中国城市地区控制空气污染的心血管健康获益及中国成年人腹型肥胖与高血压发病风险的前瞻性研究

发布时间：2018-03-24 06:32

本文选题：空气污染　切入点：心血管死亡　出处：《北京协和医学院》2016年博士论文

【摘要】：第一部分：中国城市地区控制空气污染的心血管健康获益研究背景与目的空气污染已经成为我国面临的一个重要的环境与公共卫生问题。在可改变的危险因素中,空气污染位列造成我国疾病负担的第四位。2008年北京奥运会召开期间,中国政府采取了一系列严格的减排措施保证空气质量。流行病学研究发现,降低细颗粒物(PM2.5)水平能减少心血管疾病和全因死亡。本研究拟利用数学模型预测在2016～2030年我国城市地区35-84岁人群中空气质量提高的心血管健康获益,并与传统心血管疾病危险因素控制的健康获益进行比较。研究方法中国心血管疾病政策模型是一种基于计算机编程模拟技术建立的心血管发病、死亡和干预措施的投入和效果的预测评价模型,可以用于分析中国35～84岁人群冠心病和卒中的发病流行趋势。依据联合国人口计划署预测的我国总人口和城镇化水平,估计中国城市地区2016～2030年间的人口数量。利用中国健康与营养调查1990～2009年的传统心血管疾病危险因素的变化趋势,预测2016～2030年危险因素的变化趋势。应用meta分析汇总长期PM2.5暴露对冠心病、卒中死亡以及全因死亡的效应。在维持传统心血管疾病危险因素的背景趋势变化基础上,模拟2016～2030年间PM2.5水平导致的我国城市地区35～84岁成年人中因冠心病和卒中死亡数。其中,现况情境保持PM2.5水平不变(62μg/m3)；空气污染改善情境包括三种,假定2016～2030年间,PM2.5年平均浓度能逐渐线性地降低到以下三个PM2.5目标值：(1)北京2008年北京奥运会PM2.5浓度(55μg/m3)；(2)我国二级空气质量标准(35μg/m3)；(3)世界卫生组织推荐浓度限值(10μg/m3)。为了进一步比较控制空气污染的健康获益,假定传统心血管疾病危险因素的背景趋势变化影响同样存在、PM2.5浓度保持在现况水平,分析2016～2030年间,以下两种情景的心血管健康获益,包括：(1)50%的高血压患者收缩压达标(即2030年达50%的高血压控制率)；(2)吸烟率(包括主动吸烟与被动二手烟暴露)降低50%。研究结果如果PM2.5水平维持在62μg/m3,在仅有传统危险因素趋势变化和人口数变化的背景影响,2016～2030年我国城市地区35～84岁人群中每年约55.3万冠心病死亡和77.3万卒中死亡。PM2.5浓度降低到2008奥运会水平每年将减少3.8万例冠心病死亡和2.0万例卒中死亡。到2030年,吸烟率逐渐下降到2016年吸烟率的50%,每年将减少6.4万例冠心病死亡和1.7万例卒中死亡。收缩压达标率(140mmHg)达到50%,每年将减少7.5万例冠心病和13.0万例卒中死亡,其健康获益远大于空气污染达到2008年北京奥运水平,但与达到中国二级空气质量标准获益接近。结论空气污染是我国城市地区重要的且又是可控制的心血管疾病危险因素。我们的研究结果提示,空气污染的小幅度改善(达到北京奥运会水平)就能取得明显的心血管疾病健康获益。空气污染改善幅度越大,其心血管疾病健康获益越大。我国政府已经意识到经济发展不能以牺牲空气质量为代价,有必要从长远发展的角度,采取切实可行的空气污染治理措施,将空气质量提升到我国二级空气质量标准。第二部分：中国成年人腹性肥胖与高血压发病风险的前瞻性研究研究背景与目的高血压是导致我国心血管疾病和全因死亡最重要的危险因素。2002年我国成年人高血压患病率为18%,2012年我国高血压患病率达25.2%,我国高血压患病率呈上升的趋势。与此同时,我国成年男性腹型肥胖(腰围≥90cm)和女性腹型肥胖(腰围≥80cm)患病率分别从1993年的8.5%和27.8%迅猛上升,2009年分别达到27.8%和45.9%。本研究拟利用前瞻性队列研究设计探讨腹型肥胖与高血压发病之间的关系,为制定健康政策提供科学依据。研究对象与方法研究对象来自中国心血管流行病学多中心协作研究和中国心血管健康多中心研究,两项研究分别于1998年和2000～2001年开展基线调查,研究共27020人,年龄35～74岁,其中男性13063人,女性13957人。在2007～2008年和2013～2015年开展两次随访调查,最终分析纳入15289人,其中男性6952人,女性8337人。基线调查时,收集人口学指标、生活方式、疾病史等信息,并测量腰围、血压、身高和体重等。腹型肥胖定义为：男性腰围≥90cm,女性腰围≥85cm。随访阶段测量研究对象血压并收集服药信息。高血压定义为：收缩压≥140mmHg和/或舒张压≥90mmHg,和/或最近两周内服用降压药。采用Cox比例风险模型逐步校正混杂因素,评估腹型肥胖对高血压发病风险比(Hazard ratio, HR)及95%置信区间(Confidence interval, CI)。研究结果经过平均11.2年随访,共有6126例新诊断高血压,其中男性2857例,女性3269例。在949例男性腹型肥胖者和1187例女性腹型肥胖者中,分别有493例和667例在随访阶段诊断为高血压,男女性腹型肥胖者高血压累积发病率分别为51.9%和56.2%。与非腹型肥胖(正常)者比较,腹型肥胖者多因素校正的高血压发病风险明显升高,男性HR(95%CI)为1.30(1.17-1.44),女性HR(95%CI)为1.40(1.28-1.54)。与正常腰围(90cm)男性相比,腰围90-94cm、95-99cm和≥100cm的男性,多因素校正的高血压发病HR(95%CI)分别为1.23(1.08-1.40)、1.36(1.14-1.63)、1.53(1.18-1.99)(P趋势0.001)；与正常腰围(85cm)女性相比,腰围为85-89cm、90-94cm和≥95cm的女性,高血压发病风险明显升高,HR(95%CI)分别是1.41(1.26-1.58)、1.31(1.11-1.54)、1.55(1.28-1.87)(P趋势0.001)。亚组分析和敏感性分析的结果与主要分析结果相似。结论在中国中老年人群中,腹型肥胖(以腰围值判断)是高血压发病的重要危险因素,腰围水平与高血压发病风险呈线性关系。高血压是最重要的心血管疾病危险因素,腹型肥胖的流行可能是我国高血压患病率持续升高的重要原因之一。加强人群的健康促进与教育,提倡健康生活方式,应将腹型肥胖(腰围)作为高血压防控干预的重要指标之一。
[Abstract]:The first part: the city air pollution control area Chinese cardiovascular health benefit research background and purpose of air pollution has become an important environmental and public health problems in China. The modifiable risk factors, air pollution in China caused by the disease burden of fourth.2008 in Beijing during the Olympics, the government China take a series of strict emission reduction measures to ensure air quality. Epidemiological studies have found that reducing fine particulate matter (PM2.5) levels can reduce cardiovascular disease and all-cause death. This study intends to measure benefit to improve air quality in 2016~2030 people aged 35-84 years in our city in the area of cardiovascular health by using mathematical model of pre, health benefits and control with the traditional cardiovascular risk factors were compared. The method of Chinese cardiovascular disease policy model is a programming model based on computer The incidence of cardiovascular technology was established, the prediction and evaluation of death and intervention measures of investment and the effect of the model can analyze the epidemic trends of the incidence of coronary heart disease and stroke China for people aged 35~84. According to China's total population and urbanization level of the United Nations Population Prediction programme, the estimated 2016~2030 City area China population quantity. Use change the trend of the traditional risk factors of cardiovascular disease Chinese health and Nutrition Survey in 1990~2009 years, the change trend of factors in predicting the risk of 2016~2030 years. The application of meta analysis and summary of long-term PM2.5 exposure on coronary heart disease, stroke, death and all-cause death effect. In the background of traditional cardiovascular risk factors to maintain the changes on the basis of simulation of PM2.5 2016~2030 years the level of city of our country lead to 35~84 years of age in adults due to coronary heart disease and stroke deaths. Among them, the status. PM2.5 environment is kept unchanged (62 g/m3); to improve the situation including three air pollution, assuming that 2016~2030 years, the annual average concentration of PM2.5 gradually decreased linearly to the following three PM2.5 target value: (1) the Beijing 2008 Olympic Games in Beijing PM2.5 concentration (55 g/m3); (2) the two level air quality standards China (35 g/m3); (3) the WHO recommended concentration limit (10 g/m3). In order to further compare the health benefits of air pollution control, the background trend assumes that traditional cardiovascular risk factors also influence the concentration of PM2.5 in the current situation, to maintain the level of analysis, 2016~2030 years, the following two scenarios of the benefit. Cardiovascular health include: (1) 50% hypertensive patients with systolic blood pressure standard (i.e., the control rate of hypertension was 50% in 2030); (2) the smoking rate (including active and passive smoking exposure to secondhand smoke) to reduce the 50%. results if the horizontal dimension PM2.5 In 62 g/m3, in the background of the influence trend of traditional risk factors only changes and population changes, 2016~2030 years of our country city area 35~84 people each year about 553 thousand deaths from coronary heart disease and 773 thousand stroke death.PM2.5 concentration reduced to 2008 games per year will reduce the death of 38 thousand cases of coronary heart disease and 20 thousand cases of stroke death. By 2030. The smoking rate decreased gradually to the 2016 smoking rate of 50% per year will reduce the death of 64 thousand cases of coronary heart disease and 17 thousand cases of stroke death. Systolic blood pressure (140mmHg) compliance rate reached 50%, annual reduction of 75 thousand cases of coronary heart disease and 130 thousand cases of stroke death, its health benefits far outweigh the air pollution reached the 2008 Beijing Olympic Games, but reached two air quality standards Chinese benefit. Conclusion the air pollution is close to the city of our country and it is an important area of cardiovascular disease risk factors can control our research. The results suggest that air pollution improved (up to the Beijing Olympic Games level) can achieve significant health benefits of cardiovascular disease. Air pollution improvement is greater, the cardiovascular health benefits more. Our government has been aware of the economic development must not be carried at the cost of air quality, it is necessary from the perspective of long-term development air pollution control measures, take feasible, will enhance the air quality to two air quality standards in China. The second part: Chinese adult abdominal obesity and the risk of hypertension background and objective prospective study of hypertension cardiovascular disease and all-cause mortality in China the most important risk factors of.2002 in China the adult prevalence rate of hypertension was 18%, in 2012 China's 25.2% prevalence rate of hypertension, the prevalence rate of hypertension was increased. At the same time, China's adult male abdomen Obesity (waist = 90cm) and female abdominal obesity (waist circumference greater than 80cm) prevalence rate from 8.5% in 1993 and 27.8% rapid rise, 2009 reached 27.8% and 45.9%. of this study is to explore the relationship between abdominal obesity and hypertension using prospective cohort study design, and to provide scientific basis for health policy research. China cardiovascular epidemiology research collaboration center and Chinese cardiovascular health centers from research objects and methods, two studies were carried out baseline survey in 1998 and 2000~2001 years of study, a total of 27020 people, aged 35~74, of which 13063 were male, 13957 female. Two to carry out follow-up survey in 2007~2008 years and 2013~2015 years. The final analysis included 15289 people, including 6952 males and 8337 female. The baseline survey, collecting demographic indicators, lifestyle, medical history information, and to measure the waist Circumference, blood pressure, height and weight. Abdominal obesity is defined as: male waistline is more than 90cm, the research object is greater than or equal to 85cm. female waist circumference measurement of blood pressure medication during the follow-up period and collect information. Hypertension is defined as systolic blood pressure greater than or equal to 140mmHg and / or diastolic pressure is above 90mmHg, and / or the last two weeks of taking antihypertensive drugs. Gradual correction confounding factors using Cox proportional hazards model, evaluation of abdominal obesity on the risk of hypertension than (Hazard ratio, HR) and 95% confidence intervals (Confidence, interval, CI). Results after a mean follow-up of 11.2 years, a total of 6126 patients with newly diagnosed hypertension, there were 2857 males and 3269 females. In 949 cases of male abdomen 1187 cases of female obesity and abdominal obesity, there were 493 cases and 667 cases during the follow-up period for the diagnosis of hypertension, abdominal obesity and the cumulative incidence of hypertension was 51.9% and 56.2%. respectively and non abdominal obesity (normal) comparison, The incidence of hypertension abdominal obesity factors correction was significantly elevated in male HR (95%CI) 1.30 (1.17-1.44), HR (95%CI) for 1.40 women (1.28-1.54). And the normal waist circumference (90cm) compared to men, waist 90-94cm, 95-99cm and 100cm than men, multi factor correction of hypertension (HR 95%CI) were 1.23 (1.08-1.40), 1.36 (1.14-1.63), 1.53 (1.18-1.99) (P trend 0.001); and the normal waist circumference (85CM) than women, waist circumference is 85-89cm, 90-94cm and 95cm than women, the incidence of hypertension was significantly increased, HR (95%CI) were 1.41 (1.26-1.58), 1.31 (1.11-1.54), 1.55 (1.28-1.87) (P trend 0.001). Subgroup analysis and sensitivity analysis of the results and the main results were similar. Conclusion in the elderly population China, abdominal obesity (waist circumference to judge) is an important risk factor for hypertension, waist circumference increased linearly with the incidence of hypertension and high blood. Pressure is the most important cardiovascular risk factors, the prevalence of abdominal obesity may be the prevalence of hypertension in China continues to rise is one of the important reasons. To strengthen health promotion and education, promoting a healthy way of life, should be abdominal obesity (waist) is one of the important indexes for prevention and intervention of hypertension.

【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R544.1;R589.2;X513

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