多环芳烃的尿代谢产物和短效β受体激动剂或全身性皮质类固醇哮喘药物在NHANES的使用
2023/03/21
摘要
背景：在美国国家健康和营养检查调查(NHANES)等横断面研究中，研究人员观察到多环芳香烃(PAH)暴露与哮喘诊断之间存在正相关。目前尚不清楚包括短期使用哮喘药物缓解症状等急性哮喘结局的衡量方法是否存在类似的关系。我们检查了近期多环芳烃暴露标志物与30天短效β激动剂(SABA)或全身皮质类固醇使用(近期哮喘症状的一个指标)之间的关系。
方法：在多波NHANES(2005-2016年)的16,550名儿童和成人中，我们拟合准泊松多元回归模型来描述尿1-羟基芘(多环芳烃的代谢物)与SABA或全身皮质类固醇使用之间的关系。我们评估了年龄组和哮喘控制药物的使用对效果的影响。所有模型都调整了尿肌酐、年龄、女性/男性名称、种族/民族、贫困、保险覆盖率和血清可替宁。
结果：在混杂因素控制后，增加的一个1-羟基芘的标准偏差，与近期SABA或全身皮质类固醇使用的患病率增加相关(PR: 1.06, 95% CI: 1.03-1.10)。在曾经诊断为哮喘的患者和使用不同的尿肌酐稀释方法的患者中，结果相似。我们没有观察到年龄组(p-相互作用= 0.22)或哮喘控制药物使用(p-相互作用= 0.73)对效果的影响。
结论：通过各种尿液稀释调整方法，近期多环芳烃暴露的标记物与SABA或全身皮质类固醇使用正相关。在横断面研究中，确保暴露和结果之间有适当的时间性是很重要的。
Urinary metabolites of polycyclic aromatic hydrocarbons and short-acting beta agonist or systemic corticosteroid asthma medication use within NHANES
Stephen P Uong, Haider Hussain, Erin Thanik, Stephanie Lovinsky-Desir, Jeanette A Stingone
Abstract
BACKGROUND: Within cross-sectional studies like the U.S. National Health and Nutritional Examination Survey (NHANES), researchers have observed positive associations between polycyclic aromatic hydrocarbon (PAH) exposure and asthma diagnosis. It is unclear whether similar relationships exist for measures of acute asthma outcomes, including short-term asthma medication use to alleviate symptoms. We examined the relationship between markers of recent PAH exposure and 30-day short-acting beta agonist (SABA) or systemic corticosteroid use, an indicator for recent asthma symptoms.
METHODS: For 16,550 children and adults across multiple waves of NHANES (2005-2016), we fit quasi-Poisson multivariable regression models to describe the association between urinary 1-hydroxypyrene (a metabolite of PAH) and SABA or systemic corticosteroid use. We assessed for effect modification by age group and asthma controller medication use. All models were adjusted for urinary creatinine, age, female/male designation, race/ethnicity, poverty, insurance coverage, and serum cotinine.
RESULTS: After controlling for confounding, an increase of one standard deviation of 1-hydroxypyrene was associated with greater prevalence of recent SABA or systemic corticosteroid use (PR: 1.06, 95% CI: 1.03-1.10). The results were similar among those with ever asthma diagnosis and across urine creatinine dilution methods. We did not observe effect modification by age group (p-interaction = 0.22) or asthma controller medication use (p-interaction = 0.73).
CONCLUSIONS: Markers of recent PAH exposure was positively associated with SABA or systemic corticosteroid use, across various urine dilution adjustment methods. It is important to ensure appropriate temporality between exposures and outcomes in cross-sectional studies.
背景：在美国国家健康和营养检查调查(NHANES)等横断面研究中，研究人员观察到多环芳香烃(PAH)暴露与哮喘诊断之间存在正相关。目前尚不清楚包括短期使用哮喘药物缓解症状等急性哮喘结局的衡量方法是否存在类似的关系。我们检查了近期多环芳烃暴露标志物与30天短效β激动剂(SABA)或全身皮质类固醇使用(近期哮喘症状的一个指标)之间的关系。
方法：在多波NHANES(2005-2016年)的16,550名儿童和成人中，我们拟合准泊松多元回归模型来描述尿1-羟基芘(多环芳烃的代谢物)与SABA或全身皮质类固醇使用之间的关系。我们评估了年龄组和哮喘控制药物的使用对效果的影响。所有模型都调整了尿肌酐、年龄、女性/男性名称、种族/民族、贫困、保险覆盖率和血清可替宁。
结果：在混杂因素控制后，增加的一个1-羟基芘的标准偏差，与近期SABA或全身皮质类固醇使用的患病率增加相关(PR: 1.06, 95% CI: 1.03-1.10)。在曾经诊断为哮喘的患者和使用不同的尿肌酐稀释方法的患者中，结果相似。我们没有观察到年龄组(p-相互作用= 0.22)或哮喘控制药物使用(p-相互作用= 0.73)对效果的影响。
结论：通过各种尿液稀释调整方法，近期多环芳烃暴露的标记物与SABA或全身皮质类固醇使用正相关。在横断面研究中，确保暴露和结果之间有适当的时间性是很重要的。
（中日友好医院呼吸与危重症医学科 李春晓 摘译 林江涛 审校）
（Environ Res 2023 Mar 1;220:115150.DOI: 10.1016/j.envres.2022.115150）
（Environ Res 2023 Mar 1;220:115150.DOI: 10.1016/j.envres.2022.115150）
Urinary metabolites of polycyclic aromatic hydrocarbons and short-acting beta agonist or systemic corticosteroid asthma medication use within NHANES
Stephen P Uong, Haider Hussain, Erin Thanik, Stephanie Lovinsky-Desir, Jeanette A Stingone
Abstract
BACKGROUND: Within cross-sectional studies like the U.S. National Health and Nutritional Examination Survey (NHANES), researchers have observed positive associations between polycyclic aromatic hydrocarbon (PAH) exposure and asthma diagnosis. It is unclear whether similar relationships exist for measures of acute asthma outcomes, including short-term asthma medication use to alleviate symptoms. We examined the relationship between markers of recent PAH exposure and 30-day short-acting beta agonist (SABA) or systemic corticosteroid use, an indicator for recent asthma symptoms.
METHODS: For 16,550 children and adults across multiple waves of NHANES (2005-2016), we fit quasi-Poisson multivariable regression models to describe the association between urinary 1-hydroxypyrene (a metabolite of PAH) and SABA or systemic corticosteroid use. We assessed for effect modification by age group and asthma controller medication use. All models were adjusted for urinary creatinine, age, female/male designation, race/ethnicity, poverty, insurance coverage, and serum cotinine.
RESULTS: After controlling for confounding, an increase of one standard deviation of 1-hydroxypyrene was associated with greater prevalence of recent SABA or systemic corticosteroid use (PR: 1.06, 95% CI: 1.03-1.10). The results were similar among those with ever asthma diagnosis and across urine creatinine dilution methods. We did not observe effect modification by age group (p-interaction = 0.22) or asthma controller medication use (p-interaction = 0.73).
CONCLUSIONS: Markers of recent PAH exposure was positively associated with SABA or systemic corticosteroid use, across various urine dilution adjustment methods. It is important to ensure appropriate temporality between exposures and outcomes in cross-sectional studies.
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