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

在美国，心脏病是导致死亡的主要原因，每年约有735,000例心肌梗死（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80万例中风事件。减少中风和心脏病的危险因素已成为一项高度优先事项，政策努力正在落实减少风险的努力。已知新的危险因素，如炎症和感染，包括流感样疾病（ILI），或环境暴露，如空气污染，是心肌梗死和中风的危险因素。此外，环境空气污染增加了ILI的风险，表明空气污染有可能引发ILI事件，进而引发中风或MI事件。种族差异在不仅是高度普遍水平的空气污染,而且在空气污染对健康的影响,以及拥有一个重要角色在伊犁的风险,中风和心肌梗死。种族和少数民族有更高风险暴露于高水平的空气污染,和t更高的感染风险,中风和心肌梗死。而空气污染/心血管疾病与空气污染之间的关系/独立伊犁已认可,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，尚未得到调查。为了克服目前的知识障碍，本应用程序旨在(1)确定种族差异对ILI对空气污染与ILI之间关联关系的影响(2)确定种族差异对ILI对空气污染与中风之间关联关系的影响，以及(3)确定由于空气污染和ILI的综合影响而患MI或中风风险最大的人群。此外，没有研究在大规模、可推广的数据集中解决这些关系，这些数据集允许探索地理、城市/农村或跨生物相关变量（如性别和年龄）的差异，这些变量可能进一步影响这些关系。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数据集中进行，然后在SPARCS数据集中进行复制。MarketScan是一个管理数据集，包含近2.3亿未识别患者的患者人口统计纵向信息，包括住宅大都市统计区（MSA）和3位邮政编码，以及ICD- 9代码（2015年之前）或ICD- 10代码（2015年之后），所有住院和门诊就诊的诊断和程序代码都由未识别的患者识别码链接。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，收集纽约州内医院入院和急诊室（ED）就诊的信息，包括患者特征、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。

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.