梁琛瑜, 王万州, 马麟, 梁泽, 王玥瑶, 李鹏飞, 杨超, 李双成, 张路霞. 大气NO2长期暴露与中国成人慢性肾脏病的关联:基于中国慢性肾脏病流行病学调查[J]. 环境与职业医学, 2021, 38(6): 566-572. DOI: 10.13213/j.cnki.jeom.2021.20597
引用本文: 梁琛瑜, 王万州, 马麟, 梁泽, 王玥瑶, 李鹏飞, 杨超, 李双成, 张路霞. 大气NO2长期暴露与中国成人慢性肾脏病的关联:基于中国慢性肾脏病流行病学调查[J]. 环境与职业医学, 2021, 38(6): 566-572. DOI: 10.13213/j.cnki.jeom.2021.20597
LIANG Chenyu, WANG Wanzhou, MA Lin, LIANG Ze, WANG Yueyao, LI Pengfei, YANG Chao, LI Shuangcheng, ZHANG Luxia. Association between long-term exposure to ambient NO2 and prevalence of chronic kidney disease: Findings from China National Survey of Chronic Kidney Disease[J]. Journal of Environmental and Occupational Medicine, 2021, 38(6): 566-572. DOI: 10.13213/j.cnki.jeom.2021.20597
Citation: LIANG Chenyu, WANG Wanzhou, MA Lin, LIANG Ze, WANG Yueyao, LI Pengfei, YANG Chao, LI Shuangcheng, ZHANG Luxia. Association between long-term exposure to ambient NO2 and prevalence of chronic kidney disease: Findings from China National Survey of Chronic Kidney Disease[J]. Journal of Environmental and Occupational Medicine, 2021, 38(6): 566-572. DOI: 10.13213/j.cnki.jeom.2021.20597

大气NO2长期暴露与中国成人慢性肾脏病的关联:基于中国慢性肾脏病流行病学调查

Association between long-term exposure to ambient NO2 and prevalence of chronic kidney disease: Findings from China National Survey of Chronic Kidney Disease

  • 摘要: 背景

    已有数项研究提示大气细颗粒物(PM2.5)长期暴露可能增加慢性肾脏病(CKD)患病风险,但对二氧化氮(NO2)的相关研究仍然有限。

    目的

    探究大气NO2长期暴露与我国成人CKD患病风险的关联。

    方法

    基于2007年1月—2010年10月期间“中国慢性肾脏病流行病学调查”健康数据,进行环境暴露数据采集与匹配。利用广义相加模型探究大气NO2长期暴露对我国成人CKD患病风险的估计效应。基于性别,年龄,体重指数(BMI),受教育程度,人月均收入,城乡,吸烟、饮酒情况,高血压、糖尿病、心肌梗死/脑卒中病史等因素进行亚组分析。建立双污染物敏感性分析,检验上述结果的稳定性。

    结果

    研究纳入我国13个省(自治区、直辖市)共47 204名研究对象。大气NO2长期暴露与我国成人CKD患病风险增加的关联具有统计学意义,且在5年时达到最大。NO2的5年滑动平均值每增加10 μg·m-3,CKD患病风险比值比(OR)为1.15(95%CI:1.11~1.19)。亚组分析结果提示:男性,65岁及以上,超重及肥胖,初中以上学历,人月均收入500元及以下,农村,每天吸烟,偶尔或经常饮酒,无高血压、糖尿病、心肌梗死/脑卒中病史的人群CKD患病风险与NO2长期暴露的关联更强:NO2暴露每增加10μg·m-3,男性人群CKD患病的OR为1.30(95%CI:1.24~1.37),高于女性(OR=1.04,95%CI:1.00~1.09)(交互项P < 0.01);农村地区人群CKD患病的OR为1.57 (95%CI:1.33~1.85),高于城市人群(OR=1.09,95%CI:0.99~1.21)(交互项P < 0.01);非糖尿病患病人群CKD患病的OR为1.21(95%CI:1.16~1.26),高于糖尿病患病人群(OR=1.01,95%CI:0.95~1.07)(交互项P < 0.01)。敏感性分析结果显示,在控制同期PM2.5的混杂后,NO2长期暴露与CKD患病风险的关联仍然稳定。

    结论

    大气NO2长期暴露与我国成人CKD患病风险增加有关。男性,65岁及以上,超重及肥胖,初中以上学历,人月均收入500元及以下,农村地区,每天吸烟,偶尔或经常饮酒,无高血压、糖尿病、心肌梗死/脑卒中病史可能是NO2长期暴露对肾脏健康影响的易感因素。

     

    Abstract: Background

    Several studies indicate that long-term exposure to fine particulate matter (PM2.5) may increase the risk of chronic kidney disease (CKD), but investigations on nitrogen dioxide (NO2) are still limited.

    Objective

    This study aims to explore the association between long-term exposure to ambient NO2 and CKD risk in Chinese adults.

    Methods

    Based on the health data derived from the China National Survey of Chronic Kidney Disease (CNSCKD) from January 2007 to October 2010, this study collected and matched the environmental exposure data. A generalized additive model was used to explore the association between long-term exposure to ambient NO2 and the risk of CKD among adult residents in China. Subgroup analyses were conducted based on data stratified by gender, age, body mass index (BMI), education level, individual income per month, residence in rural or urban areas, smoking, alcohol drinking, and history of hypertension, diabetes, or myocardial infarction/stroke. Two-pollutant sensitivity analyses were used to examine the robustness of the above results.

    Results

    A total of 47 204 subjects from 13 provinces (autonomous regions/municipalities) in China were included in this study. Longterm exposure to ambient NO2 was positively associated with an increased risk of CKD in China, and the strongest estimated effect was found at the 5-year moving average. With a 10 μg·m-3 increase in the 5-year moving average of NO2, the odds ratio (OR) of CKD was 1.15 (95% CI: 1.11-1.19). The results of subgroup analyses indicated that the risk of CKD was more strongly associated with long-term NO2 exposure in males, those 65 years and older, overweight or obese, with a diploma above junior high school, with an individual monthly income less than 500 yuan, living in rural areas, daily smokers, occasional or frequent drinkers, and without a history of hypertension, diabetes, or myocardial infarction/stroke. For instance, the estimated OR associated with an increase of 10 μg·m-3 in NO2 in males was 1.30 (95% CI: 1.24-1.37), which was higher than the OR=1.04 (95% CI: 1.00-1.09) in females (P for interaction < 0.01); the OR in rural populations was 1.57 (95% CI: 1.33-1.85), higher than the OR=1.09 (95%CI: 0.99-1.21) in urban populations (P for interaction < 0.01); the OR in non-diabetic adults was 1.21 (95%CI: 1.16-1.26), higher than the OR=1.01 (95%CI: 0.95-1.07) in diabetic adults (P for interaction < 0.01). The sensitivity analysis results showed that the association between long-term exposure to NO2 and CKD risk remained robust after controlling for the confounding effect of PM2.5 at the same exposure time window.

    Conclusion

    Long-term exposure to ambient NO2 is associated with an increased risk of CKD in Chinese adults. Males, residents ≥65 years, overweight or obese adults, those with an education above junior high school, those with an individual monthly income less than 500 yuan, rural residents, daily smokers, occasional or frequent drinkers, and those without a history of hypertension, diabetes, or myocardial infarction/stroke are more susceptible to the adverse kidney effects of long-term exposure to ambient NO2.

     

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