Occupational Exposure to PM2.5 and Cardiovascular Disease(CVD)

摘要 该项目符合PA-13-302的要求。本提案的目标是扩大我们在 职业暴露于颗粒物对健康的影响。我们将在2015年12月21日至2016年12月31日期间 活跃队列再持续5年（共20年），并随访过去终止就业的受试者， 医疗保险索赔和导致特定死亡率的队列。 目标1：根据工作接触情况，制定PM和选定化学品的工作接触矩阵 而不是不同的暴露组（DEG），根据呼吸器的使用进行调整。目标2：审查共同- 暴露于化学品和物理压力-噪音和热量-以及工作压力，作为独立的风险 IHD发病率的因素，以及作为潜在的混杂因素、中间体和效应调节剂， 铝冶炼厂和铝加工厂所有活跃工人中PM2.5暴露对心血管的影响 设施目标3：探索植物水平、社区和早期生命对社会和环境的贡献 心血管疾病的发病特点。目标4：估计 PM2.5（以及粗颗粒物PM2.5 - PM10）的累积暴露量和纵向下降 在肺功能方面。目标5：研究PM2.5累积暴露与化学品之间的关系 以及COPD和CVD死亡率，考虑到健康状况（积极就业时的风险评分）和新的 有关65岁后（离职后）健康状况的信息，来自链接的Medicare索赔文件。 总的来说，继续美铝的研究与组装团队的调查提供了一个 前所未有的机会，以解决一系列关键的经验和方法问题，以前 难以接近除了更好地了解PM暴露的哪些方面有助于急性和 IHD、COPD和加速肺功能下降的慢性风险，我们可以了解PM如何与 最普遍存在的工作场所共同暴露以及个人，工厂和社会的贡献 通过应用测量科学和流行病学中的最先进方法来确定决定因素。

ABSTRACT The proposed project is responsive to PA-13-302. The objective of this proposal is to extend our work on the health effects of occupational exposures to particulate matter. We will extend follow-up of incident IHD in the active cohort for 5 more years (total of 20 years) and follow subjects past termination of employment, linking the cohort to Medicare claims and cause specific mortality. Aim 1: Develop job-exposure matrices (JEMs) for PM and selected chemicals based on job-level exposures rather than distinct exposure groups (DEGs), adjusting for respirator use. Aim 2: Examine the impact of co- exposure to chemicals and physical stressors—noise and heat—as well as job stress, as independent risk factors for IHD incidence, and as potential confounders, intermediates and effect modifiers of the cardiovascular effects of PM2.5 exposure among all active workers in aluminum smelters and fabrication facilities. Aim 3: Explore the contribution of plant level, community and early life social and environmental characteristics to the incidence of cardiovascular disease. Aim 4: Estimate the associations between cumulative exposure to PM2.5 (as well as the coarse particle fraction PM2.5 - PM10) and longitudinal decline in pulmonary function. Aim 5: Examine the relationships between cumulative exposure to PM2.5, chemicals and COPD and CVD mortality, taking account of health status (risk score while actively employed) and new information on health status after age 65 (after leaving work) derived from linked Medicare claims files. Viewed altogether, continuation of the Alcoa study with the assembled team of investigators provides an unparalleled opportunity to address a host of critical empiric and methodologic issues previously unapproachable. In addition to understanding better what aspects of PM exposure contribute to acute and chronic risk of IHD, COPD and accelerated pulmonary function decline, we can learn how PM interacts with the most ubiquitous of workplace co-exposures as well as the contributions of personal, plant level and social determinants by applying state-of-the-art methods in measurement science and epidemiology.