Relationship Between Multiple Environmental Exposures and CVD Incidence and Survival: Vulnerability and Susceptibility

多重环境暴露与 CVD 发病率和生存率之间的关系：脆弱性和易感性

• 批准号: 10310468
• 负责人: Francesca Dominici
• 金额: $ 64.3万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-12-15 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10310468
• 关键词: Address; Adverse effects; Affect; Age; Air Pollutants; Air Pollution; Area; Caliber; Cardiovascular Diseases; Characteristics; Chronic; Collection; Computer software; Data; Diet; Disease; Ensure; Environment; Environmental Epidemiology; Environmental Exposure; Event; Exposure to; Follow-Up Studies; Goals; Green space; Health; Health Insurance; Health Professional; Hospitalization; Incidence; Individual; Intervention; Knowledge; Lead; Life Style; Link; Measurement; Measures; Medical Records; Medicare; Medicare claim; Methods; Modeling; Modification; Morbidity - disease rate; Myocardial Infarction; Nitrogen Dioxide; Nurses' Health Study; Ozone; Particulate Matter; Physical activity; Policies; Population Heterogeneity; Predisposition; Prospective cohort; Provider; Race; Reproducibility; Research; Risk; Smoking; Statistical Methods; Surveys; Techniques; Temperature; Testing; Time; Uncertainty; Weather; base; beneficiary; cardiovascular disorder risk; cohort; comorbidity; contextual factors; environmental agent; extreme temperature; fine particles; high risk; insight; knowledge base; lifestyle factors; mortality; mortality risk; novel; open source; prevent; public health relevance; racial diversity; sex; simulation; social epidemiology; study population; walkability

PROJECT SUMMARY Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in the US and worldwide. Studies provide strong evidence that long-term exposures to many air pollutants (e.g. particulate matter < 2.5 microns in diameter (PM2.5), ozone, nitrogen dioxide (NO2) and weather variables (e.g. summer temperature variability, heat and cold waves) are associated with CVD. However most of these studies estimate the impact of long-term exposure to only one environmental agent at a time, only infrequently adjusting for the potential confounding effects of the others. In reality we are exposed to these air pollutants and weather variables simultaneously. Therefore without rigorous approaches to estimate the health effects associated with multiple exposures, the health burden will likely be underestimated. In addition to a rigorous and comprehensive quantification of these health effects, it is important to characterize susceptibility and identify modifying factors so the health consequences of multiple exposures can be prevented and reduced. While inherent characteristics, lifestyle, and contextual factors are hypothesized to either exacerbate or mitigate adverse health effects, very little is known regarding their potential interaction with multiple exposures. Specifically, very little is known regarding 1) which lifestyle factors (e.g. physical activity, diet, smoking) can mitigate or further exacerbate adverse effects of both air pollution and temperature; 2) which contextual measures (e.g. walkability, green space) can mitigate these risks; and 4) whether multiple exposures also affect survival after a non-fatal myocardial infarction (MI). Furthermore, no study has been able to consider the real-world situation of the simultaneous effects of multiple modifying factors. The goals of this proposal are to comprehensively address these gaps of knowledge. We have access to an unprecedented collection of five large US-based cohorts with a wealth of time-varying information on lifestyle factors, residential addresses, and medical record confirmed cases: the Nurses' Health Study (NHS), the Nurses' Health Study II (NHSII), the Health Professionals' Follow-up Study (HPFS), the whole cohort of Medicare enrollees (MC), and the Medicare Current Beneficiary Survey linked to Medicare Claims data (MC- MCBS). Our specific aims are to develop new methods to assess multiple exposures in the context of multiple confounding and effect modification; to assess the association between long-term exposure to multiple environmental agents (air pollution and weather) on risk of CVD, mortality, and survival after a non-fatal MI; and to characterize interactions between multiple environmental exposures, inherent characteristics, contextual and lifestyle factors.

项目摘要 心血管疾病（CVD）是美国和全球发病率和死亡率的主要原因。 研究提供了有力的证据表明，长期暴露于许多空气污染物（例如颗粒物<2.5 直径微米（PM2.5），臭氧，二氧化氮（NO2）和天气变量（例如夏季温度 可变性，热和冷波与CVD相关。但是大多数研究估计了影响 长期暴露于一次对一个环境药物的暴露，仅对潜力进行调整 其他人的混淆影响。实际上，我们接触了这些空气污染物和天气变量 同时地。因此，没有严格的方法来估计与多个相关的健康影响 暴露，健康负担可能会被低估。除了严格而全面 量化这些健康影响，重要的是表征易感性并确定修改因素 因此，可以预防和减少多种暴露的健康后果。而固有 假设特征，生活方式和上下文因素会加剧或减轻不良 健康效应，关于它们与多个暴露的潜在相互作用知之甚少。具体来说，非常 关于1）哪些生活方式因素（例如体育锻炼，饮食，吸烟）可以减轻或进一步 空气污染和温度的加剧不利影响； 2）哪些上下文措施（例如 步行性，绿色空间）可以减轻这些风险； 4）多次暴露是否也影响 非致命性心肌梗塞（MI）。此外，没有研究能够考虑现实情况 多种修饰因素的同时影响。 该提案的目标是全面解决这些知识差距。我们有访问权限 为五个大型美国同伙的空前集合，并提供了很多时变信息 生活方式因素，住宅地址和病历已确认案件：护士健康研究（NHS）， 护士健康研究II（NHSII），卫生专业人员的后续研究（HPFS），整个队列 Medicare参与者（MC）和与Medicare索赔数据相关的Medicare当前受益人调查（MC- MCB）。我们的具体目的是开发新方法，以评估多个的多个暴露 混淆和效果修改；评估长期暴露于多个的关联 非致命MI后CVD，死亡率和生存风险的环境药物（空气污染和天气）； 并表征多个环境暴露，固有特征，上下文之间的相互作用 和生活方式因素。

项目成果

Evaluation of the health impacts of the 1990 Clean Air Act Amendments using causal inference and machine learning.

• DOI: 10.1080/01621459.2020.1803883
• 发表时间: 2020-09-16
• 期刊: Journal of the American Statistical Association
• 影响因子: 3.7
• 作者: Nethery RC;Mealli F;Sacks JD;Dominici F
• 通讯作者: Dominici F

ESTIMATING POPULATION AVERAGE CAUSAL EFFECTS IN THE PRESENCE OF NON-OVERLAP: THE EFFECT OF NATURAL GAS COMPRESSOR STATION EXPOSURE ON CANCER MORTALITY.

估计非重叠情况下的人口平均因果效应：天然气压缩机站暴露对癌症死亡率的影响。

• DOI: 10.1214/18-aoas1231
• 发表时间: 2019
• 期刊: The annals of applied statistics
• 作者: Nethery,RachelC;Mealli,Fabrizia;Dominici,Francesca
• 通讯作者: Dominici,Francesca

Association Between Hurricane Sandy and Emergency Department Visits in New York City by Age and Cause.

按年龄和原因划分的飓风桑迪与纽约市急诊科就诊之间的关联。

• DOI: 10.1093/aje/kwab127
• 发表时间: 2021
• 期刊: American journal of epidemiology
• 影响因子: 5
• 作者: Weinberger,KateR;Kulick,ErinR;Boehme,AmeliaK;Sun,Shengzhi;Dominici,Francesca;Wellenius,GregoryA
• 通讯作者: Wellenius,GregoryA

Corrigendum to "Association of particulate matter air pollution with leukocyte mitochondrial DNA copy number" [Environ. Int. 141 (2020) 105761].

• DOI: 10.1016/j.envint.2020.106069
• 发表时间: 2020-10
• 期刊: Environment international
• 影响因子: 11.8
• 作者: Wang X;Hart JE;Liu Q;Wu S;Nan H;Laden F
• 通讯作者: Laden F

Tropical Cyclone Exposures and Risks of Emergency Medicare Hospital Admission for Cardiorespiratory Diseases in 175 Urban United States Counties, 1999-2010.

1999-2010 年美国 175 个城市县的热带气旋暴露和心肺疾病紧急医疗住院风险。

• DOI: 10.1097/ede.0000000000001337
• 发表时间: 2021-05-01
• 期刊: Epidemiology (Cambridge, Mass.)
• 作者: Yan M;Wilson A;Dominici F;Wang Y;Al-Hamdan M;Crosson W;Schumacher A;Guikema S;Magzamen S;Peel JL;Peng RD;Anderson GB
• 通讯作者: Anderson GB