长时间暴露于PM2.5与死亡率：一项全国健康保险队列研究

Long-term exposure to PM2.5 and mortality: a national health insurance cohort study

INTERNATIONAL JOURNAL OF EPIDEMIOLOGY

影响因子:5.9

分区:医学2区 Top / 公共卫生1区

发表日期:2024 Oct 13

作者: Jeongmin Moon, Ejin Kim, Hyemin Jang, Insung Song, Dohoon Kwon, Cinoo Kang, Jieun Oh, Jinah Park, Ayoung Kim, Moonjung Choi, Yaerin Cha, Ho Kim, Whanhee Lee

DOI: 10.1093/ije/dyae140

摘要

以往大规模研究普遍报道，暴露于细颗粒物（PM2.5）与全因死亡率相关；但大多数研究采用生态时间序列设计，且仅涵盖有限的研究区域或居住在监测良好的城市地区的个体。关于不同年龄组的原因特异性死亡的全国性队列研究较少。因此，本研究利用全国性队列数据，探讨PM2.5与因果死亡的关系。我们采用一个包含187,917名2002-2019年间入组的国民健康保险局-国家样本队列中年龄在50-79岁之间的参与者的纵向队列。年度平均PM2.5浓度通过机器学习集成模型（测试R2=0.87）作为暴露指标。采用时变Cox回归模型分析长期PM2.5暴露与死亡的关系，并采用广义倾向评分加权方法以减少估计偏差。结果显示，长时间（2年移动平均）暴露于PM2.5与糖尿病（HR：1.03，95% CI：1.01-1.06）、循环系统疾病（HR：1.02，95% CI：1.00-1.03）以及癌症（HR：1.01，95% CI：1.00-1.02）相关。循环系统疾病相关死亡与较长的PM2.5暴露期（1或2年滞后）相关，而呼吸系统相关死亡则与当年PM2.5暴露相关。此外，50-64岁人群中与PM2.5的关联更明显，尤其是心力衰竭相关死亡。本研究提出长时间暴露于PM2.5与死亡相关的假设，且不同死因之间的关系可能存在差异。结果强调了一个新的易感人群：具有心力衰竭相关风险因素的中年人。

Abstract

Previous studies with large data have been widely reported that exposure to fine particulate matter (PM2.5) is associated with all-cause mortality; however, most of these studies adopted ecological time-series designs or have included limited study areas or individuals residing in well-monitored urban areas. However, nationwide cohort studies including cause-specific mortalities with different age groups were sparse. Therefore, this study examined the association between PM2.5 and cause-specific mortality in South Korea using the nationwide cohort.A longitudinal cohort with 187 917 National Health Insurance Service-National Sample Cohort participants aged 50-79 years in enrolment between 2002 and 2019 was used. Annual average PM2.5 was collected from a machine learning-based ensemble model (a test R2 = 0.87) as an exposure. We performed a time-varying Cox regression model to examine the association between long-term PM2.5 exposure and mortality. To reduce the potential estimation bias, we adopted generalized propensity score weighting method.The association with long-term PM2.5 (2-year moving average) was prominent in mortalities related to diabetes mellitus [hazard ratio (HR): 1.03 (95% CI: 1.01, 1.06)], circulatory diseases [HR: 1.02 (95% CI: 1.00, 1.03)] and cancer [HR: 1.01 (95% CI: 1.00, 1.02)]. Meanwhile, circulatory-related mortalities were associated with a longer PM2.5 exposure period (1 or 2-year lags), whereas respiratory-related mortalities were associated with current-year PM2.5 exposure. In addition, the association with PM2.5 was more evident in people aged 50-64 years than in people aged 65-79 years, especially in heart failure-related deaths.This study identified the hypothesis that long-term exposure to PM2.5 is associated with mortality, and the association might be different by causes of death. Our result highlights a novel vulnerable population: the middle-aged population with risk factors related to heart failure.