BACKGROUND Although many studies have established significant associations between short-term air pollution and the risk of getting cardiovascular diseases, there is a lack of evidence based on causal distributed lag modeling. METHODS Inverse probability weighting (ipw) propensity score models along with conditional logistic outcome regression models based on a case-crossover study design were applied to get the causal unconstrained distributed (lag0-lag5) as well as cumulative lag effect of short-term exposure to PM2.5/Ozone on hospital admissions of acute myocardial infarction (AMI), congestive heart failure (CHF) and ischemic stroke (IS) among New England Medicare participants during 2000-2012. Effect modification by gender, race, secondary diagnosis of Chronic Obstructive Pulmonary Diseases (COPD) and Diabetes (DM) was explored. RESULTS Each 10 μg/m3 increase in lag0-lag5 cumulative PM2.5 exposure was associated with an increase of 4.3% (95% confidence interval: 2.2%, 6.4%, percentage change) in AMI hospital admission rate, an increase of 3.9% (2.4%, 5.5%) in CHF rate and an increase of 2.6% (0.4%, 4.7%) in IS rate. A weakened lagging effect of PM2.5 from lag0 to lag5 could be observed. No cumulative short-term effect of ozone on CVD was found. People with secondary diagnosis of COPD, diabetes, female gender and black race are sensitive population. CONCLUSIONS Based on our causal distributed lag modeling, we found that short-term exposure to an increased ambient PM2.5 level had the potential to induce higher risk of CVD hospitalization in a causal way. More attention should be paid to population of COPD, diabetes, female gender and black race.

中文翻译：

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短期暴露于 PM2.5 和臭氧对新英格兰医疗保险参与者 CVD 住院的逆概率加权分布滞后效应 - 探索因果效应。

背景虽然许多研究已经确定短期空气污染与患心血管疾病的风险之间存在显着关联，但缺乏基于因果分布滞后模型的证据。方法 应用逆概率加权 (ipw) 倾向评分模型以及基于案例交叉研究设计的条件逻辑结果回归模型来获得短期暴露的因果无约束分布 (lag0-lag5) 以及累积滞后效应PM2.5/臭氧对 2000-2012 年新英格兰医疗保险参与者因急性心肌梗死 (AMI)、充血性心力衰竭 (CHF) 和缺血性中风 (IS) 入院的影响。探讨了性别、种族、慢性阻塞性肺疾病 (COPD) 和糖尿病 (DM) 二次诊断对效果的影响。结果 lag0-lag5 累积 PM2.5 暴露量每增加 10 μg/m3，AMI 入院率就会增加 4.3%（95% 置信区间：2.2%、6.4%，百分比变化），增加 3.9% CHF 利率上升 (2.4%, 5.5%)，IS 利率上升 2.6% (0.4%, 4.7%)。从lag0到lag5，PM2.5的滞后效应减弱。未发现臭氧对 CVD 的累积短期影响。二次诊断患有慢性阻塞性肺病、糖尿病、女性和黑人的人是敏感人群。结论 根据我们的因果分布滞后模型，我们发现短期暴露于升高的环境 PM2.5 水平有可能以因果方式诱发更高的 CVD 住院风险。应更多关注慢性阻塞性肺病、糖尿病、女性和黑人种族人群。