Racial Disparities, Influenza Like Illness and the Association between Short-term Exposure to Ambient Air Pollution and Cardiovascular Outcomes

种族差异、流感样疾病以及短期暴露于环境空气污染与心血管结果之间的关联

• 批准号: 9471050
• 负责人: Amelia K Boehme
• 金额: $ 24万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-24 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9471050
• 关键词: Acute; Acute myocardial infarction; Address; Admission activity; Adult; Affect; Age; Air; Air Pollution; Applications Grants; Area; Biological; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Characteristics; Code; Communities; Data; Data Reporting; Data Set; Databases; Diagnosis; Digit structure; Disease; Disease Outcome; Emergency department visit; Environmental Exposure; Event; Exposure to; Future; Geography; Goals; Health; Health Services Research; Heart Diseases; Hispanics; Hospitals; ICD-9; Incidence; Infection; Inflammation; Influenza; Inpatients; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10); Intervention; Knowledge; Link; Measures; Mediating; Mediator of activation protein; Medically Underserved Area; Minority; Minority Groups; Morbidity - disease rate; Myocardial Infarction; New York; Outcome; Outpatients; Patients; Policies; Population; Populations at Risk; Poverty; Prevalence; Procedures; Prophylactic treatment; Race; Research; Respiratory Tract Infections; Risk; Risk Factors; Risk Reduction; Role; Rural; Socioeconomic Status; Stroke; System; United States; Vaccination; Vaccines; Visit; Work; ambient air pollution; cardiovascular disorder risk; cost; demographics; disability; ethnic minority population; health disparity; high risk; high risk population; influenza virus vaccine; innovation; low socioeconomic status; metropolitan; minority health; modifiable risk; mortality; novel; racial and ethnic; racial disparity; racial minority; sex; socioeconomic disadvantage; socioeconomic disparity; socioeconomics

Heart Disease is the leading cause of death in the US, with approximately 735,000 myocardial infarction (MI) events per year. Stroke is the fifth leading cause of death in the US and the number one cause of long-­term adult disability with nearly 800,000 stroke events in the US each year. The reduction of risk factors for stroke and heart disease has become a high priority, with policy efforts implementing risk reduction efforts. Novel risk factors such as inflammation and infection, including influenza like illness (ILI), or environmental exposures, such as air pollution, are known to be risk factors for MI and stroke. Moreover, ambient air pollution increases the risk of ILI, suggesting the potential for air pollution triggering an ILI event, which then subsequently triggers a stroke or MI event. Racial disparities are highly prevalent in not only the levels of air pollution, but also in the health effects of air pollution, as well as having a major role in the risk of ILI, stroke and MI. Racial and ethnic minorities are at higher risk to be exposed to high levels of air pollution, and are t higher risk for infections, stroke and MI. While the relationships between air pollution/cardiovascular disease and air pollution/ILI have been independently recognized, the combined relationship between air pollution, ILI and subsequent cardiovascular events, and how racial disparities influence this relationship has not yet been investigated. To overcome the current barriers to knowledge, this application aims to (1) determine the effect racial disparities has on the relationship ILI has on the association between air pollution and MI (2) determine the effect racial disparities has on the relationship ILI has on the association between air pollution and stroke, and (3) identify the populations at greatest risk for having an MI or stroke due to the combined effects of air pollution and ILI. Furthermore, no study has addressed these relationships in a large scale, generalizable dataset that allows for exploration of geographical, urban/rural, or differences across biologically relevant variables, such as sex and age, that could further influence these relationships. We will use two separate, large-­scale administrative datasets to assess these relationships. The analyses will be conducted in the MarketScan dataset first, and then replicated in the SPARCS dataset. MarketScan is an administrative dataset with nearly 230 million de-­identified patients with longitudinal information on patient demographics, including residential metropolitan statistical area (MSA) and 3-­digit zipcode, and ICD-­9 codes (pre-­2015) or ICD-­10 codes (post-­2015) diagnosis and procedure codes for all inpatient and outpatient visits linked by a de-­identified patient identifier code. The analyses will then be replicated in the New York Department of Health Statewide Planning and Research Cooperative System (SPARCS) dataset, a comprehensive data reporting system that collects information on hospital admissions and emergency department (ED) visits within the state of New York with detailed information on patient characteristics, demographics and diagnoses. The innovation of this idea is identifying at risk groups as defined by air pollution status and ILI as opposed to traditional risk factors.

心脏病是美国的主要死亡原因，每年约有73.5万例心肌梗塞(MI)事件。中风是美国第五大死亡原因，也是导致成人长期残疾的第一大原因，美国每年有近80万起中风事件。随着政策努力实施降低风险的努力，减少中风和心脏病的风险因素已成为一项高度优先事项。新的危险因素，如炎症和感染，包括流感样疾病(ILI)，或环境暴露，如空气污染，已知是心肌梗塞和中风的危险因素。此外，环境空气污染增加了ILI的风险，表明空气污染可能触发ILI事件，继而引发中风或MI事件。种族差异不仅在空气污染水平上非常普遍，而且在空气污染对健康的影响以及在ILI、中风和MI的风险中起着重要作用。少数族裔暴露在高水平空气污染中的风险更高，感染、中风和心肌梗塞的风险也不会更高。虽然空气污染/心血管疾病和空气污染/ILI之间的关系已经被独立认识，但空气污染、ILI和随后的心血管事件之间的综合关系以及种族差异如何影响这种关系还没有被调查。为了克服目前的知识障碍，这项应用旨在(1)确定种族差异对ILI对空气污染和MI之间关系的影响，(2)确定种族差异对ILI对空气污染和中风之间关系的影响，以及(3)确定由于空气污染和ILI的综合影响而患MI或中风的风险最高的人群。此外，还没有研究以大规模、可推广的数据集来处理这些关系，这些数据集允许探索地理、城市/农村或可能进一步影响这些关系的生物相关变量(如性别和年龄)的差异。我们将使用两个独立的大规模管理数据集来评估这些关系。分析将首先在MarketScan数据集中执行，然后在SPARCS数据集中复制。MarketScan是一个管理数据集，包含近2.3亿未识别的患者的纵向人口统计信息，包括居民大都市统计区域(MSA)和3位数字的邮政编码，以及所有住院和门诊的诊断和程序代码(2015年前)或ICD-10代码(2015年后)，这些代码由未识别的患者标识符代码链接。然后，这些分析将被复制到纽约州卫生部全州规划和研究合作系统(SPARCS)数据集中，这是一个全面的数据报告系统，收集纽约州内住院和急诊科(ED)就诊的信息，以及有关患者特征、人口统计和诊断的详细信息。这一想法的创新之处在于，根据空气污染状况和ILI来确定风险群体，而不是传统的风险因素。