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1.
Int J Biometeorol ; 64(1): 139-144, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31754771

RESUMO

Limited evidence was seen as the association between fine particulate matter (PM2.5) and physician visits for allergic rhinitis (AR), especially in countries with extreme air pollution exposure. This paper addressed the issues about the association between PM2.5 and daily outpatient visits for AR among individuals residing in Beijing, China. Data on daily outpatient visits for AR obtained from Beijing Medical Claim Data for Employees and daily PM2.5 concentrations available from US embassy reports were linked by date from January 1, 2010, to June 30, 2012. A time-series analysis was conducted with a generalized additive Poisson model to assess the association between PM2.5 and AR, adjusting for daily average temperature, relative humidity, day of the week, calendar time, and public holiday. Totally, 229,685 outpatient visits for AR were included in the analysis. The daily mean (SD) concentration of PM2.5 was 99.5 (75.3) µg/m3 during the study period. We found that a 10-µg/m3 increase in PM2.5 content was associated with a 0.47% (95% CI: 0.39% to 0.55%) increase in the number of outpatient visits on the same day. Furthermore, results from subgroup analyses suggested that the association was consistently significant among the groups of different ages (< 65 years and ≥ 65 years) and gender. However, this study failed to find a statistically significant association in the autumn season but found significant positive associations during the spring and summer seasons (P for interaction < 0.001). This study indicated a possible association between PM2.5 and AR outpatients, which may benefit further researches in studying PM2.5 and its influence on diseases in a real and seriously air-polluted context.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Rinite Alérgica , Pequim , China , Humanos , Pacientes Ambulatoriais , Material Particulado
2.
Medicine (Baltimore) ; 98(40): e17411, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577753

RESUMO

Evidence on the prescription patterns of antihypertensive drug use in children and adolescents in China is scarce. A descriptive analysis of the Beijing Medical Claim Data, which covered over 95% of the urban residents, was conducted to investigate antihypertensive prescribing patterns and trends in children and adolescents aged under 18 from 2009 to 2014 in Beijing, China. An additional meta-analysis of trends in hypertension prevalence was conducted to compare trends with antihypertensive medications.A total of 11,882 patients received at least 1 prescription for antihypertensive drugs from 2009 to 2014. The number of annual antihypertensive users increased from 2009 to 2012, then declined steadily until 2014, which was consistent with the trend of the hypertension prevalence estimated from the meta-analysis. ß-receptor blockers, thiazide diuretics, and angiotensin-converting enzyme inhibitors were the 3 most commonly prescribed antihypertensive drugs. More boys took the antihypertensive drugs than girls. For users aged under 3 years, thiazide diuretics, α-receptor blockers, and angiotensin-converting enzyme inhibitors were the most prescribed drugs, while ß-receptor blockers, thiazide diuretics were the most used drugs for users above 3 years.In conclusion, antihypertensive drug prescribing for children and adolescents increased from 2009 to 2014, with different characteristics in different subgroups.


Assuntos
Anti-Hipertensivos/classificação , Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Adolescente , Fatores Etários , Pequim , Criança , Pré-Escolar , Feminino , Humanos , Hipertensão/epidemiologia , Lactente , Masculino , Padrões de Prática Médica/estatística & dados numéricos , Fatores Sexuais , População Urbana/estatística & dados numéricos
3.
Genet Test Mol Biomarkers ; 23(7): 435-441, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31294628

RESUMO

Aims: To discover possible relationships between CXCL12 single nucleotide polymorphisms (SNPs) and type 2 diabetes mellitus (T2DM) and its risk factors. Methods: The present sib-pair study was conducted in a rural community of Beijing, China. SNPs rs2297630, rs1746048, and rs1801157 located within or nearby the CXCL12 gene were genotyped using the allele-specific polymerase chain reaction method. Haseman-Elston regression was used to investigate linkages between these SNPs and T2DM. A generalized estimating equation logistic regression model was used to discover associations between the SNPs, T2DM, and its risk factors. Results: A total of 3171 participants were recruited, comprising 2277 sib pairs. After Bonferroni correction (α = 0.016), rs2297630 was found to be significantly linked to (p = 0.003) and associated with T2DM (AA vs. GG/GA: OR = 2.26, 95% CI: 1.31-3.88, p = 0.003). There were interactions between rs2297630 and dyslipidemia (p < 0.001) and between rs1746048 and hypertension (p = 0.011). Compared to dyslipidemia-free subjects with rs2297630 GG/GA genotypes, dyslipidemia patients with rs2297630 AA had a higher risk of T2DM (OR = 4.15, 95% CI: 2.24-7.67, p < 0.001). Compared to hypertension-free subjects with rs1746048 CC genotypes, hypertension-free subjects with rs1746048 CT/TT had a decreased risk of T2DM (OR = 0.77, 95% CI: 0.60-0.99, p = 0.045). Conclusions: A novel linkage and association was found between rs2297630 and T2DM. Moreover, novel interactions were found between rs2297630 and dyslipidemia as well as rs1746048 and hypertension. These findings will help identify individuals at higher risk of developing T2DM.


Assuntos
Quimiocina CXCL12/genética , Diabetes Mellitus Tipo 2/genética , China , Dislipidemias/genética , Feminino , Interação Gene-Ambiente , Estudos de Associação Genética , Humanos , Estilo de Vida , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Fatores de Risco
4.
Int J Epidemiol ; 48(4): 1142-1151, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31157384

RESUMO

BACKGROUND: The association between short-term exposure to ambient fine particulate matter (PM2.5) and morbidity risk in developing countries is not fully understood. We conducted a nationwide time-series study to estimate the short-term effect of PM2.5 on hospital admissions in Chinese adults. METHODS: Daily counts of hospital admissions for 2014-16 were obtained from the National Urban Employee Basic Medical Insurance database. We identified more than 58 million hospitalizations from 0.28 billion insured persons in 200 Chinese cities for subjects aged 18 years or older. Generalized additive models with quasi-Poisson regression were applied to examine city-specific associations of PM2.5 concentrations with hospital admissions. National-average estimates of the association were obtained from a random-effects meta-analysis. We also investigated potential effect modifiers, such as age, sex, temperature and relative humidity. RESULTS: An increase of 10 µg/m3 in same-day PM2.5 concentrations was positively associated with a 0.19% (95% confidence interval: 0.07-0.30) increase in the daily number of hospital admissions at the national level. PM2.5 exposure remained positively associated with hospital admissions on days when the daily concentrations met the current Chinese Ambient Air Quality Standards (75 µg/m3). Estimates of admission varied across cities and increased in cities with lower PM2.5 concentrations (p = 0.044) or higher temperatures (p = 0.002) and relative humidity (p = 0.003). The elderly were more sensitive to PM2.5 exposure (p < 0.001). CONCLUSIONS: Short-term exposure to PM2.5 was positively associated with adult hospital admissions in China, even at levels below current Chinese Ambient Air Quality Standards.

5.
J Thromb Thrombolysis ; 48(2): 303-314, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30980227

RESUMO

The rs7903146, an established genetic variant susceptible to type 2 diabetes (T2D), is also reported to be related to ischemic stroke (IS), though conflicting. Furthermore, it remained unknown whether the genetic association with stroke is independent of T2D. In the current study, 1603 individuals across 986 families were included. The genetic pleiotropic effect on each outcome diseases (T2D, overall IS, or each subtype) was assessed using multilevel logistic regression after adjustment for multiple covariates. Principal component of heritability (PCH) was also used to assess the pleiotropy by combining T2D and IS into one outcome for analysis. To identify the T2D-independent path out of the pleiotropic effect on IS, T2D status was additionally adjusted for the risk of IS or each subtype. The analyses of putative molecular pathways (dyslipidemia, hypertension, obesity and inflammation) and gene-lifestyle interactions were also performed. We found that rs7903146_T allele was associated with a 77% higher risk of T2D, 55% of IS, and 70% of large artery atherosclerosis (LAA) subtype respectively. Particularly, a T2D-independent genetic effect was identified to increase the risk of overall IS and LAA. No evidence on the molecular mechanisms and gene-lifestyle interaction behind the pleiotropic genetic effect was observed. In conclusion, our study provided evidence that a T2D-independent path was identified out of the pleiotropic effect of rs7903146 on IS. However, further studies were needed to validate the biological mechanisms behind the pleiotropic effect and the modification by lifestyle intervention.


Assuntos
Diabetes Mellitus Tipo 2/genética , Predisposição Genética para Doença , Variação Genética , Acidente Vascular Cerebral/genética , Grupo com Ancestrais do Continente Asiático , Aterosclerose , Isquemia Encefálica/genética , Diabetes Mellitus Tipo 2/complicações , Família , Feminino , Humanos , Masculino , Fatores de Risco , Acidente Vascular Cerebral/complicações
6.
J Atheroscler Thromb ; 26(9): 835-845, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30828007

RESUMO

AIM: ATP-binding cassette A1 (ABCA1) plays an important role in reducing the risk of stroke. Egg is the major source of dietary cholesterol and is known to be associated with the risk of stroke and atherosclerosis. We aimed to assess the effects of interaction between an ABCA1 variant (rs2066715) and egg consumption on the risk of ischemic stroke (IS), carotid plaque, and carotid-intima media thickness (CIMT) in the Chinese population. METHODS: In total, 5869 subjects (including 1213 IS cases) across 1128 families were enrolled and divided into two groups based on the median egg consumption (4 eggs per week). In the analyses for the presence of carotid plaque and CIMT, 3171 out of 4656 IS-free controls without self-reported history of coronary heart disease and lipid-lowering medications were included. Multilevel logistic regression models were used to model the genetic association of rs2066715 with the risk of IS, and mixed-effect linear regression for the genetic association of rs2066715 with carotid plaque, and CIMT. The gene-by-egg cross-product term was included in the regression model for interaction analysis. RESULTS: We found that rs2066715 was associated with the increased risk of carotid plaque among those who consumed <4 eggs per week after adjustment (odds ratio [95% confidence interval]: 1.61 [1.08, 2.39], P =0.019). A significant effect of interaction between rs2066715 and egg consumption on the risk of carotid plaque was identified (P =0.011). CONCLUSION: rs2066715 was found to interact with egg consumption in modifying the risk of carotid plaque in the Chinese population.

7.
Medicine (Baltimore) ; 98(8): e14370, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813137

RESUMO

The purpose of this study was to describe the prescription pattern of initial treatment for type 2 diabetes (T2DM) in Beijing from 2011 to 2015.We selected 790,339 newly diagnosed outpatients with T2DM from the Beijing Medical Claim Data for Employees database between January 2011 and December 2015. The percentages of different treatments and agents were calculated from the patients' 1st prescriptions. Subgroup analyses were conducted for primary, secondary, and tertiary hospital settings.The initial treatments given to 57.7%, 30.7%, and 11.7% of patients were oral hypoglycemic agent (OHA) monotherapy, OHA polytherapy, and insulin, respectively. Alpha-glucosidase inhibitors (AGIs) (43.0%) were the most commonly used agents for monotherapy, followed by metformin (35.5%) and sulfonylureas (14.9%). AGIs were most commonly used in primary hospitals (52.0%), while metformin was prescribed most often in secondary (37.6%) and tertiary (41.8%) hospitals. From 2011 to 2015, there were increases in the use of AGIs (40.1-41.1%, P < .001) and metformin (34.0-40.4%, P < .001), but a decrease in the use of sulfonylureas (18.1-12.8%, P < .001). Similar trends were seen in the different hospital settings. Metformin plus an AGI, a sulfonylurea plus an AGI, and metformin plus a sulfonylurea were the most common OHA polytherapy combinations. The use of metformin plus an AGI increased from 13.8% in 2011 to 19.7% in 2015 (P < .001), while the use of a sulfonylurea plus an AGI, and metformin plus a sulfonylurea, did not change significantly.Half of newly diagnosed patients with T2DM received an initial treatment of OHA monotherapy. Although the use of metformin increased from 2011 to 2015, both AGIs and metformin were the most commonly prescribed agents. The patterns differed from those of most other countries and identification of the underlying reasons will require further investigation.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Padrões de Prática Médica , Adulto , Idoso , Pequim , Prescrições de Medicamentos/estatística & dados numéricos , Quimioterapia Combinada , Feminino , Inibidores de Glicosídeo Hidrolases/uso terapêutico , Humanos , Insulina/uso terapêutico , Masculino , Metformina/uso terapêutico , Pessoa de Meia-Idade , Compostos de Sulfonilureia/uso terapêutico
8.
Stroke ; 50(4): 813-819, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30841819

RESUMO

Background and Purpose- Evidence on the effects of coarse particulate matter (PM10-2.5) on ischemic stroke is limited and inconsistent. We evaluated the acute effects of PM10-2.5 exposure on hospital admissions for ischemic stroke in China. Methods- We conducted a national time-series analysis of associations between daily PM10-2.5 concentrations and daily hospital admissions for ischemic stroke in China between January 2014 and December 2016. Hospital admissions for ischemic stroke were identified from the database of Urban Employee Basic Medical Insurance, which contains data from 0.28 billion beneficiaries. We applied a city-specific Poisson regression to examine the associations of PM10-2.5 and daily ischemic stroke admissions. We combined the city-specific effect estimates with a random effects meta-analysis, and further evaluated the exposure-response relationship curve and potential effect modifiers. Results- We identified >2 million hospital admissions for ischemic stroke in 172 Chinese cities. A 10 µg/m3 increase in PM10-2.5 concentrations (lag day 0) was associated with a 0.91% (95% CI, 0.73-1.10) increase in hospital admissions for ischemic stroke. The association remained significant after adjusting for PM2.5 (percentage change, 0.96%; 95% CI, 0.75-1.18). The exposure-response relationship was approximately linear, with a moderate response at lower levels (<200 µg/m3) and a steeper response at higher levels. The association was stronger in cities with lower PM10-2.5 concentrations, higher temperatures, or higher relative humidity. Conclusions- This nationwide study provides robust evidence of the short-term association between exposure to PM10-2.5 and increased hospital admissions for ischemic stroke and supports the hypothesis that the association differs by city characteristics.


Assuntos
Isquemia Encefálica/etiologia , Material Particulado/efeitos adversos , Acidente Vascular Cerebral/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos/análise , Poluição do Ar/análise , China , Cidades , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Material Particulado/análise , Adulto Jovem
9.
Environ Sci Pollut Res Int ; 26(14): 14178-14183, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30859442

RESUMO

The effects of ambient fine particulate matter (PM2.5) on the incidence of myocardial infarction have been reported, but little is known about this association in China. We conducted a time-series study of ambient PM2.5 concentrations and inpatient visits for myocardial infarction in Beijing. A generalized additive model with a Poisson link was applied to estimate the percentage change in inpatient visits for myocardial infarction following a 10-µg/m3 increase in PM2.5 concentrations. A total of 15,432 inpatient visits for myocardial infarction were identified between January 1, 2010, and June 30, 2012. A 10-µg/m3 increase in PM2.5 concentrations was associated with a 0.46% (P ≤ 0.001) increase in daily inpatient visits for myocardial infarction. Males were more sensitive to the adverse effects, and the association was more significant during the warm season (May through October). Short-term exposure to PM2.5 was associated with increased risk of inpatient visits for myocardial infarction in Beijing. The findings may be useful in developing more accurate targeted interventions.


Assuntos
Poluição do Ar/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Infarto do Miocárdio/epidemiologia , Material Particulado/análise , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Pequim/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Humanos , Hipersensibilidade , Incidência , Pacientes Internados/estatística & dados numéricos , Masculino , Infarto do Miocárdio/induzido quimicamente , Estações do Ano
10.
Artigo em Inglês | MEDLINE | ID: mdl-30781785

RESUMO

Few studies have examined the association between fine particulate matter (PM2.5) and upper respiratory tract infections (URTI) in urban cities. The principal aim of the present study was to evaluate the short-term impact of PM2.5 on the incidence of URTI in Beijing, China. Data on hospital visits due to URTI from 1 October 2010 to 30 September 2012 were obtained from the Beijing Medical Claim Data for Employees, a health insurance database. Daily PM2.5 concentration was acquired from the embassy of the United States of America (US) located in Beijing. A generalized additive Poisson model was used to analyze the effect of PM2.5 on hospital visits for URTI. We found that a 10 µg/m³ increase in PM2.5 concentration was associated with 0.84% (95% CI, 0.05⁻1.64%) increase in hospital admissions for URTI at lag 0⁻3 days, but there were no significant associations with emergency room or outpatient visits. Compared to females, males were more likely to be hospitalized for URTI when the PM2.5 level increased, but other findings did not differ by age group or gender. The study suggests that short-term variations in PM2.5 concentrations have small but detectable impacts on hospital utilization due to URTI in adults.


Assuntos
Poluentes Atmosféricos/análise , Hospitalização/estatística & dados numéricos , Material Particulado/análise , Infecções Respiratórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos/efeitos adversos , Pequim/epidemiologia , Feminino , Humanos , Incidência , Masculino , Tamanho da Partícula , Material Particulado/efeitos adversos , Infecções Respiratórias/induzido quimicamente , Fatores Sexuais , Saúde da População Urbana
11.
PLoS Med ; 16(1): e1002738, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30689640

RESUMO

BACKGROUND: Epidemiological studies have provided compelling evidence of associations between ambient temperature and cardiovascular disease. However, evidence of effects of daily temperature variability on cardiovascular disease is scarce and mixed. We aimed to examine short-term associations between temperature variability and hospital admissions for cause-specific cardiovascular disease in urban China. METHODS AND FINDINGS: We conducted a national time-series analysis in 184 cities in China between 2014 and 2017. Data on daily hospital admissions for ischemic heart disease, heart failure, heart rhythm disturbances, and ischemic stroke were obtained from the database of Urban Employee Basic Medical Insurance (UEBMI) including 0.28 billion enrollees. Temperature data were acquired from the China Meteorological Data Sharing Service Center. Temperature variability was calculated from the standard deviation (SD) of daily minimum and maximum temperatures over exposure days. City-specific associations between temperature variability and cardiovascular disease were examined with overdispersed Poisson models controlling for calendar time, day of the week, public holiday, and daily mean temperature and relative humidity. Random-effects meta-analyses were performed to obtain national and regional average associations. We also plotted exposure-response relationship curve using a natural cubic spline of temperature variability. There were 8.0 million hospital admissions for cardiovascular disease during the study period. At the national-average level, a 1-°C increase in temperature variability at 0-1 days (TV0-1) was associated with a 0.44% (0.32%-0.55%), 0.31% (0.20%-0.43%), 0.48% (0.01%-0.96%), 0.34% (0.01%-0.67%), and 0.82% (0.59%-1.05%) increase in hospital admissions for cardiovascular disease, ischemic heart disease, heart failure, heart rhythm disturbances, and ischemic stroke, respectively. The estimates decreased but remained significant when controlling for ambient fine particulate matter (PM2.5), NO2, and SO2 pollution. The main limitation of the present study was the unavailability of data on individual exposure to temperature variability. CONCLUSIONS: Our findings suggested that short-term temperature variability exposure could increase the risk of cardiovascular disease, which may provide new insights into the health effects of climate change.


Assuntos
Doenças Cardiovasculares/epidemiologia , Hospitalização/estatística & dados numéricos , Temperatura Ambiente , Adolescente , Adulto , Idoso , Poluentes Atmosféricos/efeitos adversos , Doenças Cardiovasculares/terapia , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , População Urbana/estatística & dados numéricos , Tempo (Meteorologia) , Adulto Jovem
12.
J Diabetes ; 11(7): 552-562, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30520249

RESUMO

BACKGROUND: Metabolic syndrome (MetS) share a genetic basis with type 2 diabetes (T2D). However, whether MetS and its components mediate genetic susceptibility to T2D is not completely understood. METHODS: We assessed the effects of MetS and its components on associations T2D and 18 genome-wide association studies-identified variants using a two-stage strategy based on parametric models involving 7110 Chinese participants (2436 were T2D patients) across 2885 families. Multilevel logistic regression was used to account for the intrafamilial correlation. RESULTS: Metabolic syndrome significantly mediated the effect of a melatonin receptor 1B (MTNR1B) polymorphism on T2D risk (OR of average causal mediation effect [ORACME ] 1.004; 95% confidence interval [CI] 1.001-1.008; P = 0.018). In addition, low high-density lipoprotein cholesterol (HDL-C) levels mediated the genetic effects of MTNR1B (ORACME 1.012; 95% CI 1.007-1.015; P < 0.001), solute carrier family 30 member 8 (SLC30A8; ORACME 1.001; 95% CI 1.000-1.007; P < 0.040), B-cell lymphoma/leukemia 11A (BCL11A; ORACME 1.009; 95% CI 1.007-1.016; P < 0.001), prospero homeobox 1 (PROX1; ORACME 1.005; 95% CI 1.003-1.011; P < 0.001) and a disintegrin and metallopeptidase with thrombospondin type 1 motif 9 (ADAMTS9; ORACME 1.006; 95% CI 1.001-1.009; P = 0.022), whereas increased fasting blood glucose (FBG) significantly mediated the genetic effect of BCL11A (ORACME 1.017; 95% CI 1.003-1.021; P = 0.012). CONCLUSIONS: This study provides evidence that MetS and two of its components (HDL-C, FBG) may be involved in mediating the genetic predisposition to T2D, which emphasize the importance of maintaining normal HDL-C and FBG levels.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Biomarcadores/análise , Diabetes Mellitus Tipo 2/etiologia , Predisposição Genética para Doença , Síndrome Metabólica/complicações , Polimorfismo de Nucleotídeo Único , China/epidemiologia , HDL-Colesterol/genética , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/patologia , Feminino , Seguimentos , Estudo de Associação Genômica Ampla , Genótipo , Proteínas de Homeodomínio/genética , Humanos , Incidência , Masculino , Síndrome Metabólica/genética , Pessoa de Meia-Idade , Prognóstico , Receptor MT2 de Melatonina/genética , Proteínas Repressoras/genética , Fatores de Risco , Proteínas Supressoras de Tumor/genética
13.
BMJ ; 367: l6572, 2019 12 30.
Artigo em Inglês | MEDLINE | ID: mdl-31888884

RESUMO

OBJECTIVE: To estimate the risks of daily hospital admissions for cause specific major cardiovascular diseases associated with short term exposure to ambient fine particulate matter (aerodynamic diameter ≤2.5 µm; PM2.5) pollution in China. DESIGN: National time series study. SETTING: 184 major cities in China. POPULATION: 8 834 533 hospital admissions for cardiovascular causes in 184 Chinese cities recorded by the national database of Urban Employee Basic Medical Insurance from 1 January 2014 to 31 December 2017. MAIN OUTCOME MEASURES: Daily counts of city specific hospital admissions for primary diagnoses of ischaemic heart disease, heart failure, heart rhythm disturbances, ischaemic stroke, and haemorrhagic stroke among different demographic groups were used to estimate the associations between PM2.5 and morbidity. An overdispersed generalised additive model was used to estimate city specific associations between PM2.5 and cardiovascular admissions, and random effects meta-analysis used to combine the city specific estimates. RESULTS: Over the study period, a mean of 47 hospital admissions per day (standard deviation 74) occurred for cardiovascular disease, 26 (53) for ischaemic heart disease, one (five) for heart failure, two (four) for heart rhythm disturbances, 14 (28) for ischaemic stroke, and two (four) for haemorrhagic stroke. At the national average level, an increase of 10 µg/m3 in PM2.5 was associated with a 0.26% (95% confidence interval 0.17% to 0.35%) increase in hospital admissions on the same day for cardiovascular disease, 0.31% (0.22% to 0.40%) for ischaemic heart disease, 0.27% (0.04% to 0.51%) for heart failure, 0.29% (0.12% to 0.46%) for heart rhythm disturbances, and 0.29% (0.18% to 0.40%) for ischaemic stroke, but not with haemorrhagic stroke (-0.02% (-0.23% to 0.19%)). The national average association of PM2.5 with cardiovascular disease was slightly non-linear, with a sharp slope at PM2.5 levels below 50 µg/m3, a moderate slope at 50-250 µg/m3, and a plateau at concentrations higher than 250 µg/m3. Compared with days with PM2.5 up to 15 µg/m3, days with PM2.5 of 15-25, 25-35, 35-75, and 75 µg/m3 or more were significantly associated with increases in cardiovascular admissions of 1.1% (0 to 2.2%), 1.9% (0.6% to 3.2%), 2.6% (1.3% to 3.9%), and 3.8% (2.1% to 5.5%), respectively.According to projections, achieving the Chinese grade 2 (35 µg/m3), Chinese grade 1 (15 µg/m3), and World Health Organization (10 µg/m3) regulatory limits for annual mean PM2.5 concentrations would reduce the annual number of admissions for cardiovascular disease in China. Assuming causality, which should be done with caution, this reduction would translate into an estimated 36 448 (95% confidence interval 24 441 to 48 471), 85 270 (57 129 to 113 494), and 97 516 (65 320 to 129 820), respectively. CONCLUSIONS: These data suggest that in China, short term exposure to PM2.5 is associated with increased hospital admissions for all major cardiovascular diseases except for haemorrhagic stroke, even for exposure levels not exceeding the current regulatory limits.


Assuntos
Doenças Cardiovasculares/induzido quimicamente , Material Particulado/análise , Admissão do Paciente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/classificação , China/epidemiologia , Cidades , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Material Particulado/efeitos adversos , Adulto Jovem
14.
Artigo em Inglês | MEDLINE | ID: mdl-30314262

RESUMO

There is little evidence that acute exposure to fine particulate matter (PM2.5) impacts the rate of hospitalization for congestive heart failure (CHF) in developing countries. The primary purpose of the present retrospective study was to evaluate the short-term association between ambient PM2.5 and hospitalization for CHF in Beijing, China. A total of 15,256 hospital admissions for CHF from January 2010 to June 2012 were identified from Beijing Medical Claim Data for Employees and a time-series design with generalized additive Poisson model was used to assess the obtained data. We found a clear significant exposure response association between PM2.5 and the number of hospitalizations for CHF. Increasing PM2.5 daily concentrations by 10 µg/m³ caused a 0.35% (95% CI, 0.06⁻0.64%) increase in the number of CHF admissions on the same day. We also found that female and older patients were more susceptible to PM2.5. These associations remained significant in sensitivity analyses involving changing the degrees of freedom of calendar time, temperature, and relative humidity. PM2.5 was associated with significantly increased risk of hospitalization for CHF in this citywide study. These findings may contribute to the limited scientific evidence about the acute impacts of PM2.5 on CHF in China.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Material Particulado/efeitos adversos , Adolescente , Adulto , Idoso , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Pequim/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Material Particulado/análise , Estudos Retrospectivos , Adulto Jovem
15.
PLoS Med ; 15(10): e1002668, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30286080

RESUMO

BACKGROUND: Evidence of the short-term effects of ambient air pollution on the risk of ischemic stroke in low- and middle-income countries is limited and inconsistent. We aimed to examine the associations between air pollution and daily hospital admissions for ischemic stroke in China. METHODS AND FINDINGS: We identified hospital admissions for ischemic stroke in 2014-2016 from the national database covering up to 0.28 billion people who received Urban Employee Basic Medical Insurance (UEBMI) in China. We examined the associations between air pollution and daily ischemic stroke admission using a two-stage method. Poisson time-series regression models were firstly fitted to estimate the effects of air pollution in each city. Random-effects meta-analyses were then conducted to combine the estimates. Meta-regression models were applied to explore potential effect modifiers. More than 2 million hospital admissions for ischemic stroke were identified in 172 cities in China. In single-pollutant models, increases of 10 µg/m3 in particulate matter with aerodynamic diameter <2.5 µm (PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3) and 1 mg/m3 in carbon monoxide (CO) concentrations were associated with 0.34% (95% confidence interval [CI], 0.20%-0.48%), 1.37% (1.05%-1.70%), 1.82% (1.45%-2.19%), 0.01% (-0.14%-0.16%), and 3.24% (2.05%-4.43%) increases in hospital admissions for ischemic stroke on the same day, respectively. SO2 and NO2 associations remained significant in two-pollutant models, but not PM2.5 and CO associations. The effect estimates were greater in cities with lower air pollutant levels and higher air temperatures, as well as in elderly subgroups. The main limitation of the present study was the unavailability of data on individual exposure to ambient air pollution. CONCLUSIONS: As the first national study in China to systematically examine the associations between short-term exposure to ambient air pollution and ischemic stroke, our findings indicate that transient increase in air pollution levels may increase the risk of ischemic stroke, which may have significant public health implications for the reduction of ischemic stroke burden in China.


Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar/estatística & dados numéricos , Isquemia Encefálica/epidemiologia , Admissão do Paciente/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Idoso , Isquemia Encefálica/complicações , Monóxido de Carbono/toxicidade , China/epidemiologia , Cidades/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dióxido de Nitrogênio/toxicidade , Tamanho da Partícula , Material Particulado/toxicidade , Acidente Vascular Cerebral/etiologia , Dióxido de Enxofre/toxicidade , Temperatura Ambiente , Fatores de Tempo , Adulto Jovem
16.
Sci Rep ; 8(1): 13336, 2018 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-30190544

RESUMO

Evidence on the acute effects of ambient carbon monoxide (CO) pollution on morbidity risk in developing countries is scarce and inconsistent. We conducted a multicity case-crossover study in 26 largest cities in China from January, 2014 to December, 2015 to examine the association between short-term exposure to CO and daily hospital admission. We fitted conditional logistic regression to obtain effect estimates of the associations. We also performed subset analyses to explore the health effects of CO at low levels. During the study period, a total of 14,569,622, 2,008,786 and 916,388 all-cause, cardiovascular and respiratory admissions were identified, respectively. A 1 mg/m3 increase in the CO concentrations corresponded to a 3.75% (95% CI, 3.63-3.87%), 4.39% (95% CI, 4.07-4.70%), and 4.44% (95% CI, 3.97-4.92%) increase in all-cause, cardiovascular, and respiratory admissions on the same day, respectively. The associations were robust to controlling for criteria co-pollutants. In subset analyses, negative effects of short-term CO exposure on hospital admission were observed at lower concentrations (<1 mg/m3), while positive effects were observed at higher concentrations (>2 mg/m3). In conclusion, current CO levels in China were significantly associated with increased daily hospital admissions.


Assuntos
Intoxicação por Monóxido de Carbono/epidemiologia , Monóxido de Carbono , Admissão do Paciente , Adulto , Idoso , Intoxicação por Monóxido de Carbono/terapia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Environ Pollut ; 242(Pt B): 1042-1049, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30096542

RESUMO

There have been few large multicity studies to evaluate the acute health effects of ambient air pollution on morbidity risk in developing counties. In this study, we examined the short-term associations of air pollution with daily hospital admissions in China. We conducted a nationwide time-series study in 218 Chinese cities between 2014 and 2016. Data on daily hospital admissions counts were obtained from the National Health Insurance Database for Urban Employees covering 0.28 billion enrollees. We used generalized additive model with Poisson regression to estimate the associations in each city, and we performed random-effects meta-analysis to pool the city-specific estimates. More than 60 million hospital admissions were analyzed in this study. At the national-average level, each 10 µg/m3 increase in PM10, SO2, and NO2, and 1 mg/m3 increase in CO at lag 0 day was associated with a 0.29% (95% CI, 0.23%-0.36%), 1.16% (95% CI, 0.92%-1.40%), 1.68% (95% CI, 1.40%-1.95%), and 2.59% (95% CI, 1.69%-3.50%) higher daily hospital admissions, respectively. The associations of air pollution with hospital admissions remained statistically significant at levels below the current Chinese Ambient Air Quality Standards. The effect estimates were larger in cities with lower air pollutants levels or higher air temperatures and relative humidity, as well as in the elderly. In conclusion, our findings provide robust evidence of increased hospital admissions in association with short-term exposure to ambient air pollution in China.


Assuntos
Poluição do Ar/análise , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Idoso , Poluentes Atmosféricos/análise , Monóxido de Carbono/análise , China/epidemiologia , Cidades/epidemiologia , Monitoramento Ambiental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dióxido de Nitrogênio/análise , Material Particulado/análise , Risco , Dióxido de Enxofre/análise , Temperatura Ambiente , Adulto Jovem
18.
Epidemiology ; 29(5): 649-657, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29870428

RESUMO

BACKGROUND: Few studies have evaluated the short-term impacts of ambient particulate matter (PM) pollution on morbidity in China. The aims of this study were to examine the short-term association between hospital admissions and ambient PM and also to explore whether PM2.5 at levels below current regulatory limits also increases the risk of hospitalizations in 26 Chinese cities. METHODS: We identified 14,569,622 all-cause, 2,008,786 cardiovascular, and 916,388 respiratory admissions during 2014-2015. We employed conditional logistic regression to estimate the association between hospital admissions and ambient PM. RESULTS: A 10 µg/m increase in PM2.5 at lag 0 day corresponded to increases of 0.19% (95% confidence interval [CI] = 0.18%, 0.20%) in all-cause, 0.23% (95% CI = 0.20%, 0.26%) in cardiovascular, and 0.26% (95% CI = 0.22%, 0.31%) in respiratory admissions. For PM10, the values were 0.12% (95% CI = 0.11%, 0.13%) for all-cause, 0.15% (95% CI = 0.13%, 0.17%) for cardiovascular, and 0.21% (95% CI = 0.17%, 0.24%) for respiratory admissions. The associations held at PM2.5 levels below the current Chinese and European/WHO standards. Among individuals with exposure levels below 25 µg/m, increasing PM2.5 levels from below 15 µg/m to above 15 µg/m was associated with increases of 1.8% (odds ratio, 1.018; 95% CI = 1.015, 1.022) in all-cause admissions and 2.5% (odds ratio, 1.025; 95% CI = 1.017, 1.034) in cardiovascular admissions. CONCLUSIONS: Short-term PM exposures were associated with increased hospitalizations, even for exposure levels not exceeding the current regulatory limits.


Assuntos
Hospitalização/estatística & dados numéricos , Material Particulado/efeitos adversos , Adolescente , Adulto , Idoso , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Doenças Cardiovasculares/epidemiologia , Criança , Pré-Escolar , China/epidemiologia , Cidades/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Material Particulado/análise , Doenças Respiratórias/epidemiologia , Fatores de Risco , Tempo (Meteorologia) , Adulto Jovem
19.
Int J Mol Sci ; 19(4)2018 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-29597287

RESUMO

C-Maf Inducing Protein (CMIP) gene polymorphisms were reported to be associated with type 2 diabetes mellitus (T2DM). Whether the association between CMIP and T2DM is mediated via obesity-related phenotypes is still unclear. We analyzed the association of CMIP rs2925979 with T2DM and a comprehensive set of obesity-related phenotypes in 1576 families ascertained from a Chinese population. These families included a total of 3444 siblings (1582 with T2DM, 963 with prediabetes, and 899 with a normal glucose level). Using multi-level mixed effects regression models, we found that each copy of CMIP rs2925979_T allele was associated with a 29% higher risk of T2DM in females (p = 9.30 × 10-4), while it was not significantly associated with T2DM in males (p = 0.705). Meanwhile, rs2925979_T allele was associated with lower levels of body mass index (BMI), waist circumference (WC), hip circumference (HC), percentage of body fat (PBF), PBF of arms, PBF of legs, and PBF of trunk in nondiabetes females (all p < 0.05). The opposite associations of rs2925979_T allele with T2DM and obesity-related phenotypes suggest that CMIP may exert independent pleiotropic effects on T2DM and obesity-related phenotypes in females.


Assuntos
Alelos , Diabetes Mellitus Tipo 2/genética , Obesidade/genética , Polimorfismo Genético , Proteínas Adaptadoras de Transdução de Sinal , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , China/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Fatores Sexuais
20.
Sci Rep ; 8(1): 2775, 2018 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-29426845

RESUMO

Little is known about the acute effects of ozone on morbidity risk in China. We conducted a time-series study to examine the association between ozone and daily emergency room visits (ERVs) in Beijing, China. We identified 7,088,309 ERVs between January 1, 2014 and December 31, 2015. A generalized additive model with Poisson regression incorporating penalized spline functions was employed to analyze ERVs in association with daily 8-h maximum ozone concentrations. An increase of 10 µg/m3 of same-day ozone concentration was significantly associated with a 0.24% (95% CI, 0.21%-0.26%), 0.31% (95% CI, 0.27%-0.35%), and 0.43% (95% CI, 0.36%-0.50%) increase in daily ERVs for the whole study period, days when the daily 8-h maximum ozone met the Chinese Ambient Air Quality Standards (CAAQS) Grade II standard, and days that met the CAAQS Grade I standard, respectively. These results were robust when considering the potential confounding effects of PM2.5, PM10, NO2, SO2, and CO. In conclusion, our findings suggested significant effects of ozone exposure on daily ERVs in Beijing. Improving air quality with even lower ozone level than the current CAAQS could yield important public health.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/análise , Assistência Ambulatorial/estatística & dados numéricos , Serviço Hospitalar de Emergência , Exposição Ambiental , Ozônio/análise , Adolescente , Adulto , Idoso , Poluentes Atmosféricos/toxicidade , Pequim , Feminino , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Dióxido de Nitrogênio/química , Ozônio/toxicidade , Material Particulado/química , Estudos Retrospectivos , Dióxido de Enxofre/química
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