长期暴露于臭氧与心血管疾病死亡率及其代谢介质的关系：一项全国范围、基于人口的前瞻性队列研究提供的证据

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific Pub Date : 2024-10-09 DOI:10.1016/j.lanwpc.2024.101222

Zenglei Zhang , Chunqi Wang , Chunying Lin , Yi Wu , Jing Wei , Jiapeng Lu , Bowang Chen , Chaoqun Wu , Xiaoyan Zhang , Yang Yang , Jianlan Cui , Wei Xu , Lijuan Song , Hao Yang , Yan Zhang , Wenyan He , Yuan Tian , Xianliang Zhou , Xi Li

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引用次数: 0

摘要

背景以前关于臭氧（O3）对心血管死亡率的慢性影响的研究很少，而且没有定论。我们的目的是调查心血管死亡率与广泛的长期臭氧暴露水平之间的关系。方法这项分析纳入了参加中国心血管病研究（ChinaHEART）的 3,206,871 名年龄在 35-75 岁之间的参与者。参与者于 2015 年 1 月至 2020 年 12 月期间从中国大陆 31 个省份招募。结果在中位随访期4.7年（四分位间距：3.7-6.2）期间，35553名参与者（1.1%）死于心血管疾病（CVD）。经过多变量调整后，发现臭氧浓度与心血管疾病和缺血性心脏病（IHD）死亡率之间存在非线性关系，拐点分别为 85.44 和 88.15 μg/m3。在这些点之上，O3 水平每增加 10.0 μg/m3 ，心血管疾病和缺血性心脏病的死亡风险分别增加 13.9%（危险比 [HR]：1.139，95% 置信区间 [CI]：1.096-1.184）和 25.0%（危险比：1.250，95% 置信区间：1.151-1.357）。相反，臭氧暴露与缺血性中风死亡率呈线性关系。此外，新陈代谢因素解释了臭氧暴露与心血管疾病死亡率之间一半以上的关系。本研究得到了中国医学科学院医学科学创新基金（2021-1-I2M-011）、中国医学科学院医学科学创新基金（CIFMS，2022-I2M-C&T-A-010）、国家高层次医院临床研究基金（2022-GSP-GG-4）、国家财政部和国家卫生健康委员会、教育部 "111 "项目（B16005）的资助。

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Association of long-term exposure to ozone with cardiovascular mortality and its metabolic mediators: evidence from a nationwide, population-based, prospective cohort study

Background

Previous studies about chronic effects of ozone (O₃) on cardiovascular mortality are scarce and inconclusive. We aimed to investigate the association between cardiovascular mortality and a broad range of long-term O₃ exposure levels.

Methods

This analysis included 3,206,871 participants aged 35–75 years enrolled in the ChinaHEART study. Participants were recruited from the 31 provinces of the Chinese mainland between January 2015 and December 2020. The five-year average O₃ concentrations before baseline visits were calculated to represent long-term exposure.

Findings

Over a median follow-up period of 4.7 (interquartile range: 3.7−6.2) years, 35,553 (1.1%) participants died from cardiovascular diseases (CVD). Following multivariable adjustment, nonlinear relationships were identified between O₃ concentrations and CVD and ischemic heart disease (IHD) mortality, with inflection points at 85.44 and 88.15 μg/m³, respectively. Above these points, a 10.0 μg/m³ increase in the O₃ level was associated with a 13.9% (hazard ratio [HR]: 1.139, 95% confidence interval [CI]: 1.096−1.184) and 25.0% (HR: 1.250, 95% CI: 1.151−1.357) greater risk of CVD and IHD mortality, respectively. Conversely, O₃ exposure exhibited a linear relationship with ischemic stroke mortality. Moreover, the metabolic factors explained more than half of the association between O₃ exposure and CVD mortality.

Interpretation

Substantial influences of long-term O₃ exposure on CVD mortality were identified, with notable mediation proportions attributed to metabolic factors. These findings could facilitate the air quality standard revisions and risk reduction strategy making in the future.

Funding

This study was supported by the CAMS Innovation Fund for Medical Science (2021-1-I2M-011), the CAMS Innovation Fund for Medical Science (CIFMS, 2022-I2M-C&T-A-010), the National High Level Hospital Clinical Research Funding (2022-GSP-GG-4), the Ministry of Finance of China and National Health Commission of China, the 111 Project from the Ministry of Education of China (B16005).

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来源期刊

The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health

CiteScore

8.80

自引率

2.80%

发文量

305

审稿时长

11 weeks

期刊介绍： The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.