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

描述（由申请人提供）：由于其相关的医疗保健成本高，老年人数量迅速增长，老年人的身体残疾已成为一个重要的临床和公共卫生问题。过去20年来，尽管取得了进展，但残疾发生率有所上升。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风险因素，很少受到关注。特别是，暴露于空气污染与心血管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似乎在老年人中被放大了。然而，单系统终点的研究并不能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共病状况在老年人中很常见。空气污染与老年人残疾之间的直接关系实际上仍未得到探讨。显示空气污染与年龄相关残疾之间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（ESTA）的现有数据，该项目对居住在伊利诺伊州芝加哥南部的10，000多名65岁以上的成年人进行了研究。该项目于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到最近的忙碌拉德（DTR;包括）的住宅距离来估计与交通相关的空气污染暴露。高速公路、卡车路线和公共汽车路线，沿着与交通计数数据）和暴露于氮氧化物（NOx），氮氧化物是车辆排放物的主要成分。DTR将评估长期暴露，因为该地区的道路和公交线路已经存在了几十年，大多数参与者已经在同一地址生活了多年。估计的氮氧化物暴露可能在时空上更精确，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。这个探索性的项目结合了两个特点， 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无法获得。1)居住稳定的人口包括老年白人和黑人，有详细的残疾纵向数据。(2)城市研究区域不仅随着时间的推移具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。该项目将产生关于空气污染暴露与残疾之间关系的可信性的重要证据，促进进一步的工作，以确认和阐述所发现的任何关联。

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.