network. Time-series analysis (using pre-specified lags) will be performed, and generalised additive models generated in order to accurately determine the association between AAP exposure and acute cardiovascular/respiratory events for CKB participants. Unlike the majority of studies which focus solely on single pollutant modelling from fixed monitoring sites, this project will perform sensitivity analysis utilising multi-pollutant modelling. It will also examine various potential effect modifiers such as differing geographic region, in addition to the main confounders including demographic characteristics, seasonal trends, and meteorological variables. In terms of the chronic health impacts of AAP exposure, this will involve examining;- The association of long term AAP exposure and blood pressure/hypertension in CKB participants. - The association of long term AAP exposure and incidence of cardiovascular/respiratory disease in CKB participants. To quantify long term exposure to AAP for CKB participants, satellite based estimates of PM2.5 will be utilised with further calibration from fixed monitoring measurements and personal exposure assessment. These methods of exposure assessment will minimise exposure misclassification providing a more reliable estimate of the health impacts of AAP exposure in China. Bibliography(1) Institute for Health Metrics and Evaluation. Poor air quality kills 5.5 million annually. 2016; Available at: http://www.healthdata.org/news-release/poor-air-quality-kills-55-million-worldwide-annually. Accessed 24/10, 2016.

背景环境空气污染(AAP)对健康的急性和慢性影响在整个流行病学文献中都得到了一致的记录。然而，目前大多数证据适用于发达地区，在这些地区，健康结果数据和污染物数据都更容易获得，质量保证程度更高。因此，从发达地区到包括中国在内的低收入和/或中等收入国家(LMIC)的健康影响的一般性外推在证据库中越来越常见。这种对结果的外推通常被认为是更好的选择，而LMIC本身的研究往往受到方法学问题的限制。这些问题源于他们复杂的医疗保健系统，缺乏统一的健康数据记录，以及一致的暴露错误分类。因此，AAP暴露对LMIC内的人群的健康影响的证据仍然是坊间传闻。具体地说，在中国内部，经济发展是以牺牲空气质量为代价的，估计每年有160万人死于急性呼吸道感染(1)。然而，即使在中国内部，AAP暴露对人群健康的确切影响仍存在重大不确定性。此外，大多数高质量的流行病学研究都是在中国的“特大城市”进行的，很少考虑到对更广泛地区的健康影响，尽管AAP的接触无处不在。因此，本项目旨在使用一种以前几乎只为发达地区保留的方法，在中国的不同地区准确地确定急性和慢性接触对健康的影响。方法本项目将利用中国嘉道理生物库，该队列由50万名参与者组成，覆盖中国的10个不同地区。通过健康保险数据链接获得高质量的标准化健康数据，将使CKB内的个人能够准确地检查与AAP接触有关的健康结果。急性呼吸道感染的急性健康影响将从心血管和呼吸系统入院人数两个方面进行检查，这些入院记录来自中国的五个城区。这将涉及对从中国国家空气污染监测网获得的主要空气污染物(PM2.5、PM10、SO2、NOx、O3)进行单一污染物建模。将进行时间序列分析(使用预先指定的滞后时间)，并生成通用的相加模型，以便准确地确定AAP暴露与CKB参与者的急性心血管/呼吸事件之间的关联。与大多数只关注固定监测点单一污染物模型的研究不同，该项目将利用多污染物模型进行敏感性分析。它还将审查各种潜在的影响因素，如不同的地理区域，以及包括人口特征、季节趋势和气象变量在内的主要混杂因素。就慢性接触AAP对健康的影响而言，这将涉及研究；-长期接触AAP与CKB参与者的血压/高血压之间的关系。-CKB参与者长期接触AAP与心血管/呼吸系统疾病发病率的关系。为了量化CKB参与者长期接触AAP的情况，将使用基于卫星的PM2.5估计值，并通过固定监测测量和个人暴露评估进行进一步校准。这些暴露评估方法将最大限度地减少暴露的错误分类，为中国AAP暴露的健康影响提供更可靠的估计。参考书目(1)健康计量与评估研究所。糟糕的空气质量每年导致550万人死亡。2016；可在：http://www.healthdata.org/news-release/poor-air-quality-kills-55-million-worldwide-annually.上获得2016年10月24日访问。