Air pollution and risk of incident hypertension and diabetes in U.S. black women

描述（由申请人提供）：空气污染增加急性心血管事件的风险。它是否会增加高血压和糖尿病的风险，这是心血管疾病的慢性易感条件，目前尚不清楚。高血压和2型糖尿病在美国黑人女性中比白人女性更常见，已知的危险因素只能部分解释这种差异。无论社会经济地位如何，美国黑人女性往往比白人女性生活在空气污染更严重的社区。采用最先进的方法，我们建议测试暴露于空气污染会增加非裔美国妇女高血压和2型糖尿病风险的假设。我们将重点关注d2.5 <g空气动力学直径的颗粒物（PM2.5）和交通相关污染，如二氧化氮（NO2）和氧化物（NO）。我们将在黑人妇女健康研究（BWHS）中前瞻性地检验这些假设，这是一项对59,000名美国黑人妇女进行的队列研究。在1995年的基线和两年一次的随访问卷中收集了有关疾病风险因素、生活方式因素和疾病终点的详细信息。基于洛杉矶参与者的初步调查结果表明，在控制了个人和社区社会经济地位之后，感兴趣的污染物与高血压和糖尿病的发病率呈正相关。我们将根据为加拿大卫生部开发并免费提供给该研究的一个新的美国数据层来估计长期暴露于PM2.5浓度。我们将使用分散模型，使用最佳指标NO和NO2来估计与交通有关的污染物。我们将对交通噪声水平进行建模，以便在高血压分析中包括噪声作为潜在的混杂因素。我们将使用新开发的空间队列生存建模技术来解释区域和本地两个地理水平上空气污染物的聚集。暴露测量将适用于整个BWHS队列，该队列分布在美国各地。到2007年随访周期结束时，BWHS中发生了10,137例高血压病例和4861例2型糖尿病病例，具有较高的统计能力。BWHS人群特别适合研究目标，因为他们高血压和糖尿病的发病率很高，接触空气污染物的程度也很高。这项拟议的研究将是第一次调查空气污染对高血压发病率的影响，第一次大规模调查空气污染对糖尿病发病率的影响，以及第一次研究空气污染对非裔美国妇女的影响。考虑到高血压和糖尿病在美国的高发病率和不断增长的患病率，美国黑人和白人妇女发病率的差异，以及无处不在的空气污染，这些假设对公共卫生至关重要。积极的发现将为空气质量监管的公共政策提供信息，为空气污染导致心血管事件的新途径提供见解，阐明高血压和糖尿病发病率的种族差异的原因，并促进对空气污染物对其他疾病影响的研究。

DESCRIPTION (provided by applicant): Air pollution increases the risk of acute cardiovascular events. Whether it contributes to the risk of hypertension and diabetes, chronic predisposing conditions to cardiovascular disease, is unknown. Hypertension and type 2 diabetes occur much more commonly among U.S. black women than white women, a discrepancy only partly explained by known risk factors. U.S. black women tend to live in neighborhoods with more air pollution than their white counterparts, regardless of socioeconomic status. With state-of-the-art methods, we propose to test the hypotheses that exposure to air pollution increases the risks of incident hypertension and type 2 diabetes in African American women. We will focus on particulate matter of d2.5 <g aerodynamic diameter (PM2.5) and traffic-related pollution as indicated by nitrogen dioxide (NO2) and oxide (NO). We will prospectively test the hypotheses in the Black Women's Health Study (BWHS), an ongoing cohort study of 59,000 U.S. black women. Detailed information on risk factors for disease, lifestyle factors, and disease endpoints was collected at baseline in 1995 and in biennial follow-up questionnaires. Preliminary findings based on Los Angeles participants indicate positive associations of the pollutants of interest with incident hypertension and diabetes, after control for personal and neighborhood socioeconomic status. We will estimate long-term exposure to PM2.5 concentrations based on a new U.S. data layer developed for Health Canada and provided to the study at no cost. We will use dispersion modeling to estimate traffic-related pollutants using the best indicators, NO and NO2. We will model traffic noise levels for the purpose of including noise as a potential confounder in the hypertension analyses. We will use the newly developed spatial cohort survival modeling technique to account for clustering of air pollutants at two geographic levels, regional and local. Exposure measures will be available for the entire BWHS cohort, which is geographically dispersed across the U.S. By the end of the 2007 follow-up cycle, 10,137 incident hypertension cases and 4861 incident type 2 diabetes cases had occurred in the BWHS, allowing for high statistical power. The BWHS cohort is particularly well suited to the study aims because it has high rates of hypertension and diabetes and high levels of exposure to air pollutants. The proposed study will be the first investigation of the effect of air pollution on incidence of hypertension, the first large-scale investigation its effect on incidence of diabetes, and the first study of air pollution effects specifically in African American women. The hypotheses are of critical public health importance, given the high and growing prevalence of hypertension and diabetes in the U.S., the disparity between incidence rates among U.S. black and white women, and the ubiquity of exposure to air pollution. Positive findings will inform public policy on air quality regulation, provide insight into a novel pathway whereby air pollution causes cardiovascular events, illuminate causes of racial disparities in hypertension and diabetes incidence, and spur research on effects of air pollutants on other diseases.