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

描述（由申请人提供）：由于相关的高医疗费用和老年人数量的迅速增长，老年身体残疾已成为一个重要的临床和公共卫生问题。尽管早些时候取得了进展，但在过去20年里，残疾的发病率有所上升。因此，与年龄有关的残疾仍然是一个重大的公共卫生负担。暴露于环境毒素是潜在的可改变的危险因素，很少受到关注。特别是，接触空气污染与疾病、心血管和呼吸系统疾病的风险增加有关，而这些疾病是致残的主要原因。空气污染对老年人健康的影响似乎更大。然而，单系统终点的研究并没有反映空气污染暴露对多器官系统的影响，尽管临床和亚临床的合并症在老年人中很常见。空气污染与老年人残疾之间的直接关系实际上尚未得到探索。表明空气污染与与年龄有关的残疾之间存在联系的数据对于制定环境政策至关重要，这可以减轻人口中的残疾负担。我们建议对空气污染暴露进行一项探索性流行病学研究，特别是暴露于交通相关的空气污染与老年人残疾的关系。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，这是一项对居住在伊利诺伊州芝加哥南侧的10,000多名65岁以上成年人的研究。CHAP于1993年招募了第一批参与者。参与者每三年进行一次家庭考察，其中包括残疾评估。我们将通过估算参与者到最近的繁忙道路（DTR，包括高速公路、卡车路线和公共汽车路线，以及交通统计数据）的住宅距离和暴露于氮氧化物（NOx）（汽车排放的主要组成部分）来估计与交通有关的空气污染的暴露程度。在CHAP， DTR将评估长期暴露，因为该地区的道路和公交线路已经铺设了几十年，而且大多数参与者已经在同一个地址住了很多年。估计的氮氧化物暴露可能在时空上更为精确，并可追溯到1999年。我们将使用所有这些数据来评估暴露于交通产生的空气污染是否与事故残疾和残疾进展有关。这个探索性项目结合了两个特性

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.