Long-Term Exposures to Air Pollution and the Risk of Atrial Fibrillation in the Women’s Health Initiative Cohort,Environmental Health Perspectives

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Long-Term Exposures to Air Pollution and the Risk of Atrial Fibrillation in the Women’s Health Initiative Cohort
Environmental Health Perspectives ( IF 10.4 ) Pub Date : 2021-9-15 , DOI: 10.1289/ehp7683
Jaime E Hart _{1,

2} , Chancellor Hohensee ₃ , Francine Laden _{1,

2,

4} , Isabel Holland ₁ , Eric A Whitsel _{5,

6} , Gregory A Wellenius ₇ , Wolfgang C Winkelmayer ₈ , Gloria E Sarto ₉ , Lisa Warsinger Martin ₁₀ , JoAnn E Manson _{1,

4,

11} , Philip Greenland ₁₂ , Joel Kaufman ₁₃ , Christine Albert _{11,

14} , Marco V Perez ₁₅

Affiliation

Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.
Women's Health Initiative Clinical Coordinating Center, Division of Public Health, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA.
Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas, USA.
Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA.
Department of Cardiology, Cedars Sinai Medical Center, Los Angeles, California, USA.
Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.

Abstract

Background:

Atrial fibrillation (AF) is associated with substantial morbidity and mortality. Short-term exposures to air pollution have been associated with AF triggering; less is known regarding associations between long-term air pollution exposures and AF incidence.

Objectives:

Our objective was to assess the association between long-term exposures to air pollution and distance to road on incidence of AF in a cohort of U.S. women.

Methods:

We assessed the association of high resolution spatiotemporal model predictions of long-term exposures to particulate matter ( $particulate matter begin subscript 10 end subscript$ and $particulate matter begin subscript 2.5 end subscript$ ), sulfur dioxide ( ${SO}_{2}$ ), nitrogen dioxide ( ${NO}_{2}$ ), and distance to major roads with incidence of AF diagnosis, identified through Medicare linkage, among 83,117 women in the prospective Women’s Health Initiative cohort, followed from enrollment in Medicare through December 2012, incidence of AF, or death. Using time-varying Cox proportional hazards models adjusted for age, race/ethnicity, study component, body mass index, physical activity, menopausal hormone therapy, smoking, diet quality, alcohol consumption, educational attainment, and neighborhood socioeconomic status, we estimated the relative risk of incident AF in association with each pollutant.

Results:

A total of 16,348 incident AF cases were observed over 660,236 person-years of follow-up. Most exposure–response associations were nonlinear. ${NO}_{2}$ was associated with risk of AF in multivariable adjusted models [ $hazard ratio equals 1.18$ ; 95% confidence interval (CI): 1.13, 1.24, comparing the top to bottom quartile, $lowercase italic p for trend equals less than 0.0001$ ]. Women living closer to roadways were at higher risk of AF (e.g., $hazard ratio equals 1.07$ ; 95% CI: 1.01, 1.13 for living within $50 meters$ of A3 roads, compared with $greater than or equal to 1000 meters$ , $lowercase italic p for trend equals 0.02$ ), but we did not observe adverse associations with exposures to $particulate matter begin subscript 10 end subscript$ , $particulate matter begin subscript 2.5 end subscript$ , or ${SO}_{2}$ . There were adverse associations with $particulate matter begin subscript 10 end subscript$ (top quartile $hazard ratio equals 1.10$ ; 95% CI: 1.05, 1.16, $lowercase italic p for trend equals less than 0.0001$ ) and $particulate matter begin subscript 2.5 end subscript$ (top quartile $hazard ratio equals 1.09$ ; 95% CI: 1.03, 1.14, $lowercase italic p for trend equals 0.002$ ) in sensitivity models adjusting for census region.

Discussion:

In this study of postmenopausal women, ${NO}_{2}$ and distance to road were consistently associated with higher risk of AF. https://doi.org/10.1289/EHP7683

中文翻译：

女性健康倡议队列中长期暴露于空气污染和心房颤动的风险

摘要

背景：

心房颤动（AF）与大量的发病率和死亡率相关。短期暴露于空气污染与房颤触发有关；关于长期空气污染暴露与房颤发病率之间的关系，人们知之甚少。

目标：

我们的目标是评估一组美国女性中长期暴露于空气污染和距道路距离与房颤发病率之间的关系。

方法：

我们评估了长期暴露于颗粒物的高分辨率时空模型预测的关联（ $particulate matter begin subscript 10 end subscript$ 和 $particulate matter begin subscript 2.5 end subscript$ ），二氧化硫（ ${所以}_{2}$ ），二氧化氮（ $不_{2}$ ），以及与 AF 诊断发生率相关的主要道路的距离，通过 Medicare 链接确定，在预期妇女健康倡议队列中的 83,117 名女性中，从参加 Medicare 到 2012 年 12 月，跟踪 AF 发生率或死亡。使用根据年龄、种族/族裔、研究组成部分、体重指数、体力活动、更年期激素治疗、吸烟、饮食质量、饮酒量、教育程度和社区社会经济地位进行调整的时变 Cox 比例风险模型，我们估计了相对与每种污染物相关的房颤事件风险。

结果：

在 660,236 人年的随访中，总共观察到 16,348 起房颤病例。大多数暴露-反应关联是非线性的。 $不_{2}$ 在多变量调整模型中与房颤风险相关[ $hazard ratio equals 1.18$ ; 95% 置信区间 (CI)：1.13、1.24，比较顶部和底部四分位数， $lowercase italic p for trend equals less than 0.0001$ ]。居住在靠近道路的女性患房颤的风险较高（例如， $hazard ratio equals 1.07$ ; 95% CI: 1.01, 1.13 居住在 $50 meters$ A3 道路的数量，与 $greater than or equal to 1000 meters$ , $lowercase italic p for trend equals 0.02$ ），但我们没有观察到与暴露于 $particulate matter begin subscript 10 end subscript$ , $particulate matter begin subscript 2.5 end subscript$ ，或者 ${所以}_{2}$ 。存在不良关联 $particulate matter begin subscript 10 end subscript$ （最高四分位数 $hazard ratio equals 1.10$ ; 95% CI: 1.05, 1.16, $lowercase italic p for trend equals less than 0.0001$ ）和 $particulate matter begin subscript 2.5 end subscript$ （最高四分位数 $hazard ratio equals 1.09$ ; 95% CI: 1.03, 1.14, $lowercase italic p for trend equals 0.002$ ）在针对人口普查区域进行调整的敏感度模型中。