加利福尼亚州空气质量变化与儿童哮喘发病率之间的关系，1993-2014
2019/11/12
摘要
重要性：暴露于空气污染物是儿童哮喘急性发作的公认原因；然而，对于空气污染物是否在儿童哮喘的发展中起作用仍不清楚。
目的：探索儿童哮喘发病率的降低是否与区域空气污染物减少相关。
实验设计及参与者：根据空气污染下降期间，南加州儿童健康研究的3次调查，组成多层次纵向队列研究。每个队列的随访时间为4年级-12年级（8年时间）：1993-2001、1996-2004和2006-2014。这些数据的最后一次访视是在2014年6月。基于人群从公立小学招募参与者。共纳入了无哮喘病史，且基线时住在这9个儿童健康研究社区中的4140例儿童。
暴露：记录3个队列在基线年度平均社区水平的臭氧、二氧化氮、颗粒物分别小于10μm（PM10）和小于2.5μm（PM2.5）。
主要结果和措施：随访期间通过问卷收集，前瞻性识别哮喘发作情况。
结果：本研究共纳入4140例儿童（平均[SD]基线年龄9.5[0.6]岁；52.6%女性[n=2179]；58.6%是白人[n=2273]；42.2%是西班牙裔[n=1686]），确定了525例哮喘发作病例。对二氧化氮而言，中位数减少4.3ppb，绝对发病率每年下降了0.83%，哮喘的发病率比率为（incidence rate ratio，IRR）0.80（95%CI，0.71-0.90）。对PM2.5而言， 其IRR为0.81（95%CI，0.67-0.98），平均减少8.1μg/m³，绝对发病率每年下降1.53%。臭氧的IRR为0.85（95%CI，0.71-1.02），中位数减少了8.9ppb，绝对发病率每年下降了0.78%。PM10的IRR为0.93（95%CI，0.82-1.07），中位数减少4.0μg/m³，绝对发病率每年下降0.46%。
结论和相关性：在南加州儿童中，1993-2014年间环境中二氧化氮和PM2.5的减少与哮喘发病率降低显著相关。臭氧和PM10与哮喘发病率之间并无相关性。
Garcia E, Berhane KT, Islam T, McConnell R, Urman R, Chen Z, Gilliland FD
JAMA. 2019 May 21;321(19):1906-1915. doi: 10.1001/jama.2019.5357.
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公认原因；然而，对于空气污染物是否在儿童哮喘的发展中起作用仍不清楚。
目的：探索儿童哮喘发病率的降低是否与区域空气污染物减少相关。
实验设计及参与者：根据空气污染下降期间，南加州儿童健康研究的3次调查，组成多层次纵向队列研究。每个队列的随访时间为4年级-12年级（8年时间）：1993-2001、1996-2004和2006-2014。这些数据的最后一次访视是在2014年6月。基于人群从公立小学招募参与者。共纳入了无哮喘病史，且基线时住在这9个儿童健康研究社区中的4140例儿童。
暴露：记录3个队列在基线年度平均社区水平的臭氧、二氧化氮、颗粒物分别小于10μm（PM10）和小于2.5μm（PM2.5）。
主要结果和措施：随访期间通过问卷收集，前瞻性识别哮喘发作情况。
结果：本研究共纳入4140例儿童（平均[SD]基线年龄9.5[0.6]岁；52.6%女性[n=2179]；58.6%是白人[n=2273]；42.2%是西班牙裔[n=1686]），确定了525例哮喘发作病例。对二氧化氮而言，中位数减少4.3ppb，绝对发病率每年下降了0.83%，哮喘的发病率比率为（incidence rate ratio，IRR）0.80（95%CI，0.71-0.90）。对PM2.5而言， 其IRR为0.81（95%CI，0.67-0.98），平均减少8.1μg/m³，绝对发病率每年下降1.53%。臭氧的IRR为0.85（95%CI，0.71-1.02），中位数减少了8.9ppb，绝对发病率每年下降了0.78%。PM10的IRR为0.93（95%CI，0.82-1.07），中位数减少4.0μg/m³，绝对发病率每年下降0.46%。
结论和相关性：在南加州儿童中，1993-2014年间环境中二氧化氮和PM2.5的减少与哮喘发病率降低显著相关。臭氧和PM10与哮喘发病率之间并无相关性。
(朱文娟1 张红萍1 张欣1 王刚2 四川大学华西医院中西医结合科呼吸病组 610041 摘译)
（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（JAMA. 2019 May 21;321(19):1906-1915. doi: 10.1001/jama.2019.5357.）
Garcia E, Berhane KT, Islam T, McConnell R, Urman R, Chen Z, Gilliland FD
JAMA. 2019 May 21;321(19):1906-1915. doi: 10.1001/jama.2019.5357.
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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队列研究：英国初级保健机构中学龄儿童的肺功能和哮喘控制情况
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