《新英格兰医学杂志》2017年6月28日在线先发

http://www.nejm.org/doi/full/10.1056/NEJMoa1702747

在医疗保险人群中空气污染与死亡率的关系

Qian Di, M.S., Yan Wang, M.S., Antonella Zanobetti, Ph.D., Yun Wang, Ph.D., Petros Koutrakis, Ph.D., Christine Choirat, Ph.D., Francesca Dominici, Ph.D., and Joel D. Schwartz, Ph.D.

N Engl J Med 2017; 376:2513-2522June 29, 2017DOI: 10.1056/NEJMoa1702747

背景

有研究显示，长期暴露在空气污染中会增加死亡率，但低于最新的“（美国）国家环境空气质量标准”的空气污染水平对死亡率影响的证据不足。既往研究主要涉及的是城市人口，在其它人口中并没有统计效能来估算空气污染对健康的影响。

方法

我们构建了一个开放性队列，这个队列来自2000-2012年美国大陆上所有医疗保险投保的受益人（60925443人），并进行了460310521人年的随访。采用既往证实有效的预测模型，按照每一位入组居民的邮政编码，估算细颗粒物（总气体动力学中位数直径小于2.5μm的颗粒[PM2.5]）和臭氧的年平均值。我们采用双污染Cox比例风险模型，并对人口学特征、医疗补助资格以及地区层面的协变量进行控制，估算了PM2.5暴露每增加10μg/m3、臭氧每增加10ppb所引起的死亡风险。

结果

PM2.5增加10μg/m3和臭氧每增加10ppb，全因死亡率分别增加7.3%（95%可信区间[CI]，7.1-7.5）和1.1%（95%CI，1.0-1.2）。将分析限定在PM2.5暴露人年小于12μg/m3和臭氧小于50ppb时，PM2.5和臭氧同样的增加，死亡风险分别增加13.6%（95%CI,13.1-14.1）和1.0%（95%CI，0.9-1.1）。对于PM2.5，男性、黑人和有医疗补助资格人员的死亡风险高于其它人群。

结论

在（美国）整个医疗保险人群中，有明显的证据显示，在低于目前（美国）国家标准浓度下的PM2.5和臭氧暴露对人体会有不良影响，在低收入人群和自认为是少数民族中这种影响最大。

《壹篇》南南和北北

Air Pollution and Mortality in the Medicare Population

Qian Di, M.S., Yan Wang, M.S., Antonella Zanobetti, Ph.D., Yun Wang, Ph.D., Petros Koutrakis, Ph.D., Christine Choirat, Ph.D., Francesca Dominici, Ph.D., and Joel D. Schwartz, Ph.D.

N Engl J Med 2017; 376:2513-2522June 29, 2017DOI: 10.1056/NEJMoa1702747

Background

Studies have shown that long-term exposure to air pollution increases mortality. However, evidence is limited for air-pollution levels below the most recent National Ambient Air Quality Standards. Previous studies involved predominantly urban populations and did not have the statistical power to estimate the health effects in underrepresented groups.

Methods

We constructed an open cohort of all Medicare beneficiaries (60,925,443 persons) in the continental United States from the years 2000 through 2012, with 460,310,521 person-years of follow-up. Annual averages of fine particulate matter (particles with a mass median aerodynamic diameter of less than 2.5 μm [PM2.5]) and ozone were estimated according to the ZIP Code of residence for each enrollee with the use of previously validated prediction models. We estimated the risk of death associated with exposure to increases of 10 μg per cubic meter for PM2.5 and 10 parts per billion (ppb) for ozone using a two-pollutant Cox proportional-hazards model that controlled for demographic characteristics, Medicaid eligibility, and area-level covariates.

Results

Increases of 10 μg per cubic meter in PM2.5 and of 10 ppb in ozone were associated with increases in all-cause mortality of 7.3% (95% confidence interval [CI], 7.1 to 7.5) and 1.1% (95% CI, 1.0 to 1.2), respectively. When the analysis was restricted to person-years with exposure to PM2.5 of less than 12 μg per cubic meter and ozone of less than 50 ppb, the same increases in PM2.5 and ozone were associated with increases in the risk of death of 13.6% (95% CI, 13.1 to 14.1) and 1.0% (95% CI, 0.9 to 1.1), respectively. For PM2.5, the risk of death among men, blacks, and people with Medicaid eligibility was higher than that in the rest of the population.

Conclusions

In the entire Medicare population, there was significant evidence of adverse effects related to exposure to PM2.5 and ozone at concentrations below current national standards. This effect was most pronounced among self-identified racial minorities and people with low income. (Supported by the Health Effects Institute and others.)

《壹篇》（与桓兴医讯同步）系主要面向医务人员的公益性头条号，不以营利为目的，不进行任何有偿咨询和服务，不出售任何产品，与ASCO、CSCO等所有专业学会和机构没有任何关系和联系，也不代表任何官方学会发声。

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