Exposure to Traffic-Related Air Pollution and to Disability in Older Adults

描述(由申请人提供)：老年人的身体残疾已成为一个严重的临床和公共卫生问题，因为其相关的医疗保健成本很高，而且老年人的数量迅速增加。尽管取得了较早的进展，但在过去20年中，残疾患病率有所增加。因此，与年龄有关的残疾仍然是一个沉重的公共卫生负担。暴露于环境毒素是潜在的可改变的危险因素，几乎没有受到关注。特别是，暴露在空气污染中与疾病、心血管疾病和呼吸系统疾病的风险增加有关，这些疾病是残疾的主要原因。空气污染对健康的影响在老年人中似乎被放大了。然而，对单一系统终点的研究并未反映空气污染暴露对多个器官系统的影响，尽管临床和亚临床并存的情况在老年人中很常见。空气污染与老年人残疾的直接关系实际上仍未得到探索。表明空气污染与年龄相关残疾之间存在关联的数据将对制定环境政策至关重要，因为环境政策可能会减轻人口中的残疾负担。我们建议就暴露于空气污染的情况进行一项探索性流行病学研究，特别是暴露于与交通有关的空气污染与老年人残疾之间的关系。这项研究是老龄化和环境健康学科的合作，将利用芝加哥健康和老龄化项目(CHAP)的现有数据，该项目对居住在伊利诺伊州芝加哥南部的1万多名65岁以上的成年人进行了研究。CHAP于1993年招收了第一批参与者。参与者每三年进行一次家庭学习访问，其中包括残疾评估。我们将通过估计参与者的住宅与最近的繁忙雷德的距离来估计与交通相关的空气污染的暴露程度。高速公路、卡车路线和公共汽车路线，以及交通统计数据)和接触氮氧化物(NOx)，这是机动车排放的主要成分。在CHAP中，DTR将衡量长期风险敞口，因为该地区的道路和公交路线已经存在了几十年，而且大多数参与者都在同一个地址生活了很多年。估计的NOx暴露量可能在时空上更精确，并可以追溯到1999年。我们将使用所有这些数据来评估暴露在交通产生的空气污染中是否与事故残疾和残疾进展有关。此探索性项目结合了以下两个功能 目前在任何其他关于空气污染和晚年健康的大型队列研究中都没有。1)居住稳定的人口包括年龄较大的白人和黑人，他们拥有详细的残疾纵向数据。(2)城市研究区不仅有稳定的道路和交通模式，而且还位于进行详细NOx测量的区域内。该项目将产生重要证据，证明空气污染暴露与残疾之间的关系是可信的，刺激进一步的工作，以证实和阐述所发现的任何联系。

DESCRIPTION (provided by applicant): Physical disability in older age has become a critical clinical and public health concern due to its high associated health care costs and the rapidly growing number of older adults. The prevalence of disability has increased over the past 2 decades, in spite of earlier progress. Thus, age-related disability remains a substantial public health burden. Exposures to environmental toxins are potential modifiable risk factors that have received little attention. In particular, exposure to air pollution is associated with elevated riss of conditions, cardiovascular and respiratory disease, that are primary causes of disability. And health effects of air pollution appear to be magnified in older adults. Yet studies of single syste endpoints do not reflect the effects of air pollution exposure on multiple organ systems, even though co-morbid conditions, clinical and subclinical, are common in older adults. The direct relation of air pollution to disability among older adults remains virtually unexplored. Data indicating an association between air pollution and age-related disability would be critical for setting environmental policy, which could reduce the burden of disability in the population. We propose to conduct an exploratory epidemiologic study of air pollution exposure, specifically, exposure to traffic-related air pollution in relation to disability in older adults. This study, a collaboration of aging and environmental health disciplines, will capitalize on existing data from the Chicago health and Aging Project (CHAP), a study of over 10,000 adults, ages 65+, who live on the south side of Chicago, IL. CHAP enrolled its first participants in 1993. Participants have triennial in-home study visits, which include disability assessments. We will estimate exposures to traffic-related air pollution by estimating participants' residential distance to nearest busy rad (DTR; incl. highways, truck routes and bus routes, along with the traffic count data) and exposure to oxides of nitrogen (NOx), a major component of vehicle emissions. In CHAP, DTR will gauge long-term exposure, because the area's roads and bus routes have been in place for decades, and most participants have lived at the same address for many years. Estimated NOx exposures are potentially more spatiotemporally precise and extend back to 1999. We will use all of this data to evaluate whether exposure to traffic-generated air pollution is related to incident disability and disability progression. This exploratory project combines two features that are presently not available in any other large cohort study of air pollution and late-life health. 1) The residentially stable population comprises older whites and blacks with detailed longitudinal data on disability. (2) The urban study area not only has had stable road and traffic patterns over time, but also lies within a region where detailed NOx measurements have been taking place. This project will generate important evidence on the plausibility of a relation between air pollution exposure and disability, stimulating further work to confirm and elaborate any associations found.