长期大气二氧化氮暴露与心脑血管住院风险的因果关联研究

Causal links between long-term exposure to NO2 and the risk of cardiovascular hospitalization

目的探讨长期大气二氧化氮(NO_(2))暴露与心脑血管住院的因果关联。方法依托我国“基于社区人群的健康队列”广州市子队列,将2015年在广州市35个社区招募的36271名成年参与者纳入研究,收集基本人口学特征、生活行为方式、NO_(2)暴露及心脑血管住院结局信息。采用基于逆概率加权的边际结构模型估计发病风险比(HR)及其95%CI。结果截至2020年12月31日共随访203822人年,调查对象的年龄为(50.9±17.8)岁,心脑血管住院率为8.7%。2015-2020年,研究对象年均NO_(2)污染暴露为48.7μg/m^(3)。NO_(2)长期暴露每增加10μg/m^(3),心脑血管、心血管及脑血管住院的HR值(95%CI)分别为1.33(1.16~1.52)、1.36(1.16~1.60)及1.25(1.00~1.55)。分层分析结果提示未婚/已婚、文化程度为初中/高中、高运动频率以及从未吸烟/当前吸烟人群可能更加易感。结论长期大气NO_(2)暴露可增加心脑血管住院风险。

Objective To determine the causal association between long-term Nitrogen dioxide(NO_(2))exposure and the risk of cardiovascular hospitalization.Methods Based on a sub-cohort of a community-based prospective cohort study,a total of 36271 participants were recruited from 35 communities randomly selected in Guangzhou in 2015.The annual average exposure of NO_(2),demographic characteristics,lifestyle factors,and information on the causes of hospitalization was collected.We applied marginal structural Cox models to investigate the effect of NO_(2)on cardiovascular hospitalization.Demographic and behavioral factors also stratified results.Results The mean age of participants in the present study was(50.9±17.8)years,and the cardiovascular admission rate was 8.7%,with 203822 person-years of follow-up.The annual mean NO_(2)concentration was 48.7μg/m^(3)during 2015-2020.For each 10μg/m^(3)increase in NO_(2)concentrations,the HRs(95%CIs)of total cardiovascular hospitalization,cardiovascular hospitalization,and cerebrovascular hospitalization were 1.33(1.16-1.52),1.36(1.16-1.60)and 1.25(1.00-1.55),respectively.Participants who were never married/married,with secondary education,high exercise frequency,or non-smokers/current smokers may be more susceptible than their counterparts.Conclusion Long-term exposure to NO_(2)significantly increased hospitalization risk for cardiovascular disease.