Jiaqi Gao PhD , Carlos F Mendes de Leon PhD , Boya Zhang PhD , Jennifer Weuve ScD , Kenneth M Langa PhD , Jennifer D'Souza PhD , Adam Szpiro PhD , Jessica Faul PhD , Joel D Kaufman MD , Richard Hirth PhD , Sara D Adar ScD
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As part of the Environmental Predictors of Cognitive Health and Aging study, we estimated 10-year average PM<sub>2·5</sub>, PM<sub>10</sub><sub>–</sub><sub>2·5</sub>, nitrogen dioxide (NO<sub>2</sub>), and ozone (O<sub>3</sub>) concentrations at participant residences before each survey using spatiotemporal prediction models. We used a time-varying, weighted Cox model to estimate hazard ratios (HRs) for incident physical disability per interquartile increase of air pollution with detailed adjustments for confounders.</div></div><div><h3>Findings</h3><div>Among 15 411 respondents aged 65 years and older (mean age 70·2 [SD 6·5] years; 55% female, 45% male), 48% of respondents reported newly having ADL disability during a mean follow-up of 7·9 years (SD 4·7). 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引用次数: 0
摘要
背景：残疾是老年人整体身体健康的一个重要标志，而且往往先于慢性疾病。虽然空气污染是公认的多种慢性疾病的风险因素，但它与身体残疾的关系还没有得到很好的描述。我们在美国一个具有代表性的老年人大型队列中调查了空气污染物与身体残疾的关系：我们使用了 2000 年至 2016 年期间从健康与退休调查（Health and Retirement Survey）受访者处收集的两年一次的日常生活活动（ADL）残疾事件数据。作为认知健康和老龄化环境预测研究的一部分，我们使用时空预测模型估算了每次调查前受访者住所的 PM2-5、PM10-2-5、二氧化氮（NO2）和臭氧（O3）的 10 年平均浓度。我们使用时变加权 Cox 模型估算了空气污染每增加四分位数所导致的身体残疾的危险比（HRs），并对混杂因素进行了详细调整：在 15 411 名 65 岁及以上的受访者中（平均年龄 70-2 [SD 6-5] 岁；55% 为女性，45% 为男性），48% 的受访者表示在平均 7-9 年（SD 4-7 年）的随访期间新近出现了 ADL 残疾。在完全调整模型中，我们发现，PM2-5（HR 1-03 per 3-7 μg/m³ [95% CI 0-99-1-08]，p=0-16）、PM10-2-5（1-05 per 4-9 μg/m³ [1-00-1-11]，p=0-022）和 NO2（1-03 per 7-5 ppb [0-99-1-08]，p=0-064）浓度越高，ADL 残疾的风险越大，但并非所有这些关联都具有统计学意义。相比之下，O3 与较低的 ADL 残疾风险相关（每 3-7 ppb 0-95 [0-91-1-00]，p=0-030）。在多污染物模型中，PM10-2-5（1-05 per 4-9 μg/m³ [1-00-1-11]，p=0-041）和臭氧（0-94 per 3-7 ppb [0-88-1-01]，p=0-083）的相关性与单污染物模型相似：我们的研究结果表明，空气污染可能是导致晚年身体残疾的一个未被充分重视的风险因素，尽管还需要更多的研究：国家环境健康科学研究所和国家老龄化研究所。
Long-term air pollution exposure and incident physical disability in older US adults: a cohort study
Background
Disability is a key marker of overall physical health in older adults and is often preceded by chronic disease. Although air pollution is a well recognised risk factor for multiple chronic diseases, its association with physical disability has not been well characterised. We investigated the associations of air pollutants with physical disability in a large cohort representative of older adults in the USA.
Methods
We used biennial data on incident activities of daily living (ADL) disability collected from respondents of the Health and Retirement Survey between 2000 and 2016. As part of the Environmental Predictors of Cognitive Health and Aging study, we estimated 10-year average PM2·5, PM10–2·5, nitrogen dioxide (NO2), and ozone (O3) concentrations at participant residences before each survey using spatiotemporal prediction models. We used a time-varying, weighted Cox model to estimate hazard ratios (HRs) for incident physical disability per interquartile increase of air pollution with detailed adjustments for confounders.
Findings
Among 15 411 respondents aged 65 years and older (mean age 70·2 [SD 6·5] years; 55% female, 45% male), 48% of respondents reported newly having ADL disability during a mean follow-up of 7·9 years (SD 4·7). In fully adjusted models, we found greater risks of ADL disability associated with higher concentrations of PM2·5 (HR 1·03 per 3·7 μg/m³ [95% CI 0·99–1·08], p=0·16), PM10–2·5 (1·05 per 4·9 μg/m³ [1·00–1·11], p=0·022), and NO2 (1·03 per 7·5 ppb [0·99–1·08]. p=0·064), although not all these associations were statistically significant. In contrast, O3 was associated with a lower risk of ADL disability (0·95 per 3·7 ppb [0·91–1·00], p=0·030). In a multi-pollutant model, associations were similar to the single-pollutant models for PM10–2·5 (1·05 per 4·9 μg/m³ [1·00–1·11], p=0·041) and O3 (0·94 per 3·7 ppb [0·88–1·01], p=0·083).
Interpretation
Our findings suggest that air pollution might be an underappreciated risk factor for physical disability in later life, although additional research is needed.
Funding
National Institutes of Environmental Health Sciences and National Institute on Aging.
期刊介绍：
The Lancet Healthy Longevity, a gold open-access journal, focuses on clinically-relevant longevity and healthy aging research. It covers early-stage clinical research on aging mechanisms, epidemiological studies, and societal research on changing populations. The journal includes clinical trials across disciplines, particularly in gerontology and age-specific clinical guidelines. In line with the Lancet family tradition, it advocates for the rights of all to healthy lives, emphasizing original research likely to impact clinical practice or thinking. Clinical and policy reviews also contribute to shaping the discourse in this rapidly growing discipline.
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