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

基本信息

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
项目类别：
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&apos 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

项目摘要

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.

项目概要心血管疾病（CVD）是美国和全世界发病率和死亡率的主要原因。研究提供了强有力的证据表明，长期暴露于许多空气污染物（例如颗粒物 < 2.5 微米直径 (PM2.5)、臭氧、二氧化氮 (NO2) 和天气变量（例如夏季温度）变异性、热浪和冷浪）与 CVD 相关。然而，大多数这些研究都估计了影响一次只长期接触一种环境物质，很少根据潜在的影响进行调整其他因素的混杂影响。事实上，我们面临着这些空气污染物和天气变量同时地。因此，如果没有严格的方法来估计与多种疾病相关的健康影响暴露，健康负担可能会被低估。除了严谨、全面的为了量化这些健康影响，重要的是描述易感性并确定改变因素因此可以预防和减少多次接触对健康的影响。虽然固有假设特征、生活方式和背景因素会加剧或减轻不利的影响对于健康影响，人们对它们与多次接触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（例如体力活动、饮食、吸烟）可以减轻或进一步缓解，人们知之甚少。加剧空气污染和气温的不利影响； 2）哪些上下文测量（例如步行性、绿色空间）可以减轻这些风险； 4）多次暴露是否也会影响术后生存非致命性心肌梗死 (MI)。此外，没有研究能够考虑现实世界的情况多种改变因素的同时影响。该提案的目标是全面解决这些知识差距。我们有访问权限史无前例地收集了五个来自美国的大型群体，其中包含大量随时间变化的信息生活方式因素、居住地址和医疗记录确诊病例：护士健康研究 (NHS)、护士健康研究 II (NHSII)、卫生专业人员随访研究 (HPFS)、整个队列医疗保险参保者 (MC) 以及与医疗保险索赔数据相关的医疗保险当前受益人调查 (MC- MCBS）。我们的具体目标是开发新方法来评估多重风险背景下的多重风险混杂和效果修改；评估长期暴露于多种环境之间的关联环境因素（空气污染和天气）对心血管疾病风险、死亡率和非致命性心肌梗死后生存的影响；并描述多种环境暴露、固有特征、背景之间的相互作用和生活方式因素。

项目成果

期刊论文数量（15）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Estimating a Causal Exposure Response Function with a Continuous Error-Prone Exposure: A Study of Fine Particulate Matter and All-Cause Mortality.

估计连续易错暴露的因果暴露响应函数：细颗粒物和全因死亡率的研究。

DOI：
发表时间：
2023-03
期刊：
影响因子：
0
作者：
Josey, Kevin P;deSouza, Priyanka;Wu, Xiao;Braun, Danielle;Nethery, Rachel
通讯作者：
Nethery, Rachel

Unequal airborne exposure to toxic metals associated with race, ethnicity, and segregation in the USA.

在美国，有毒金属在空气中的暴露程度与种族、民族和种族隔离有关。

DOI：
发表时间：
2022-11-01
期刊：
影响因子：
16.6
作者：
Kodros, John K;Bell, Michelle L;Dominici, Francesca;L'Orange, Christian;Godri Pollitt, Krystal J;Weichenthal, Scott;Wu, Xiao;Volckens, John
通讯作者：
Volckens, John

Discovering Heterogeneous Exposure Effects Using Randomization Inference in Air Pollution Studies.

在空气污染研究中使用随机推理发现异质暴露效应。