我国华中地区大气PM_(2.5)长期暴露与成人血压水平的相关性分析
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摘要
目的:探索华中地区大气PM_(2.5)长期暴露与成人血压(收缩压、舒张压、平均动脉压、脉压)水平的相关性。方法:研究基于心血管病高危人群早期筛查与综合干预项目在华中地区(河南省,湖北省,湖南省)18个城市的横断面调查数据,同时收集该地区研究期间PM_(2.5)日均浓度以估计调查对象PM_(2.5)的长期暴露水平。利用多水平线性回归模型研究华中地区人群PM_(2.5)长期暴露与血压(收缩压、舒张压、平均动脉压、脉压)水平的相关性,并通过交互检验进一步探索个体因素对此相关关系的影响。结果:研究共纳入243 904例调查对象,92 819例(38.1%)为男性。PM_(2.5)每增高10μg/m3,收缩压、舒张压、脉压和平均动脉压分别增加2.47(95%CI:2.34～2.61)mmHg(1mmHg=0.133kPa)、0.69(95%CI:0.62～0.77)mmHg、1.79(95%CI:1.68～1.89)mmHg和1.28(95%CI:1.19～1.37)mmHg。老年人(年龄≥60岁)、男性、高血压患者PM_(2.5)长期暴露与收缩压升高的关联程度更高(P交互<0.05)。结论:PM_(2.5)长期暴露与华中地区人群血压水平显著相关。老年人、男性、患高血压者PM_(2.5)长期暴露后收缩压升高更为显著。
Objectives: To explore the association between the long-term exposure to ambient PM_(2.5) and blood pressure(systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse pressure) among adults in Central China.Methods: The cross-sectional survey data from China Patient-Centered Evaluative Assessment of Cardiac Events(PEACE)Million Persons Project in 18 cities of Central China(Henan, Hubei, Hunan Province) were studied. The daily average PM_(2.5) concentration in this region during the study period were collected to estimate the long-term exposure to ambient PM_(2.5). Multi-level linear regression model was used to investigate the association between long-term exposure to ambient PM_(2.5) and blood pressure(systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse pressure) in the population of Central China, and further evaluate the impact of individual characteristics on the association between long-term exposure to ambient PM_(2.5) and blood pressure by including interaction terms between long-term exposure to ambient PM_(2.5) and individual characteristics.Results: A total of 243 904 subjects were included in the study, and 92 819 subjects(38.1%) were male. For an increase of 10 μg/m3 in PM_(2.5), systolic, diastolic, pulse and mean arterial blood pressure increased by 2.47(95% CI: 2.34-2.61) mmHg,0.69(95% CI: 0.62-0.77) mmHg, 1.79(95%CI:1.68-1.89)mmHg and 1.28(95%CI:1.19-1.37)mmHg, respectively. The association of systolic blood pressure and long-term exposure to ambient PM_(2.5) was more significant among older adults(age≥60 years), male and participants with hypertension(P for interaction<0.05).Conclusions: Long-term exposure to ambient PM_(2.5) is closely associated with elevated blood pressure among adults in Central China. The elderly, male and hypertensive subjects are more vulnerable to long-term exposure to ambient PM_(2.5).
Objectives: To explore the association between the long-term exposure to ambient PM_(2.5) and blood pressure(systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse pressure) among adults in Central China.Methods: The cross-sectional survey data from China Patient-Centered Evaluative Assessment of Cardiac Events(PEACE)Million Persons Project in 18 cities of Central China(Henan, Hubei, Hunan Province) were studied. The daily average PM_(2.5) concentration in this region during the study period were collected to estimate the long-term exposure to ambient PM_(2.5). Multi-level linear regression model was used to investigate the association between long-term exposure to ambient PM_(2.5) and blood pressure(systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse pressure) in the population of Central China, and further evaluate the impact of individual characteristics on the association between long-term exposure to ambient PM_(2.5) and blood pressure by including interaction terms between long-term exposure to ambient PM_(2.5) and individual characteristics.Results: A total of 243 904 subjects were included in the study, and 92 819 subjects(38.1%) were male. For an increase of 10 μg/m3 in PM_(2.5), systolic, diastolic, pulse and mean arterial blood pressure increased by 2.47(95% CI: 2.34-2.61) mmHg,0.69(95% CI: 0.62-0.77) mmHg, 1.79(95%CI:1.68-1.89)mmHg and 1.28(95%CI:1.19-1.37)mmHg, respectively. The association of systolic blood pressure and long-term exposure to ambient PM_(2.5) was more significant among older adults(age≥60 years), male and participants with hypertension(P for interaction<0.05).Conclusions: Long-term exposure to ambient PM_(2.5) is closely associated with elevated blood pressure among adults in Central China. The elderly, male and hypertensive subjects are more vulnerable to long-term exposure to ambient PM_(2.5).
引文
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[19]Foraster M,Basagana X,Aguilera I,et al.Association of longterm exposure to traffic-related air pollution with blood pressure and hypertension in an adult population-based cohort in Spain(the REGICOR study)[J].Environ Health Perspect,2014,122(4):404-411.DOI:10.1289/ehp.1306497.
[20]Brook RD,Urch B,Dvonch JT,et al.Insights into the mechanisms and mediators of the effects of air pollution exposure on blood pressure and vascular function in healthy humans[J].Hypertension(Dallas,Tex:1979),2009,54(3):659-667.DOI:10.1161/hypertensionaha.109.130237.
[21]臧希文.PM2.5对心血管系统的影响[J].中国循环杂志,2018,33(3):305-307.DOI:10.3969/j.issn.1000-3614.2018.03.027.
[22]Dong GH,Qian ZM,Xaverius PK,et al.Association between longterm air pollution and increased blood pressure and hypertension in China[J].Hypertension(Dallas,Tex:1979),2013,61(3):578-584.DOI:10.1161/hypertensionaha.111.00003.
[23]Auchincloss AH,Diez Roux AV,Dvonch JT,et al.Associations between recent exposure to ambient fine particulate matter and blood pressure in the Multi-ethnic Study of Atherosclerosis(MESA)[J].Environ Health Perspect,2008,116(4):486-491.DOI:10.1289/ehp.10899.
[24]Sacks JD,Stanek LW,Luben TJ,et al.Particulate matter-induced health effects:who is susceptible?[J].Environmental Health Perspectives,2011,119(4):446-454.DOI:10.1289/ehp.1002255.
[25]樊萌语,吕筠,郭彧,等.中国慢性病前瞻性研究:10个项目地区成人体力活动和休闲静坐时间特征差异的分析[J].中华流行病学杂志,2015,8(36):779-785.DOI:10.3760/cma.j.issn.0254-6450.2015.08.002.
[26]刘倩楠,刘之光,尹潞,等.我国成人户外体力活动与PM2.5的相关性研究[J].中国循环杂志,2018,33(10):1001-1005.DOI:10.3969/j.issn.1000-3614.2018.10.013.
[27]Liao D,Duan Y,Whitsel EA,et al.Association of higher levels of ambient criteria pollutants with impaired cardiac autonomic control:a population-based study[J].Am J Epidemiol,2004,159(8):768-777.DOI:10.1093/aje/kwh109.
[28]Chobanian AV,Bakris GL,Black HR,et al.Seventh report of the joint national committee on prevention,detection,evaluation,and treatment of high blood pressure[J].Hypertension(Dallas,Tex:1979),2003,42(6):1206-1252.DOI:10.1161/01.HYP.0000107251.49515.c2.(:2019-02-03)
[2]Yang G,Wang Y,Zeng Y,et al.Rapid health transition in China,1990-2010:findings from the Global Burden of Disease Study 2010[J].Lancet(London,England),2013,381(9882):1987-2015.DOI:10.1016/s0140-6736(13)61097-1.
[3]Lewington S,Lacey B,Clarke R,et al.The burden of hypertension and associated risk for cardiovascular mortality in China[J].JAMAIntern Med,2016,176(4):524-532.DOI:10.1001/jamainternmed.2016.0190.
[4]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2017》概要[J].中国循环杂志,2018,33(1):1-8.DOI:10.3969/j.issn.1000-3614.2018.01.001.
[5]Lu J,Lu Y,Wang X,et al.Prevalence,awareness,treatment,and control of hypertension in China:data from 1.7 million adults in a population-based screening study(China PEACE Million Persons Project)[J].Lancet(London,England),2017,390(10112):2549-2558.DOI:10.1016/s0140-6736(17)32478-9.
[6]Dockery DW.Epidemiologic evidence of cardiovascular effects of particulate air pollution[J].Environ Health Perspect,2001,109(Suppl 4):483-486.DOI:10.1289/ehp.01109s4483.
[7]Miller KA,Siscovick DS,Sheppard L,et al.Long-term exposure to air pollution and incidence of cardiovascular events in women[J].N Engl J Med,2007,356(5):447-458.DOI:10.1056/NEJMoa054409.
[8]Chan SH,Van Hee VC,Bergen S,et al.Long-term air pollution exposure and blood pressure in the sister study[J].Environ Health Perspect,2015,123(10):951-958.DOI:10.1289/ehp.1408125.
[9]Chuang KJ,Yan YH,Chiu SY,et al.Long-term air pollution exposure and risk factors for cardiovascular diseases among the elderly in Taiwan[J].Occup Environ Med,2011,68(1):64-68.DOI:10.1136/oem.2009.052704.
[10]Fuks K,Moebus S,Hertel S,et al.Long-term urban particulate air pollution,traffic noise,and arterial blood pressure[J].Environ Health Perspect,2011,119(12):1706-1711.DOI:10.1289/ehp.1103564.
[11]Liang R,Zhang B,Zhao X,et al.Effect of exposure to PM2.5on blood pressure:a systematic review and meta-analysis[J].JHypertens,2014,32(11):2130-2140;discussion 41.DOI:10.1097/hjh.0000000000000342.
[12]Rajagopalan S,Al-Kindi SG,Brook RD.Air pollution and cardiovascular disease:JACC state-of-the-art review[J].J Am Coll Cardiol,2018,72(17):2054-2070.DOI:10.1016/j.jacc.2018.07.099.
[13]Lu J,Xuan S,Downing NS,et al.Protocol for the China PEACE(patient-centered evaluative assessment of cardiac events)million persons project pilot[J].BMJ Open,2016,6(1):e010200.DOI:10.1136/bmjopen-2015-010200.
[14]环境保护部.HJ 663-2013环境空气质量评价技术规范[S].北京:中国环境科学出版社,2013.
[15]环境保护部,国家质量监督检验检疫总局.GB 3095-2012环境空气质量标准[S].北京:中国环境科学出版社,2012.
[16]Lin H,Guo Y,Zheng Y,et al.Long-term effects of ambient PM2.5 on hypertension and blood pressure and attributable risk among older Chinese adults[J].Hypertension(Dallas,Tex:1979),2017,69(5):806-812.DOI:10.1161/hypertensionaha.116.08839.
[17]Chen SY,Wu CF,Lee JH,et al.Associations between long-term air pollutant exposures and blood pressure in elderly residents of Taipei city:a cross-sectional study[J].Environ Health Perspect,2015,123(8):779-784.DOI:10.1289/ehp.1408771.
[18]Liu C,Chen R,Zhao Y,et al.Associations between ambient fine particulate air pollution and hypertension:a nationwide crosssectional study in China[J].Sci Total Environ,2017,584-585(869-874).DOI:10.1016/j.scitotenv.2017.01.133.
[19]Foraster M,Basagana X,Aguilera I,et al.Association of longterm exposure to traffic-related air pollution with blood pressure and hypertension in an adult population-based cohort in Spain(the REGICOR study)[J].Environ Health Perspect,2014,122(4):404-411.DOI:10.1289/ehp.1306497.
[20]Brook RD,Urch B,Dvonch JT,et al.Insights into the mechanisms and mediators of the effects of air pollution exposure on blood pressure and vascular function in healthy humans[J].Hypertension(Dallas,Tex:1979),2009,54(3):659-667.DOI:10.1161/hypertensionaha.109.130237.
[21]臧希文.PM2.5对心血管系统的影响[J].中国循环杂志,2018,33(3):305-307.DOI:10.3969/j.issn.1000-3614.2018.03.027.
[22]Dong GH,Qian ZM,Xaverius PK,et al.Association between longterm air pollution and increased blood pressure and hypertension in China[J].Hypertension(Dallas,Tex:1979),2013,61(3):578-584.DOI:10.1161/hypertensionaha.111.00003.
[23]Auchincloss AH,Diez Roux AV,Dvonch JT,et al.Associations between recent exposure to ambient fine particulate matter and blood pressure in the Multi-ethnic Study of Atherosclerosis(MESA)[J].Environ Health Perspect,2008,116(4):486-491.DOI:10.1289/ehp.10899.
[24]Sacks JD,Stanek LW,Luben TJ,et al.Particulate matter-induced health effects:who is susceptible?[J].Environmental Health Perspectives,2011,119(4):446-454.DOI:10.1289/ehp.1002255.
[25]樊萌语,吕筠,郭彧,等.中国慢性病前瞻性研究:10个项目地区成人体力活动和休闲静坐时间特征差异的分析[J].中华流行病学杂志,2015,8(36):779-785.DOI:10.3760/cma.j.issn.0254-6450.2015.08.002.
[26]刘倩楠,刘之光,尹潞,等.我国成人户外体力活动与PM2.5的相关性研究[J].中国循环杂志,2018,33(10):1001-1005.DOI:10.3969/j.issn.1000-3614.2018.10.013.
[27]Liao D,Duan Y,Whitsel EA,et al.Association of higher levels of ambient criteria pollutants with impaired cardiac autonomic control:a population-based study[J].Am J Epidemiol,2004,159(8):768-777.DOI:10.1093/aje/kwh109.
[28]Chobanian AV,Bakris GL,Black HR,et al.Seventh report of the joint national committee on prevention,detection,evaluation,and treatment of high blood pressure[J].Hypertension(Dallas,Tex:1979),2003,42(6):1206-1252.DOI:10.1161/01.HYP.0000107251.49515.c2.(:2019-02-03)