长期接触PM2.5和死亡率：国家健康保险队列研究
Long-term exposure to PM2.5 and mortality: a national health insurance cohort study
影响因子:5.90000
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
摘要
先前对大数据的研究已被广泛报道，暴露于细颗粒物（PM2.5）与全因死亡率有关。但是，这些研究中的大多数采用了生态序列设计，或者包括居住在监视良好的城市地区的有限研究领域或个人。但是，包括不同年龄段的特定原因死亡率在内的全国队列研究很少。因此，这项研究检查了PM2.5和韩国特定原因的死亡率，使用全国同伙。使用187 917的纵向队列，使用了2002年至2019年之间的50-79岁的国家健康保险服务社会同伙参与者。从基于机器学习的集合模型（测试R2 = 0.87）收集年平均PM2.5作为暴露。我们进行了随时间变化的COX回归模型，以检查长期PM2.5暴露与死亡率之间的关联。 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）]。同时，与循环相关的死亡率与较长的PM2.5暴露期（1或2年滞后）相关，而与呼吸有关的死亡率与当前年度PM2.5暴露有关。此外，在50-64岁的人群中，与PM2.5的关联比65-79岁的人更为明显，尤其是在与心力衰竭有关的死亡中。这项研究确定了以下假设：长期暴露于PM2.5与死亡率有关，并且该关联可能因死亡原因而不同。我们的结果凸显了一个新型脆弱人群：中年人口具有与心力衰竭有关的危险因素。
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.