1993-2014年加利福尼亚州空气质量变化与儿童哮喘事件的关系
2019/06/13
摘要
重要性：暴露于空气污染物是儿童哮喘急性发作的明确原因；然而，空气污染物是否在儿童哮喘的发展中发挥作用仍然不明确。
目的：检测减少区域空气污染物是否与儿童哮喘发病率降低有关。
实验设计与受试人群：本研究多级纵向队列取自空气污染减少期的3波南加州儿童健康研究。每个队列随访4至12年级（8年）：1993-2001,1996-2004和2006-2014。这些数据的随访终点为2014年6月。受试人群招募自公立小学，共纳入4140名儿童，这些儿童没有哮喘病史，居住在9个儿童健康研究社区中的1个。
暴露：在3个队列中，每年平均社区级臭氧，二氧化氮和颗粒物小于10μm（PM10）且小于2.5μm（PM2.5）。
主要结果和措施：在随访期间通过问卷收集的前瞻性发现的哮喘事件。
结果：在本研究的4140名儿童中（平均[SD]年龄基线，9.5 [0.6]年; 52.6％女性[n = 2 179]; 58.6％白人[n = 2273]; 42.2％西班牙裔[n = 1686] ]），共确定了525例哮喘病例。对于二氧化氮，哮喘的发病率比（IRR）为0.80（95％CI，0.71-0.90），中位数减少为十亿分之4.3，绝对发病率每百人年减少0.83例。对于PM2.5，IRR为0.81（95％CI，0.67-0.98），中值降低8.1μg/ m3，绝对发病率降低1.53个病例/ 100人年。对于臭氧，哮喘的IRR为0.85（95％CI，0.71-1.02），中位数减少8.9个十亿分之一，绝对发病率每百人年减少0.78个病例。对于PM10，IRR为0.93（95％CI，0.82-1.07），中值降低4.0μg/ m3，绝对发病率降低0.46个病例/ 100人年。
结论和相关性：在南加州的儿童中，1993年至2014年间环境二氧化氮和PM2.5的减少与哮喘发病率降低显著相关。臭氧或PM10没有统计学显著相关性。
Association of Changes in Air Quality With Incident Asthma in Children in California, 1993-2014.
Garcia E, Berhane KT, Islam T, McConnell R, Urman R, Chen Z, Gilliland FD.
Abstract
IMPORTANCE:Exposure to air pollutants is a well-established cause of asthma exacerbation in children; whether air pollutants play a role in the development of childhood asthma, however, remains uncertain.
OBJECTIVE:To examine whether decreasing regional air pollutants were associated with reduced incidence of childhood asthma.
DESIGN, SETTING, AND PARTICIPANTS:A multilevel longitudinal cohort drawn from 3 waves of the Southern California Children's Health Study over a period of air pollution decline. Each cohort was followed up from 4th to 12th grade (8 years): 1993-2001, 1996-2004, and 2006-2014. Final follow-up for these data was June 2014. Population-based recruitment was from public elementary schools. A total of 4140 children with no history of asthma and residing in 1 of 9 Children's Health Study communities at baseline were included.
EXPOSURES:Annual mean community-level ozone, nitrogen dioxide, and particulate matter less than 10 μm (PM10) and less than 2.5 μm (PM2.5) in the baseline year for each of 3 cohorts.
MAIN OUTCOMES AND MEASURES:Prospectively identified incident asthma, collected via questionnaires during follow-up.
RESULTS:Among the 4140 children included in this study (mean [SD] age at baseline, 9.5 [0.6] years; 52.6% female [n = 2 179]; 58.6% white [n = 2273]; and 42.2% Hispanic [n = 1686]), 525 incident asthma cases were identified. For nitrogen dioxide, the incidence rate ratio (IRR) for asthma was 0.80 (95% CI, 0.71-0.90) for a median reduction of 4.3 parts per billion, with an absolute incidence rate decrease of 0.83 cases per 100 person-years. For PM2.5, the IRR was 0.81 (95% CI, 0.67-0.98) for a median reduction of 8.1 μg/m3, with an absolute incidence rate decrease of 1.53 cases per 100 person-years. For ozone, the IRR for asthma was 0.85 (95% CI, 0.71-1.02) for a median reduction of 8.9 parts per billion, with an absolute incidence rate decrease of 0.78 cases per 100 person-years. For PM10, the IRR was 0.93 (95% CI, 0.82-1.07) for a median reduction of 4.0 μg/m3, with an absolute incidence rate decrease of 0.46 cases per 100 person-years.
CONCLUSIONS AND RELEVANCE:Among children in Southern California, decreases in ambient nitrogen dioxide and PM2.5 between 1993 and 2014 were significantly associated with lower asthma incidence. There were no statistically significant associations for ozone or PM10.
重要性：暴露于空气污染物是儿童哮喘急性发作的明确原因；然而，空气污染物是否在儿童哮喘的发展中发挥作用仍然不明确。
目的：检测减少区域空气污染物是否与儿童哮喘发病率降低有关。
实验设计与受试人群：本研究多级纵向队列取自空气污染减少期的3波南加州儿童健康研究。每个队列随访4至12年级（8年）：1993-2001,1996-2004和2006-2014。这些数据的随访终点为2014年6月。受试人群招募自公立小学，共纳入4140名儿童，这些儿童没有哮喘病史，居住在9个儿童健康研究社区中的1个。
暴露：在3个队列中，每年平均社区级臭氧，二氧化氮和颗粒物小于10μm（PM10）且小于2.5μm（PM2.5）。
主要结果和措施：在随访期间通过问卷收集的前瞻性发现的哮喘事件。
结果：在本研究的4140名儿童中（平均[SD]年龄基线，9.5 [0.6]年; 52.6％女性[n = 2 179]; 58.6％白人[n = 2273]; 42.2％西班牙裔[n = 1686] ]），共确定了525例哮喘病例。对于二氧化氮，哮喘的发病率比（IRR）为0.80（95％CI，0.71-0.90），中位数减少为十亿分之4.3，绝对发病率每百人年减少0.83例。对于PM2.5，IRR为0.81（95％CI，0.67-0.98），中值降低8.1μg/ m3，绝对发病率降低1.53个病例/ 100人年。对于臭氧，哮喘的IRR为0.85（95％CI，0.71-1.02），中位数减少8.9个十亿分之一，绝对发病率每百人年减少0.78个病例。对于PM10，IRR为0.93（95％CI，0.82-1.07），中值降低4.0μg/ m3，绝对发病率降低0.46个病例/ 100人年。
结论和相关性：在南加州的儿童中，1993年至2014年间环境二氧化氮和PM2.5的减少与哮喘发病率降低显著相关。臭氧或PM10没有统计学显著相关性。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(JAMA. 2019 May 21;321(19):1906-1915. doi: 10.1001/jama.2019.5357.)
(JAMA. 2019 May 21;321(19):1906-1915. doi: 10.1001/jama.2019.5357.)
Association of Changes in Air Quality With Incident Asthma in Children in California, 1993-2014.
Garcia E, Berhane KT, Islam T, McConnell R, Urman R, Chen Z, Gilliland FD.
Abstract
IMPORTANCE:Exposure to air pollutants is a well-established cause of asthma exacerbation in children; whether air pollutants play a role in the development of childhood asthma, however, remains uncertain.
OBJECTIVE:To examine whether decreasing regional air pollutants were associated with reduced incidence of childhood asthma.
DESIGN, SETTING, AND PARTICIPANTS:A multilevel longitudinal cohort drawn from 3 waves of the Southern California Children's Health Study over a period of air pollution decline. Each cohort was followed up from 4th to 12th grade (8 years): 1993-2001, 1996-2004, and 2006-2014. Final follow-up for these data was June 2014. Population-based recruitment was from public elementary schools. A total of 4140 children with no history of asthma and residing in 1 of 9 Children's Health Study communities at baseline were included.
EXPOSURES:Annual mean community-level ozone, nitrogen dioxide, and particulate matter less than 10 μm (PM10) and less than 2.5 μm (PM2.5) in the baseline year for each of 3 cohorts.
MAIN OUTCOMES AND MEASURES:Prospectively identified incident asthma, collected via questionnaires during follow-up.
RESULTS:Among the 4140 children included in this study (mean [SD] age at baseline, 9.5 [0.6] years; 52.6% female [n = 2 179]; 58.6% white [n = 2273]; and 42.2% Hispanic [n = 1686]), 525 incident asthma cases were identified. For nitrogen dioxide, the incidence rate ratio (IRR) for asthma was 0.80 (95% CI, 0.71-0.90) for a median reduction of 4.3 parts per billion, with an absolute incidence rate decrease of 0.83 cases per 100 person-years. For PM2.5, the IRR was 0.81 (95% CI, 0.67-0.98) for a median reduction of 8.1 μg/m3, with an absolute incidence rate decrease of 1.53 cases per 100 person-years. For ozone, the IRR for asthma was 0.85 (95% CI, 0.71-1.02) for a median reduction of 8.9 parts per billion, with an absolute incidence rate decrease of 0.78 cases per 100 person-years. For PM10, the IRR was 0.93 (95% CI, 0.82-1.07) for a median reduction of 4.0 μg/m3, with an absolute incidence rate decrease of 0.46 cases per 100 person-years.
CONCLUSIONS AND RELEVANCE:Among children in Southern California, decreases in ambient nitrogen dioxide and PM2.5 between 1993 and 2014 were significantly associated with lower asthma incidence. There were no statistically significant associations for ozone or PM10.
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葡萄球菌肠毒素的敏感性和哮喘严重程度：EGEA队列中的纵向研究
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2008年至2016年瑞典西部哮喘患病率和呼吸系统症状的变化
