Ambient PM2.5 is a ubiquitous air pollutant with demonstrated adverse health impacts in population. Hemodialysis patients are a highly vulnerable population and may be particularly susceptible to the effects of PM2.5 exposure. This study examines associations between short-term PM2.5 exposure and cardiovascular disease (CVD) and mortality among patients receiving maintenance in-center hemodialysis. Using the United State Renal Data System (USRDS) registry, we enumerated a cohort of all US adult kidney failure patients who initiated in-center hemodialysis between 1/1/2011 and 12/31/2016. Daily ambient PM2.5 exposure estimates were assigned to cohort members based on the ZIP code of the dialysis clinic. CVD incidence and mortality were ascertained through 2016 based on USRDS records. Discrete time hazards regression was used to estimate the association between lagged PM2.5 exposure and CVD incidence, CVD-specific mortality, and all-cause mortality 1 t adjusting for temperature, humidity, day of the week, season, age at baseline, race, employment status, and geographic region. Effect measure modification was assessed for age, sex, race, and comorbidities. Among 314,079 hemodialysis patients, a 10 µg/m3 increase in the average lag 0–1 daily PM2.5 exposure was associated with CVD incidence (HR: 1.03 (95% CI: 1.02, 1.04)), CVD mortality (1.05 (95% CI: 1.03, 1.08)), and all-cause mortality (1.04 (95% CI: 1.03, 1.06)). The association was larger for people who initiated dialysis at an older age, while minimal evidence of effect modification was observed across levels of sex, race, or baseline comorbidities. Short-term ambient PM2.5 exposure was positively associated with incident CVD events and mortality among patients receiving in-center hemodialysis. Older patients appeared to be more susceptible to PM2.5-associated CVD events than younger hemodialysis patients.

中文翻译：

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短期环境 PM2.5 暴露对美国血液透析患者心血管疾病发病率和死亡率的影响：一项回顾性队列研究

环境 PM2.5 是一种无处不在的空气污染物，已证明对人群健康有不利影响。血液透析患者是一个高度脆弱的人群，可能特别容易受到 PM2.5 暴露的影响。本研究调查了在中心接受维持性血液透析的患者中，短期 PM2.5 暴露与心血管疾病 (CVD) 和死亡率之间的关联。我们使用美国肾脏数据系统 (USRDS) 登记处，列举了 2011 年 1 月 1 日至 2016 年 12 月 31 日期间开始中心血液透析的所有美国成年肾衰竭患者队列。根据透析诊所的邮政编码，将每日环境 PM2.5 暴露估计分配给队列成员。根据 USRDS 记录，确定了 2016 年的 CVD 发病率和死亡率。离散时间风险回归用于估计滞后 PM2.5 暴露与 CVD 发病率、CVD 特定死亡率和全因死亡率之间的关联 1 t 调整温度、湿度、星期几、季节、基线年龄、种族、就业状况和地理区域。对年龄、性别、种族和合并症的影响测量修改进行了评估。在 314,079 名血液透析患者中​​，平均滞后 0-1 天的 PM2.5 暴露增加 10 µg/m3 与 CVD 发病率（HR：1.03（95% CI：1.02，1.04））、CVD 死亡率（1.05（95% CI：1.03，1.08)）和全因死亡率（1.04（95% CI：1.03，1.06））。对于年龄较大的开始透析的人来说，这种关联更大，而在性别、种族或基线合并症水平上观察到的影响改变的证据很少。短期环境PM2.5 5 暴露与接受中心血液透析的患者的 CVD 事件和死亡率呈正相关。与年轻的血液透析患者相比，老年患者似乎更容易发生 PM2.5 相关的 CVD 事件。