Association between Mortality and Long-term Exposure to Outdoor Air Pollution in

描述（由申请人提供）：在发达国家，长期暴露于室外空气污染与心肺死亡率增加有关，但在发展中国家没有前瞻性证据。目前尚不清楚发达国家低空气污染暴露环境的研究结果是否适用于发展中国家，因为发展中国家的室外空气污染特征和当地居民的社会人口状况不同。该项目的总体目标是确定长期暴露于室外空气污染对中国52个地区79，984名中年男性和女性的全国代表性队列死亡率的影响。我们将致力于以下具体目标：1。获得1991 - 2000年各地区的年平均空气污染物暴露量（TSP、SO2和NOx）。2.确定长期暴露于室外空气污染对总死亡率和死因特异性死亡率的影响。3.研究长期暴露于空气污染与死亡率之间关系的潜在修正因素。参与者的人口统计学特征，病史，生活方式相关的危险因素，血压和体重的基线数据是在1991年使用标准协议获得的。1999年和2000年进行了后续评价。将通过将固定站点监测数据与居民邮政编码联系起来，估计1991年至2000年期间的年平均空气污染暴露量。空气污染与死亡率的关系将使用比例风险回归模型进行研究，并对广泛的个人风险因素进行调整。将评估总死亡率和死因特异性死亡率。我们将拟合单污染物和多污染物模型来评估污染物效应的稳定性，并将呈现死亡率与污染物浓度之间的非参数平滑的响应关系。将按性别、吸烟状况、肥胖和教育程度进行分层分析，以研究空气污染与死亡率之间关系的潜在修饰因素。这项拟议的研究将产生第一个关于发展中国家空气污染与死亡率之间关系的前瞻性证据。这项研究的结果将有助于科学文献中关于空气污染对发展中国家典型的高暴露环境的长期影响的非常有限的数据。该研究符合美国国立卫生研究院当前的全球环境健康战略，并将填补中国空气污染健康影响的关键知识空白。公共卫生相关性：中国的室外空气污染水平是世界上最高的;然而，中国没有空气污染长期影响的前瞻性数据。这个拟议的项目将建立在一个具有良好特征的中国全国代表性队列的基础上，并评估长期暴露于空气污染和死亡率之间的关系。本研究的发现将填补中国空气污染健康影响的关键知识空白。

DESCRIPTION (provided by applicant): Long-term exposure to outdoor air pollution has been associated with increased cardiopulmonary mortality in developed countries, but there exist no prospective evidence in developing countries. It is unknown whether the findings from low air pollution exposure settings in developed countries apply to developing countries, where characteristics of outdoor air pollution and socio-demographic status of local residents are different. The overall objective of this proposed project is to determine the effects of long-term exposure to outdoor air pollution on mortality in a nationally representative cohort of 79,984 middle-aged men and women in 52 districts of China. We will address the following specific aims: 1. To obtain the annual average air pollution exposure (TSP, SO2, and NOx) between 1991 and 2000 in each district. 2. To determine the effects of long-term exposure to outdoor air pollution on total and cause-specific mortality. 3. To examine potential modifiers of the association between long-term exposure to air pollution and mortality. Baseline data on the participants' demographic characteristics, medical history, lifestyle-related risk factors, blood pressure, and body weight were obtained in 1991 with the use of a standard protocol. The follow-up evaluation was conducted in 1999 and 2000. Annual average air pollution exposure between 1991 and 2000 will be estimated by linking fixed-site monitoring data with resident zip code. The association of air pollution with mortality will be examined using proportional hazards regression models, with adjustment for a wide range of individual risk factors. Both total and cause-specific mortality will be assessed. We will fit both single-pollutant and multi-pollutant models to assess the stability of pollutants' effects, and will present the nonparametric smoothed exposure-response relationship between mortality and pollutant concentrations. Stratified analyses by sex, smoking status, obesity, and education will be conducted to examine potential modifiers of the association between air pollution and mortality. The proposed study will generate the first prospective evidence of the association between air pollution and mortality in developing countries. The results from this study will contribute to very limited data in the scientific literature on long-term effects of air pollution for high exposure settings typical in developing countries. The study matches the NIH's current strategy of global environmental health, and will fill key knowledge gap of air pollution health effects in China. PUBLIC HEALTH RELEVANCE: Levels of outdoor air pollution in China are among the highest in the world; however, there exists no prospective data of the long-term effects of air pollution in China. This proposed project will build on a well-characterized nationally representative cohort in China and assess the relationship between long-term exposure to air pollution and mortality. The findings of this study will fill key knowledge gap of air pollution health effects in China.