Spatio-temporal analyses of the role of environmental factors on cystic fibrosis severity, with a focus on fungal infections

空气污染是一个全球性的重大环境健康问题。患有囊性纤维化（CF）、慢性阻塞性肺病（COPD）和哮喘等肺部疾病的受试者特别容易受到空气污染的负面影响。颗粒物（PM2.5和PM10）、二氧化氮和臭氧被世界卫生组织确定为对健康有重大影响的空气污染物。在英国有超过12，000人患有CF。尽管有越来越多的证据表明环境因素（例如空气污染、暴露于二手烟）和社会经济状况对健康的影响，但英国关于环境因素在CF严重程度中的作用的证据有限，包括肺部加重和其他并发症。真菌感染被认为与当地环境特征密切相关，也与肺功能的快速下降有关。我的博士学位的目的将填补这一重要的研究空白，建立在美国和一些欧洲国家的发现基础上。首先，我想评估空气质量、气候和房屋属性（特别是湿度、潮湿和霉菌）对CF疾病严重程度的短期影响。第二，我想帮助更好地了解CF患者居住地对真菌感染患病率的影响。我的项目将使用英国CF登记处（2007-2017）的数据，其中包括来自英国每个专科中心和诊所的数据，代表了99%以上的CF患者。我将专注于使用基于小面积方法的时空分析来研究环境与健康的关联，并严格量化可能的因果关系。更好地了解这些相互作用和识别可能的环境风险因素可能对CF个体有直接的好处。该项目由英国小区域健康统计单位（SAHSU，https://www.sahsu.org）进行，由英国CF信托基金资助（https：//www.cysticfibrosis.org.uk/）和帝国的MRC DTP（https：//www.imperial.ac.uk/mrc-dtp-studentships），与CF-EpiNet战略研究中心合作（https：//www.cysticfibrosis.org.uk/the-work-we-do/research/research-we-are-funding/strategic-research-centres/src-4-bilton-data）。

Air pollution is a major environmental health problem worldwide. Subjects with lung diseases such as cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD) and asthma are especially vulnerable to the negative effects of air pollution. Particulate matters (PM2.5 and PM10), NO2 and O3 have been identified as air pollutants which have a major impact on health reported by the World Health Organisation. There are over 12,000 people with CF in the UK. Despite growing evidence of the health impact of environmental factors (e.g. air pollution, exposure to second-hand smoke) and socio-economic status, there is limited evidence from the UK on the role of environmental factors in the severity of CF, including pulmonary exacerbations and other complications. Fungal infections, which are believed to be closely associated to local environmental characteristics, are also linked to a rapid decline in lung function. The aims of my Ph.D. are to fill in this important research gap, building on findings from the US and some European countries. First, I want to assess the short-term influence of air quality, climate, and housing properties (particularly humidity, dampness and molds) on disease severity in CF. Second, I would like to contribute to a better understanding of the influence of where individuals with CF live on the prevalence of fungal infections.My project will use data from the UK CF Registry (2007-2017), which includes data from every specialist centre and clinic across the UK, representing over 99% of people with CF. I will focus on using spatio-temporal analyses based on small-area methods to study environment-health associations and to rigorously quantify possible causative interactions. A better understanding of these interactions and the identification of possible environmental risk factors could have direct benefits for CF individuals.This project, conducted in the UK Small-Area Health Statistics Unit (SAHSU, https://www.sahsu.org), is funded by UK CF Trust (https://www.cysticfibrosis.org.uk/) and the MRC DTP at Imperial (https://www.imperial.ac.uk/mrc-dtp-studentships), in collaboration with the CF-EpiNet Strategic Research Centre (https://www.cysticfibrosis.org.uk/the-work-we-do/research/research-we-are-funding/strategic-research-centres/src-4-bilton-data).