评估高血压在长期接触空气污染对痴呆症影响中的中介作用

IF 3.3 Q2 ENVIRONMENTAL SCIENCES
Tanya E. Libby, S. Ilango, C. Leary, E. Semmens, Claire E Adam, Annette L. Fitzpatrick, J. Kaufman, A. Hajat
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引用次数: 0

摘要

越来越多的证据表明,空气污染与痴呆症的风险有关。我们假设高血压可能会部分介导这种效应。 我们曾在《银杏记忆评估研究》(Ginkgo Evaluation of Memory Study)中记录了空气污染与痴呆症之间的联系,该研究是一项随机、安慰剂对照试验,在 2000-2008 年间,美国四个地方的 3069 名年龄≥75 岁的成年人每 6 个月接受一次痴呆症评估。我们采用两阶段回归法进行因果中介分析,将空气污染对痴呆症的总体影响分解为自然直接影响和通过高血压流行产生的间接影响。我们使用 PM2.5、PM10 和 NO2 的精细尺度时空模型估算了入组前 10 年或 20 年的空气污染暴露情况。我们对高血压采用泊松回归模型,对全因痴呆的发病时间采用 Cox 比例危险模型,并对先验混杂因素进行了调整。 参与者在基线时没有轻度认知障碍(分析中的人数为 2564 人);69% 的人在基线时患有高血压。在随访期间,12%的人患上了全因痴呆(阿尔茨海默病 [AD] = 212 人;伴有或不伴有 AD 的血管性痴呆 [VaD/AD 混合] = 97 人)。我们没有发现任何空气污染物对高血压有不利影响。高血压与 VaD/AD 混合型(HR,1.92 [95% CI = 1.14,3.24])相关,但与 AD 无关。我们没有观察到任何污染物通过高血压对痴呆症结果的影响产生中介作用。 缺乏中介效应可能是由于其他机制途径以及空气污染对这组老年人高血压的影响极小。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
An assessment of the mediating role of hypertension in the effect of long-term air pollution exposure on dementia
Growing evidence links air pollution exposure to the risk of dementia. We hypothesized that hypertension may partially mediate this effect. We previously documented an association between air pollution and dementia in the Ginkgo Evaluation of Memory Study, a randomized, placebo-controlled trial of 3069 adults ≥75 years across four US sites who were evaluated for dementia every 6 months from 2000–2008. We utilized a two-stage regression approach for causal mediation analysis to decompose the total effect of air pollution on dementia into its natural direct and indirect effect through prevalent hypertension. Exposure to air pollution in the 10 or 20 years before enrollment was assigned using estimates from fine-scale spatial-temporal models for PM2.5, PM10, and NO2. We used Poisson regression models for hypertension and Cox proportional hazard models for time-to-incident all-cause dementia, adjusting for a priori confounders. Participants were free of mild cognitive impairment at baseline (n = 2564 included in analyses); 69% had prevalent hypertension at baseline. During follow-up, 12% developed all-cause dementia (Alzheimer’s disease [AD] = 212; vascular dementia with or without AD [VaD/AD mixed] = 97). We did not find an adverse effect of any air pollutant on hypertension. Hypertension was associated with VaD/AD mixed (HR, 1.92 [95% CI = 1.14, 3.24]) but not AD. We did not observe mediation through hypertension for the effect of any pollutant on dementia outcomes. The lack of mediated effect may be due to other mechanistic pathways and the minimal effect of air pollution on hypertension in this cohort of older adults.
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来源期刊
Environmental Epidemiology
Environmental Epidemiology Medicine-Public Health, Environmental and Occupational Health
CiteScore
5.70
自引率
2.80%
发文量
71
审稿时长
25 weeks
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