A population-based case-crossover study of polyethylene glycol use and acute renal failure risk in the elderly

AIM:To evaluate the possibility of an association between polyethylene glycol(PEG) and acute renal failure(ARF) in elderly patients using a health insurance claims database.METHODS:We conducted a population-based casecrossover study using information obtained from Korean Health Insurance Review and Assessment Service(HIRA) claims from January 1,2005 to December 31,2005(Seoul,Korea).The study population consisted of elderly patients who received PEG prior to experiencing their first ARF-related hospitalization from April 1,2005 to December 31,2005.For each patient,one case and two control periods were matched.PEG use in a 2-or 4-wk window period prior to hospitalization for ARF was compared with PEG use in two earlier 2-or 4-wk control window periods.Conditional logistic regression analysis was used to estimate odds ratios(ORs) and 95% CI,adjusting for concomitant uses of diuretics,angiotensin converting enzyme inhibitors,non-steroidal anti-inflammatory drugs,antibiotics,anti-cancer drugs,and contrast media.RESULTS:Within the HIRA database which contained 1 093 262 elderly patients,1156 hospitalized ARF cases were identified.Among these cases,PEG was prescribed to 17(1.5%) patients before hospitalization.The adjusted ORs when applying the 2-and 4-wk window periods were 0.4(95% CI:0.03-5.24) and 2.1(95% CI:0.16-27.78),respectively.CONCLUSION:No increased risk of ARF was found in elderly PEG users.However,based on the limited number of study subjects,further analysis should be performed to confirm these results.

Ambient Nitrogen Dioxide and Hospitalizations of Full-Spectrum Respiratory Diseases:A National Case-Crossover Study

Few multicity studies have examined the acute effects of nitrogen dioxide(NO_(2))on respiratory disease(RD),especially its specific causes.This study aimed to investigate the associations between short-term exposure to NO_(2)and hospitalization of full-spectrum RDs in China.Hospitalization of 10 major categories and 40 cause-specific RDs were obtained from 20 provinces over the study period of 2013−2020.A time-stratified case-crossover study was conducted at the individual level to explore the associations between NO_(2)and RDs.NO_(2)was significantly associated with increased hospitalization of eight major RDs(acute upper respiratory infections,influenza and pneumonia,acute lower respiratory infections,upper respiratory tract diseases,chronic lower respiratory diseases,respiratory interstitium diseases,pleura diseases,and other respiratory diseases)and 18 specific causes of RDs,with the largest associations observed on lag 0−1 day.The effect estimates ranged from 0.75 to 4.09%per 10μg/m^(3)of NO_(2)exposure.The associations remained robust after controlling for copollutants.The concentration−response curves were mostly positive and linear.This nationwide study provides comprehensive information on the acute effects of NO_(2)on respiratory morbidity across the full spectrum,highlighting the need for caution with regard to this important traffic-related air pollutant in current pollution control programs.

Short-term exposure to fine particulate matter constituents and mortality:case-crossover evidence from 32 counties in China

A growing number of studies associated increased mortality with exposures to specific fine particulate(PM_(2.5))constituents,while great heterogeneity exists between locations.In China,evidence linking PM_(2.5)constituents and mortality was extensively sparse.This study primarily aimed to quantify short-term associations between PM_(2.5)constituents and non-accidental mortality among the Chinese population.We collected daily mortality records from 32 counties in China between January 1,2011,and December 31,2013.Daily concentrations of main PM_(2.5)constituents(organic carbon(OC),elemental carbon(EC),nitrate(NO_(3)^(-)),sulfate(SO_(4)^(2−)),and ammonium(NH_(4)^(+)))were estimated using the modified Community Multiscale Air Quality model.Time-stratified case-crossover design with conditional logistic regression models was adopted to estimate mortality risks associated with short-term exposures to PM_(2.5)mass and its constituents.Stratification analyses were done by sex,age,and season.A total of 116,959 non-accidental deaths were investigated.PM_(2.5)concentrations on the day of death were averaged at 75.7μg m^(−3)(control day:75.6μg m^(−3)),with an interquartile range(IQR)of 65.2μg m^(−3).Per IQR rise in PM_(2.5),EC,OC,NO_(3)^(-),SO_(4)^(2−),and NH_(4)^(+)at lag-04 day was associated with an increase in non-accidental mortality of 2.4%(95%confidence interval,(1.0–3.7),1.7%(0.8–2.7),2.9%(1.6–4.3),2.1%(0.4–3.9),1.0%(0.2–1.9),and 1.6%(0.3–2.9),respectively.Both PM_(2.5)mass and its constituents were strongly associated with elevated cardiovascular mortality risks,but only PM_(2.5),EC,and OC were positively associated with respiratory mortality at lag-3 day.PM_(2.5)mass and its constituents associated effects on mortality varied among sex-and age-specific subpopulations.Differences in the seasonal pattern of associations exist among PM_(2.5)constituents,with stronger effects related to EC and NO_(3)^(-)in warm months but SO_(4)^(2−)and NH_(4)^(+)in cold months.Short-term exposures to PM_(2.5)compositions were positively associated with increased risks of mortality,particularly those constituents from combustion-related sources.

Criteria air pollutants and hospitalizations of a wide spectrum of cardiovascular diseases: A nationwide case-crossover study in China

Few national studies have systemically examined the effects of criteria air pollutants on cardiovascular morbidity.This study aimed to investigate the associations between all criteria air pollutants and hospitalization of causespecific cardiovascular diseases(CVD)in China.We obtained data on CVD hospitalization events of four major categories and 12 specific diseases from 153 hospitals distributed in 20 provincial-level regions from 2013 to 2020.We adopted a time-stratified case-crossover study design using individual cases to capture the effect of short-term exposure to six criteria air pollutants on CVD hospitalizations,using conditional logistic regression models.More than 1.1 million CVD hospitalization events were included.The lag pattern exploration demonstrated the largest effect for six air pollutants on lag 0–1 day.PM_(2.5),PM_(10),NO_(2),and CO were significantly associated with increased hospitalization from ischemic heart diseases,cerebrovascular diseases,other heart diseases,and five specific causes of CVD.The effect estimates of NO_(2)were the most robust when adjusting for copollutants.The concentration-response curves were positive and linear for most pollutant–endpoint pairs(except for O_(3)),and these positive associations remained even below the 24-h levels recommended by WHO Air Quality Guidelines and China Air Quality Standards.This nationwide case-crossover study in China demonstrated that short-term exposure to multiple ambient air pollutants may significantly increase the risk of cause-specific CVD hospitalizations even under the most stringent air quality regulations,striking an alert for potential CVD patients against these environmental risk factors.

Ambient Air Particulate Matter and Hospital Admissions for Chronic Kidney Disease in China:A Nationwide Case-Crossover Study

Incident chronic kidney disease(CKD)may be accelerated(could be indicated by repeated admissions to the hospital)by environmental triggers such as ambient particulate matter(PM).Additionally,hospital admission is a sensitive proxy reflecting the disease burden.However,the association of PM exposure with hospital admissions for CKD is still unknown,let alone the excess risks(ERs)in hospital admissions for CKD due to high PM level exposure.In this study,a two-stage time-stratified case-crossover study was conducted to investigate the association of ambient air PM exposure with hospital admission for CKD in 282 Chinese cities of prefecture-level or above during 2013–2017.City-specific associations of single and cumulative 0–3 days lagged exposure to fine particulate matter(PM_(2.5))and inhalable particles(PM_(10))with hospital admissions for total CKD and its subtypes were evaluated by the conditional logistic regression model,then were pooled using the random-effect model.A total of 3,490,416 hospital admissions for CKD were identified.We found that per interquartile range(IQR)increment in PM_(2.5) at lag02 and per IQR increment in PM_(10) at lag03 were associated with increases of 2.36%(95%CI:1.58%,3.14%)and 2.87%(95%CI:1.91%,3.85%)in hospital admissions for total CKD,respectively.Compared to control concentrations(PM_(2.5):35μg/m^(3);PM_(10):50μg/m^(3)),the largest ERs in hospital admissions for total CKD were 2.63%(95%CI:2.15%–3.11%)and 4.45%(95%CI:3.85%–5.06%)in association with exposure to heavily excessive PM_(2.5)(≥75μg/m^(3))and PM_(10)(≥150μg/m^(3)),respectively.Moreover,the attributable fractions(AFs)for CKD admissions were 2.83%for PM_(2.5) and 3.46%for PM_(10) during the study period.These findings suggested that exposure to PM_(2.5) and PM_(10) is associated with substantially increased risk and burden of CKD admissions.

Short-term effects of fine particulate matter constituents on myocardial infarction death

Existing evidence suggested that short-term exposure to fine particulate matter(PM_(2.5))may increase the risk of death from myocardial infarction(MI),while PM_(2.5) constituents responsible for this association has not been determined.We collected 12,927 MI deaths from 32 counties in southern China during 2011–2013.County-level exposures of ambient PM_(2.5) and its 5 constituents(i.e.,elemental carbon(EC),organic carbon(OC),sulfate(SO_(4)^(2-)),ammonium(NH_(4)^(+)),and nitrate(NO_(3)^(-)))were aggregated from gridded datasets predicted by Community Multiscale Air Quality Modeling System.We employed a space-time-stratified casecrossover design and conditional logistic regression models to quantify the association of MI mortality with short-term exposure to PM_(2.5) and its constituents across various lag days.Over the study period,the daily mean PM_(2.5) mass concentration was 77.8(standard deviation(SD)=72.7)μg/m^(3).We estimated an odds ratio of 1.038(95%confidence interval(CI):1.003-1.074),1.038(1.013-1.063)and 1.057(1.023-1.097)for MI mortality associated with per interquartile range(IQR)increase in the 3-day moving-average exposure to PM_(2.5)(IQR=76.3μg/m 3),EC(4.1μg/m^(3))and OC(9.1μg/m^(3)),respectively.We did not identify significant association between MI death and exposure to water-soluble ions(SO_(4)^(2-),NH_(4)^(+)and NO_(3)^(-)).Likelihood ratio tests supported no evident violations of linear assumptions for constituents-MI associations.Subgroup analyses showed stronger associations between MI death and EC/OC exposure in the elderly,males and cold months.Short-term exposure to PM_(2.5) constituents,particularly those carbonaceous aerosols,was associated with increased risks of MI mortality.