PURE-AIR: A Global Assessment of Air Pollution and Cardiopulmonary Disease

描述（由申请人提供）：全球估计表明，每年有320万人死亡和3.1%的残疾调整生命年可归因于室外空气污染。这使得暴露于室外空气污染成为全球疾病负担最重要的可改变风险因素之一。然而，这一估计存在很大的不确定性，仍然迫切需要确定空气污染对发达国家和发展中国家人口心肺健康的影响。造成这种不确定性的部分原因是，关于细颗粒物（PM2.5）空气污染对特定心肺健康影响（例如中风和肺功能下降）的影响的现有信息有限；对弱势群体的描述不充分；事实上，很少甚至没有直接的流行病学证据可用于暴露-反应关系的上层。几乎所有与PM2.5相关的心肺健康影响的流行病学研究都是在发达国家进行的，与发展中国家相比，这些国家的PM2.5浓度相对较低。本研究申请的目的是通过利用前瞻性城乡流行病学研究（PURE）进行PM2.5空气污染与心肺疾病的首次全球流行病学研究，来解决这些重大的不确定性。该队列招募了居住在5大洲17个国家628个社区的15.5万人，目前随访完成了4年，并将继续进行6年。该研究应用程序将增加一个空气污染组件（PURE- air），该组件将使用新的基于卫星的空气污染估算、地理信息科学（GIS）和环境空气污染监测来表征628个PURE社区的社区级PM2.5浓度。流行病学分析（横断面和纵向）将检查重要的心肺结果（例如心肌梗死（MI）、心力衰竭、中风、慢性阻塞性肺疾病（COPD）和成人发作哮喘）以及肺功能变化（使用该应用程序促进的50,000名参与者的重复个体测量）。所有的分析都将控制一组综合的混杂因素（如吸烟、职业暴露、生物质利用造成的室内空气污染、饮食等）。PURE-AIR将是一项开创性的全球研究，它极大地增强了我们对室外空气污染对心肺健康影响的理解。这些信息将为人类健康风险评估提供信息，并降低美国和其他国家的发病率和死亡率

DESCRIPTION (provided by applicant): Global estimates suggest that 3.2 million deaths and 3.1% of disability-adjusted life-years are attributable to outdoor air pollution annually. This places exposure to outdoor air pollution among the most important modifiable risk factors for global disease burden. There is, however, substantial uncertainty in this estimate and there remains a critical need to characterize the impacts of air pollution on cardiopulmonary health in populations that reside in both developed and developing countries. This uncertainty stems in part from the limited information available for the effects of fine particulate matter (PM2.5) air pollution on specific cardiopulmonary health impacts (e.g. stroke and reduced lung function); the inadequate characterization of vulnerable populations; and the fact that little to no direct epidemiological evidence is available for the upper portion of exposure-response relationships. Almost all epidemiological studies of cardiopulmonary health effects associated with PM2.5 have been conducted in developed countries, where PM2.5 concentrations are relatively low compared to developing countries. The objective of this research application is to address these significant uncertainties by conducting the first global epidemiological study of PM2.5 air pollution and cardiopulmonary disease by leveraging the Prospective Urban and Rural Epidemiological Study (PURE). This cohort recruited 155,000 individuals residing in 628 communities in 17 countries and 5 continents, with current follow-up completed for four years and continuing for another six years. This research application will add an air pollution component (PURE-AIR) that will use novel satellite-based air pollution estimates, geographic information science (GIS) and ambient air pollution monitoring to characterize community-level PM2.5 concentrations in the 628 PURE communities. Epidemiological analyses (both cross-sectional and longitudinal) will examine important cardiopulmonary outcomes (e.g. myocardial infarction (MI), heart failure, stroke, chronic obstructive pulmonary disease (COPD), and adult onset asthma) as well as lung function change (using repeat individual measures for 50,000 participants that are facilitated by this application). All analyses will control for a comprehensie set of confounding factors (e.g. smoking, occupational exposures, indoor air pollution from biomass use, diet, etc.). PURE-AIR would be a seminal global study that greatly enhances our understanding of the cardiopulmonary health impacts from outdoor air pollution. This information will inform human health risk assessment and reduce morbidity and mortality in the United States and other countries