儿童早期环境空气污染暴露与儿童哮喘风险增加相关：来自瑞典斯德哥尔摩的一项队列研究
2021/06/18
摘要
导言：哮喘是一种复杂的异质性疾病，是儿童最常见的慢性疾病之一。在早期和儿童时期暴露于环境空气污染可能是哮喘发病的病因之一，但哪些空气污染的具体成分和暴露窗口是重要的还不确定。社会经济地位的作用也不清楚。因此，本研究的目的是探讨不同污染物暴露窗对早期哮喘风险的影响，及社会经济地位对这种关系的可能影响。
方法：利用2006年至2013年间大斯德哥尔摩地区所有单胎出生的登记数据构建研究人群。暴露于环境黑炭（BC）、细颗粒物（PM2.5）、一次有机碳（pOC）、二次有机气溶胶（SOA）、二次无机气溶胶，居住地址的氧化电位被模拟为整个怀孕期、出生第一年和出生前三年的平均值。瑞典国家注册被用来定义结果：在生命的前六年在医院评估哮喘诊断。用Cox比例风险模型，以年龄为基本时间标度，调整相关的潜在混杂变量，建立风险比（HRs）及其95%可信区间（CIs）。
结果：在出生后的头三年，暴露于PM2.5、pOC和SOA会增加儿童哮喘的发病风险。随着暴露量的四分位距增加，在完全调整的模型中，PM2.5、pOC和SOA的风险比分别为1.06（95%CI:1.01-1.10）、1.05（95%CI:1.02-1.09）和1.02（95%CI:1.00-1.04）。胎儿期或出生后第一年的暴露与哮喘风险无关，其他污染物与哮喘风险增加无统计学显著相关性。此外， 与PM2.5及BC、pOC和SOA组成部分相关的风险增加在社会经济地位较低的地区更强。
结论：我们的研究结果表明，在生命的前三年暴露于空气污染可能会增加儿童早期哮喘的风险。这一发现进一步暗示低社会经济地位儿童对空气污染引起的哮喘的易感性可能增加。
Early childhood exposure to ambient air pollution is associated with increased risk of paediatric asthma: An administrative cohort study from Stockholm, Sweden.
David Olsson, Bertil Forsberg, Lennart Bråbäck, Camilla Geels, Jørgen Brandt, Jesper H Christensen, Lise M Frohn, Anna Oudin.
Abstract
Introduction: Asthma is a complex, heterogeneous disease and one of the most common chronic diseases among children. Exposure to ambient air pollution in early life and childhood may influence asthma aetiology, but it is uncertain which specific components of air pollution and exposure windows are of importance. The role of socio-economic status (SES) is also unclear. The aims of the present study are, therefore, to investigate how various exposure windows of different pollutants affect risk-induced asthma in early life and to explore the possible effect SES has on that relationship.
Methods: The study population was constructed using register data on all singleton births in the greater Stockholm area between 2006 and 2013. Exposure to ambient black carbon (BC), fine particulate matter (PM2.5), primary organic carbon (pOC) secondary organic aerosols (SOA), secondary inorganic aerosols, and oxidative potential at the residential address was modelled as mean values for the entire pregnancy period, the first year of life and the first three years of life. Swedish national registers were used to define the outcome: asthma diagnosis assessed at hospital during the first six years of life. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were modelled with Cox proportional hazards model with age as the underlying time-scale, adjusting for relevant potential confounding variables.
Results: An increased risk for developing childhood asthma was observed in association with exposure to PM2.5, pOC and SOA during the first three years of life. With an interquartile range increase in exposure, the HRs were 1.06 (95% CI: 1.01-1.10), 1.05 (95% CI: 1.02-1.09) and 1.02 (95% CI: 1.00-1.04), for PM2.5, pOC and SOA, respectively, in the fully adjusted models. Exposure during foetal life or the first year of life was not associated with asthma risk, and the other pollutants were not statistically significantly associated with increased risk. Furthermore, the increase in risk associated with PM2.5 and the components BC, pOC and SOA were stronger in areas with lower SES.
Conclusion: Our results suggest that exposure to air pollution during the first three years of life may increase the risk for asthma in early childhood. The findings further imply a possible increased vulnerability to air pollution-attributed asthma among low SES children.
导言：哮喘是一种复杂的异质性疾病，是儿童最常见的慢性疾病之一。在早期和儿童时期暴露于环境空气污染可能是哮喘发病的病因之一，但哪些空气污染的具体成分和暴露窗口是重要的还不确定。社会经济地位的作用也不清楚。因此，本研究的目的是探讨不同污染物暴露窗对早期哮喘风险的影响，及社会经济地位对这种关系的可能影响。
方法：利用2006年至2013年间大斯德哥尔摩地区所有单胎出生的登记数据构建研究人群。暴露于环境黑炭（BC）、细颗粒物（PM2.5）、一次有机碳（pOC）、二次有机气溶胶（SOA）、二次无机气溶胶，居住地址的氧化电位被模拟为整个怀孕期、出生第一年和出生前三年的平均值。瑞典国家注册被用来定义结果：在生命的前六年在医院评估哮喘诊断。用Cox比例风险模型，以年龄为基本时间标度，调整相关的潜在混杂变量，建立风险比（HRs）及其95%可信区间（CIs）。
结果：在出生后的头三年，暴露于PM2.5、pOC和SOA会增加儿童哮喘的发病风险。随着暴露量的四分位距增加，在完全调整的模型中，PM2.5、pOC和SOA的风险比分别为1.06（95%CI:1.01-1.10）、1.05（95%CI:1.02-1.09）和1.02（95%CI:1.00-1.04）。胎儿期或出生后第一年的暴露与哮喘风险无关，其他污染物与哮喘风险增加无统计学显著相关性。此外， 与PM2.5及BC、pOC和SOA组成部分相关的风险增加在社会经济地位较低的地区更强。
结论：我们的研究结果表明，在生命的前三年暴露于空气污染可能会增加儿童早期哮喘的风险。这一发现进一步暗示低社会经济地位儿童对空气污染引起的哮喘的易感性可能增加。
(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)
(Environ Int. 2021 May 30;155:106667. doi: 10.1016/j.envint.2021.106667.)
(Environ Int. 2021 May 30;155:106667. doi: 10.1016/j.envint.2021.106667.)
Early childhood exposure to ambient air pollution is associated with increased risk of paediatric asthma: An administrative cohort study from Stockholm, Sweden.
David Olsson, Bertil Forsberg, Lennart Bråbäck, Camilla Geels, Jørgen Brandt, Jesper H Christensen, Lise M Frohn, Anna Oudin.
Abstract
Introduction: Asthma is a complex, heterogeneous disease and one of the most common chronic diseases among children. Exposure to ambient air pollution in early life and childhood may influence asthma aetiology, but it is uncertain which specific components of air pollution and exposure windows are of importance. The role of socio-economic status (SES) is also unclear. The aims of the present study are, therefore, to investigate how various exposure windows of different pollutants affect risk-induced asthma in early life and to explore the possible effect SES has on that relationship.
Methods: The study population was constructed using register data on all singleton births in the greater Stockholm area between 2006 and 2013. Exposure to ambient black carbon (BC), fine particulate matter (PM2.5), primary organic carbon (pOC) secondary organic aerosols (SOA), secondary inorganic aerosols, and oxidative potential at the residential address was modelled as mean values for the entire pregnancy period, the first year of life and the first three years of life. Swedish national registers were used to define the outcome: asthma diagnosis assessed at hospital during the first six years of life. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were modelled with Cox proportional hazards model with age as the underlying time-scale, adjusting for relevant potential confounding variables.
Results: An increased risk for developing childhood asthma was observed in association with exposure to PM2.5, pOC and SOA during the first three years of life. With an interquartile range increase in exposure, the HRs were 1.06 (95% CI: 1.01-1.10), 1.05 (95% CI: 1.02-1.09) and 1.02 (95% CI: 1.00-1.04), for PM2.5, pOC and SOA, respectively, in the fully adjusted models. Exposure during foetal life or the first year of life was not associated with asthma risk, and the other pollutants were not statistically significantly associated with increased risk. Furthermore, the increase in risk associated with PM2.5 and the components BC, pOC and SOA were stronger in areas with lower SES.
Conclusion: Our results suggest that exposure to air pollution during the first three years of life may increase the risk for asthma in early childhood. The findings further imply a possible increased vulnerability to air pollution-attributed asthma among low SES children.
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从儿童到成人的哮喘和过敏症状轨迹
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免疫恢复力和生物多样性与过敏性疾病和哮喘的预防
