Long-term Air Pollution Exposure and Mortality in the NIH-AARP Cohort

描述(由申请人提供)：我们已有重大发现，室外PM2.5(空气动力学直径中质量浓度小于2.5微米的颗粒物)与各种原因和主要心血管疾病(CVD)的死亡率有关，包括缺血性心脏病(IHD)，还可能与肺癌有关。然而，环境空气中的PM2.5是一种复杂的混合物，来源和化学成分差异很大。因此，关于PM2.5风险的大小以及PM2.5污染的哪些来源和/或成分对这些影响负有最大责任，仍然存在重大不确定性。此外，人们怀疑吸烟、BMI和其他因素可能会改变长期的空气污染-死亡风险，但这些潜在的改变效应及其对识别潜在易感人群的影响尚未被很好地理解。我们建议利用NIH-AARP“饮食与健康研究”进行研究，以满足这些研究需求，该研究由50多万人组成，分别针对疾病风险因素进行特征描述，并在1995-96至2008年间跟踪研究特定疾病的死亡率，在最初10年的随访中已确定超过60,000人死亡(19,400人死于心血管疾病，11,500人死于IHD，超过7,600人死于肺癌)。除了在美国引入一个主要的空气污染研究新队列外，我们的研究还将进行创新的暴露评估，将详细的NIH-AARP队列居住数据与空气污染数据联系起来。这些数据将包括来自环保局空气质量系统(AQS)网络数据的PM2.5质量和气态共污染物数据，以及来自环保局全国化学形态网络(CSN)的PM2.5组成数据。在另一个重大进展中，NIH-AARP受试者流动性数据将允许对搬家的人进行依赖时间的暴露分类。随着这些进展，我们的研究团队在NIH-AARP队列中提出了流行病学分析，这些分析将：1)更准确地量化长期PM2.5空气污染和死亡率之间的关联；2)确定与总死亡率和特定原因死亡率最密切相关的PM2.5来源类别和痕量成分；以及3)确定风险最高的人群亚群。美国环保局估计，在美国，长期暴露在PM2.5中与大约73,000例缺血性心脏病(IHD)死亡有关(美国环保局，2010年)，这与每年因吸烟导致的85,000例IHD死亡的规模相同(CDC，2005)。这项研究将独一无二地确定空气污染源类别和PM2.5成分，这些成分与全原因、心血管疾病和IHD死亡率最相关，这是为空气污染预防政策提供信息的关键进展。这项研究还将确定易感人群亚群，从而为医生提供关键的临床信息，为患者提供有关空气污染对健康的影响和预防的建议。

DESCRIPTION (provided by applicant): We have made significant findings that outdoor PM2.5 (the mass concentration of particles less than 2.5 um in aerodynamic diameters) is related to all-causes and major cardiovascular disease (CVD) mortality, including ischemic heart disease (IHD), and possibly to lung cancer. However, PM2.5 in ambient air is a complex mixture that varies greatly in sources and chemical constituents. As a result, significant uncertainty remains as to the magnitude of the PM2.5 risk and which sources and/or constituents of PM2.5 pollution are most responsible for these effects. Also, it is suspected that smoking, BMI, and other factors may modify long-term air pollution-mortality risks, but these potential modifying effects and their implications for identifying potentially susceptible populations are not well understood. We propose studies to address these research needs using the NIH-AARP "Diet and Health Study", a cohort of over one-half million people characterized individually for disease risk factors and followed for disease-specific mortality from 1995-96 to 2008, with over 60,000 deaths already ascertained in the first 10 years of follow-up (19,400 attributed to CVD, 11,500 to IHD, and over 7,600 to lung cancer). In addition to introducing a major new cohort in the U.S. for air pollution research, our study will carry out innovative exposure assessment, linking the detailed NIH-AARP cohort residence data to air pollution data. These data will include PM2.5 mass and gaseous co-pollutant data from the EPA's Air Quality System (AQS) network data, and PM2.5 constituent data from the EPA's nationwide Chemical Speciation Network (CSN). In another significant advance, the NIH-AARP subject mobility data will allow time-dependent exposure classification for those who move residence. With these advances, our research team propose epidemiologic analyses in the NIH-AARP cohort that will: 1) more accurately quantify associations between long-term PM2.5 air pollution and mortality; 2) identify the PM2.5 source categories and trace constituents most closely associated with total and cause-specific mortality; and, 3) identify the population subgroups at greatest risk. The U.S. EPA estimates that long-term exposure to PM2.5 in the US is associated with some 73,000 ischemic heart disease (IHD) deaths (U.S. EPA, 2010), which is on the same scale as the 85,000 IHD deaths per year caused by smoking (CDC, 2005). This study will uniquely identify air pollution source categories and PM2.5 constituents most strongly associated with all-cause, CVD and IHD mortality, a critically important advance for informing air pollution prevention policy. The study will also identify susceptible population sub-groups, and thereby provide physicians with critical clinical information for advising patients about air pollution health effects and prevention.