Associations Between Air Pollution and the Onset of Acute Exacerbations of COPD: A Time-Stratified Case-Crossover Study in China.

IF 9.5 1区 医学 Q1 CRITICAL CARE MEDICINE Chest Pub Date : 2024-11-01 Epub Date: 2024-06-19 DOI:10.1016/j.chest.2024.05.030
Yue Niu, Hongtao Niu, Xia Meng, Yixiang Zhu, Xiaoxia Ren, Ruoxi He, Hanna Wu, Tao Yu, Yushi Zhang, Haidong Kan, Renjie Chen, Ting Yang, Chen Wang
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Abstract

Background: Associations between air pollution and the acute exacerbations (AEs) of COPD have been established primarily in time-series studies in which exposure and health data were at the aggregate level, limiting the identification of susceptible populations.

Research question: Are air pollutants associated with the onset of AEs of COPD in China? Who is more susceptible to the effects of air pollutants?

Study design and methods: Data regarding AEs of COPD were obtained from the Acute Exacerbation of Chronic Obstructive Pulmonary Disease Registry (ACURE) study, and air pollution data were assigned to individuals based on their residential address. We adopted a time-stratified case-crossover study design combined with conditional logistic regression models to estimate the associations between six air pollutants and AEs of COPD. Stratified analyses were performed by individual characteristics, disease severity, COPD types, and the season of exacerbations.

Results: A total of 5,746 patients were included. At a 2-day lag, for each interquartile range increase in fine particulate matter and inhalable particulate matter concentrations, ORs for AEs of COPD were 1.054 (95% CI, 1.012-1.097) and 1.050 (95% CI, 1.009-1.092), respectively. The associations were more pronounced in participants who were younger than 65 years, who had experienced at least one severe AE of COPD in the past year, who had received a diagnosis of COPD between 20 and 50 years of age, and who had experienced AEs of COPD in the cool seasons. By contrast, significant associations for nitrogen dioxide, sulfur dioxide, and carbon monoxide lost significance when excluding patients collected before 2020 or with greater distance from the monitoring station, and no significant association was observed for ozone.

Interpretation: This study provides robust evidence that short-term exposure to fine particulate matter and inhalable particulate matter was associated with higher odds of AEs of COPD onset. Individuals who are young, have severe COPD, or whose first diagnosis of COPD was made when they were between 20 and 50 years of age and experience an exacerbation during the cooler seasons may be particularly susceptible.

Trial registry: ClinicalTrials.gov; No.: NCT2657525; URL: www.

Clinicaltrials: gov.

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空气污染与慢性阻塞性肺病急性加重发作之间的关系:中国的一项时间分层病例交叉研究。
背景:空气污染与慢性阻塞性肺疾病(AECOPD)急性加重之间的关系主要是在时间序列研究中确定的,这些研究中的暴露和病例数据都是总体水平的,从而限制了对易感人群的识别:研究问题:在中国,空气污染物与 AECOPD 的发病是否相关?谁更容易受到空气污染物的影响?AECOPD数据来自慢性阻塞性肺疾病急性加重期登记研究,空气污染数据根据居住地址分配给个人。我们采用时间分层病例交叉研究设计,结合条件逻辑回归模型来估计六种空气污染物与 AECOPD 之间的关系。根据个人特征、疾病严重程度、慢性阻塞性肺病类型和恶化季节进行了分层分析:最终共纳入 5746 名患者。滞后2天后,PM2.5和PM10浓度每增加1个四分位数,慢性阻塞性肺疾病的几率比分别为1.054(95% CI:1.012,1.097)和1.050(95% CI:1.009,1.092)。年龄小于 65 岁、在过去一年中至少经历过一次严重的慢性阻塞性肺疾病、首次被诊断出患有慢性阻塞性肺疾病的年龄在 20 岁至 50 岁之间、在凉爽季节经历过慢性阻塞性肺疾病的参与者的相关性更为明显。相比之下,在排除 2020 年前收集的病例或与监测站距离较远的病例后,二氧化氮、二氧化硫和一氧化碳的显著相关性失去了意义,而臭氧则未观察到显著相关性:这项研究提供了强有力的证据,表明短期暴露于 PM2.5 和 PM10 与 AECOPD 发病几率较高有关。年龄较小、患有严重慢性阻塞性肺病或年轻慢性阻塞性肺病、在凉爽季节病情加重的人可能特别容易受到影响:临床试验注册号:NCT2657525(ClinicalTrials.gov)。
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来源期刊
Chest
Chest 医学-呼吸系统
CiteScore
13.70
自引率
3.10%
发文量
3369
审稿时长
15 days
期刊介绍: At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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