Associations between Ambient Particulate Matter and Nitrogen Dioxide and Chronic Obstructive Pulmonary Diseases in Adults and Effect Modification by Demographic and Lifestyle Factors
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Spirometry
2.3. Exposure Assessment
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Variable | n (%) or mean ± SD | COPD (n) | Prevalence (%) | Adjusted * OR (95% CI) |
---|---|---|---|---|
Sex | ||||
Female | 683 (54.03) | 30 | 4.39 | Reference |
Male | 581 (45.97) | 64 | 11.02 | 1.20 (0.53–2.74) |
Age, years | ||||
<50 | 225 (17.80) | 12 | 5.33 | Reference |
50–59 | 527 (41.69) | 31 | 5.88 | 1.36 (0.66–2.78) |
60–69 | 380 (30.06) | 37 | 9.74 | 2.69 (1.25–5.78) |
≥70 | 132 (10.44) | 14 | 10.61 | 3.14 (1.25–7.91) |
Education | ||||
<High school | 341 (26.98) | 22 | 6.45 | Reference |
High school | 503 (39.79) | 43 | 8.55 | 1.39 (0.77–2.50) |
>High school | 420 (33.23) | 29 | 6.90 | 1.07 (0.56–2.02) |
BMI | ||||
<18.5 | 17 (1.34) | 1 | 5.88 | Reference |
18.5–25 | 799 (63.21) | 69 | 8.64 | 0.81 (0.10–6.51) |
>25 | 448 (35.44) | 24 | 5.36 | 0.42 (0.05–3.53) |
Smoking | ||||
Non-smoker | 796 (62.97) | 34 | 4.27 | Reference |
Former smoker | 291 (23.02) | 34 | 11.68 | 2.52 (1.09–5.81) |
Current smoker | 177 (14.00) | 26 | 14.69 | 4.33 (1.84–10.22) |
Drinking | ||||
No | 672 (53.16) | 40 | 5.95 | Reference |
Yes | 592 (46.84) | 54 | 9.12 | 1.01 (0.59–1.72) |
Exercise | ||||
Yes | 528 (41.77) | 33 | 6.25 | Reference |
No | 736 (58.23) | 61 | 8.29 | 1.19 (0.74–1.91) |
Hypertension | ||||
No | 872 (68.99) | 64 | 7.34 | Reference |
Yes | 392 (31.01) | 30 | 7.65 | 0.77 (0.46–1.29) |
Diabetes mellitus | ||||
No | 1119 (88.53) | 78 | 6.97 | Reference |
Yes | 145 (11.47) | 16 | 11.03 | 1.42 (0.76–2.65) |
Hyperlipidemia | ||||
No | 954 (75.47) | 66 | 6.92 | Reference |
Yes | 310 (24.53) | 28 | 9.03 | 1.37 (0.81–2.30) |
History of stroke | ||||
No | 1239 (98.02) | 92 | 7.43 | Reference |
Yes | 25 (1.98) | 2 | 8.00 | 0.87 (0.19–4.02) |
Family history of COPD | ||||
No | 1255 (99.29) | 92 | 7.33 | Reference |
Yes | 9 (0.71) | 2 | 22.22 | 3.97 (0.70–22.51) |
Family history of asthma | ||||
No | 1237 (97.86) | 94 | 7.60 | |
Yes | 27 (2.14) | 0 | 0 | NS |
History of angina pectoris | ||||
No | 1211 (95.81) | 89 | 7.35 | Reference |
Yes | 53 (4.19) | 5 | 9.43 | 0.80 (0.29–2.20) |
FVC, L (meanness) | 86.69 ± 12.69 | |||
FEV1, L (mean ± SD) | 90.40 ± 14.17 | |||
% FEV1/FVC | 80.63 ± 8.27 | |||
COPD (FEV1/FVC) | ||||
<0.7 | 94 (7.44) | |||
≥0.7 | 1170 (92.56) |
Length of exposure | Pollutant (μg/m3) | Mean (SD) | Median | IQR | Range |
---|---|---|---|---|---|
5 years | PM2.5 | 35.82 (5.49) | 37.07 | 6.64 | 14.94–46.5 |
PM10 | 53.56 (4.40) | 52.81 | 5.53 | 39.18–69.21 | |
NO2 | 45.63 (17.68) | 49.83 | 18.38 | 3.34–118.94 | |
3 years | PM2.5 | 33.83 (5.62) | 35.22 | 7.05 | 14.49–46.24 |
PM10 | 50.98 (4.30) | 50.17 | 5.44 | 38.87–67.32 | |
NO2 | 44.64 (17.65) | 48.6 | 18.87 | 3.34–135.87 | |
1 year | PM2.5 | 33.39 (6.05) | 34.97 | 7.26 | 14.52–48.08 |
PM10 | 50.68 (4.57) | 49.53 | 6.39 | 39.56–73.34 | |
NO2 | 44.81 (17.75) | 49.17 | 18.05 | 3.50–132.97 |
Air Pollutants * | COPD | |
---|---|---|
Crude | Adjusted † | |
OR (95% CI) | OR (95% CI) | |
NO2 (μg/m3) | ||
Lowest tertile (<41.0) | Reference | Reference |
Medium tertile (≥41.0 and <53.8) | 1.28 (0.73–2.25) | 1.39 (0.77–2.52) |
Highest tertile (≥53.8) | 1.93 (1.14–3.27) | 1.83 (1.04–3.21) |
p for trend | 0.012 | |
Per 10 μg/m3 increase | 1.13 (0.99–1.27) | 1.14 (1.00–1.30) |
PM10 (μg/m3) | ||
Lowest tertile (<48.5) | Reference | Reference |
Medium tertile (≥48.5 and <52.2) | 1.17 (0.68–2.01) | 1.23 (0.70–2.15) |
Highest tertile (≥52.2) | 1.51 (0.90–2.54) | 1.57 (0.92–2.69) |
p for trend | 0.113 | |
Per 10 μg/m3 increase | 1.38 (0.87–2.21) | 1.39 (0.85–2.25) |
PM2.5 (μg/m3) | ||
Lowest tertile (<32.7) | Reference | Reference |
Medium tertile (≥32.7 and <37.1) | 1.43 (0.82–2.48) | 1.54 (0.86–2.75) |
Highest tertile (≥37.1) | 1.77 (1.04–3.02) | 1.79 (1.02–3.13) |
p for trend | 0.035 | |
Per 10 μg/m3 increase | 1.32 (0.88–1.97) | 1.34 (0.89–2.02) |
Parameter | Length of exposure | Air Pollutant (μg/m3) | Crude | Adjusted * |
---|---|---|---|---|
β (95% CI) | β (95% CI) | |||
FVC (l) | 5 years | NO2 | 0.35 (−0.05, 0.75) | 0.18 (−0.22, 0.59) |
PM10 | −1.38 (2.97, 0.21) | −1.52 (−3.10, 0.05) | ||
PM2.5 | −0.61 (−1.89, 0.66) | −0.62 (−1.89, 0.65) | ||
3 years | NO2 | 0.33 (−0.06, 0.73) | 0.18 (−0.22, 0.58) | |
PM10 | −1.52 (−3.14, 0.11) | −1.73 (−3.35, −0.12) | ||
PM2.5 | −0.83 (−2.08, 0.41) | −0.85 (−2.10, 0.39) | ||
1 year | NO2 | 0.27 (−0.13, 0.66) | 0.11 (−0.28, 0.52) | |
PM10 | −1.46 (−2.99, 0.07) | −1.77 (−3.29, −0.25) | ||
PM2.5 | −0.80 (−1.96, 0.36) | −0.85 (−2.01, 0.30) | ||
FEV1 (l) | 5 years | NO2 | 0.19 (−0.25, 0.63) | 0.11 (−0.33, 0.56) |
PM10 | −1.58 (−3.36, 0.19) | −1.73 (−3.50, 0.03) | ||
PM2.5 | −0.81 (−2.24, 0.61) | −0.86 (−2.28, 0.56) | ||
3 years | NO2 | 0.19 (−0.25, 0.64) | 0.13 (−0.32, 0.58) | |
PM10 | −1.62 (−3.44, 0.19) | −1.85 (−3.65, −0.05) | ||
PM2.5 | −0.83 (−2.22, 0.57) | −0.94 (−2.33, 0.45) | ||
1 year | NO2 | 0.15 (−0.29, 0.59) | 0.09 (−0.36, 0.53) | |
PM10 | −1.13 (−2.84, 0.58) | −1.46 (−3.16, 0.24) | ||
PM2.5 | −0.78 (−2.07, 0.51) | −0.96 (−2.25, 0.32) | ||
FEV1/FVC | 5 years | NO2 | −0.07 (−0.32, 0.19) | −0.05 (−0.29, 0.19) |
PM10 | 0.05 (−0.99, 1.08) | 0.09 (−0.93, 1.10) | ||
PM2.5 | 0.00 (−0.83, 0.84) | −0.09 (−1.03, 0.85) | ||
3 years | NO2 | −0.04 (−0.30, 0.22) | −0.03 (−0.28, 0.21) | |
PM10 | 0.11 (−0.95, 1.17) | 0.16 (−0.89, 1.21) | ||
PM2.5 | 0.08 (−0.73, 0.90) | 0.02 (−0.89, 0.93) | ||
1 year | NO2 | −0.04 (−0.30, 0.22) | −0.03 (−0.27, 0.21) | |
PM10 | 0.28 (−0.72, 1.28) | 0.40 (−0.57, 1.37) | ||
PM2.5 | 0.00 (−0.75, 0.76) | −0.00 (−0.85, 0.85) |
Parameter | Stratified Characteristics | Air Pollutants | ||
---|---|---|---|---|
NO2 | PM10 | PM2.5 | ||
β (95% CI) | β (95% CI) | β (95% CI) | ||
FVC | Age | |||
<57 | −0.31 (−0.87, 0.24) | −0.97 (−3.19, 1.25) | −1.63 (3.33, 0.01) | |
≥57 | 0.48 (−0.05, 1.01) | −2.39 (−4.67, −0.11) | −0.57 (2.41, 1.28) | |
p for interaction | 0.545 | 0.089 | 0.252 | |
Sex | ||||
Male | 0.21 (−0.36, 0.79) | −2.69 (−4.92, −0.46) | −0.85 (−2.72, 1.02) | |
Female | 0.14 (−0.36, 0.63) | −0.98 (−3.27, 1.32) | −1.04 (−2.75, 0.68) | |
p for interaction | 0.530 | 0.403 | 0.787 | |
Body mass index | ||||
<24 | −0.03 (−0.64, 0.58) | −2.25 (−4.64, 0.15) | −0.66 (−2.52, 1.20) | |
≥24 | 0.29 (−0.23, 0.82) | −1.33 (−3.48, 0.83) | −1.35 (−2.99, 0.29) | |
p for interaction | 0.943 | 0.993 | 0.434 | |
Exercise | ||||
Yes | 0.19 (−0.39, 0.76) | −1.68 (−4.35, 0.99) | −0.11 (−2.01, 1.79) | |
No | 0.19 (−0.34, 0.72) | −1.75 (−3.83, 0.34) | −1.76 (−3.49, −0.04) | |
p for interaction | 0.653 | 0.796 | 0.171 | |
Education | ||||
<High school | 0.59 (−0.19, 0.14) | −4.26 (−7.27, −1.26) | −0.87 (−3.73, 1.99) | |
≥High school | 0.03 (−0.42, 0.49) | −0.77 (−2.62, 1.09) | −0.82 (−2.22, 0.58) | |
p for interaction | 0.193 | 0.065 | 0.939 | |
Smoking | ||||
Current smoker | 0.31 (−0.76, 1.39) | −2.53 (−6.95, 1.92) | −0.15 (−3.23, 2.93) | |
Former smoker | 0.00 (−0.82, 0.82) | −3.61 (−6.93, −0.29) | −0.31 (−3.27, 2.65) | |
Non-smoker | 0.27 (−0.23, 0.77) | −1.43 (−3.45, 0.58) | −1.57 (−3.16, 0.02) | |
p for interaction | 0.935 | 0.815 | 0.412 | |
Age | ||||
<57 | −0.27 (−0.80, 0.26) | 0.18 (−1.99, 2.35) | −0.21 (−1.97, 1.54) | |
≥57 | 0.33 (−0.25, 0.90) | −3.42 (−6.12, −0.72) | −1.89 (−4.03, 0.25) | |
p for interaction | 0.870 | 0.007 | 0.273 | |
Sex | ||||
Male | 0.18 (−0.50, 0.86) | −2.64 (−5.20, −0.01) | −0.64 (−2.69, 1.41) | |
Female | 0.05 (−0.51, 0.61) | −1.07 (−3.68, 1.53) | −1.41 (−3.34, 0.53) | |
P for interaction | 0.564 | 0.482 | 0.581 | |
Body mass index | ||||
<24 | −0.08 (−0.73, 0.58) | −1.34 (−3.94, 1.26) | −1.28 (−3.29, 0.72) | |
≥24 | 0.23 (−0.38, 0.84) | −2.49 (−4.99, 0.01) | −1.11 (−3.02, 0.80) | |
p for interaction | 0.902 | 0.276 | 0.853 | |
Exercise | ||||
Yes | 0.04 (−0.57, 0.65) | −1.95 (−4.87, 0.98) | 0.24 (−1.79, 0.23) | |
No | 0.19 (−0.40, 0.79) | −1.57 (−3.89, 0.76) | −2.03 (−3.95, −0.10) | |
p for interaction | 0.976 | 0.971 | 0.107 | |
Education | ||||
<High school | 0.63 (−0.33, 1.59) | −5.99 (−9.66, −2.32) | −3.03 (−5.98, −0.09) | |
≥High school | −0.03 (−0.54, 0.47) | −0.23 (−2.29, 0.18) | −0.03 (−1.59, 0.15) | |
p for interaction | 0.201 | 0.008 | 0.092 | |
Smoking | ||||
Current smoker | −0.01 (−1.25, 1.14) | −1.87 (−6.78, 3.04) | −2.51 (−5.89, 0.87) | |
Former smoker | 0.16 (−0.65, 0.97) | −3.51 (−7.48, 0.46) | −0.45 (−3.54, 2.65) | |
Non-smoker | 0.21 (−3.00, 0.72) | −1.60 (−3.88, 0.68) | −1.02 (−2.81, 0.78) | |
p for interaction | 0.709 | 0.839 | 0.660 |
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Lamichhane, D.K.; Leem, J.H.; Kim, H.C. Associations between Ambient Particulate Matter and Nitrogen Dioxide and Chronic Obstructive Pulmonary Diseases in Adults and Effect Modification by Demographic and Lifestyle Factors. Int. J. Environ. Res. Public Health 2018, 15, 363. https://doi.org/10.3390/ijerph15020363
Lamichhane DK, Leem JH, Kim HC. Associations between Ambient Particulate Matter and Nitrogen Dioxide and Chronic Obstructive Pulmonary Diseases in Adults and Effect Modification by Demographic and Lifestyle Factors. International Journal of Environmental Research and Public Health. 2018; 15(2):363. https://doi.org/10.3390/ijerph15020363
Chicago/Turabian StyleLamichhane, Dirga Kumar, Jong Han Leem, and Hwan Cheol Kim. 2018. "Associations between Ambient Particulate Matter and Nitrogen Dioxide and Chronic Obstructive Pulmonary Diseases in Adults and Effect Modification by Demographic and Lifestyle Factors" International Journal of Environmental Research and Public Health 15, no. 2: 363. https://doi.org/10.3390/ijerph15020363