國家衛生研究院 NHRI:Item 3990099045/14669

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Please use this identifier to cite or link to this item: http://ir.nhri.org.tw/handle/3990099045/14669

Title:	The association between long-term ambient fine particulate exposure and the mortality among adult patients initiating dialysis: A retrospective population-based cohort study in Taiwan
Authors:	Chen, SF;Chien, YH;Chen, PC
Contributors:	National Institute of Environmental Health Sciences
Abstract:	Fine particulate matter (PM2.5) has been reported to be associated with increased risk of chronic kidney disease (CKD) and progression to end-stage renal disease (ESRD). However, studies on whether long-term exposure to PM2.5 negatively impacts the survival of patients with ESRD are very limited. To conduct this study, we linked Taiwan Air Quality-Monitoring Database (TAQMD) and the National Health Insurance Research Database (NHIRD) by zip-code. A retrospective population-based cohort of 34,088 adult patients initiating dialysis over six months was formed. Cox proportional regression models were used to estimate the risk of mortality in dialysis patients per 10-μg/m3 increase of PM2.5 and by PM2.5 levels divided into quintiles. Restricted cubic spline analysis was performed to delineate the concentration-response relationship between PM2.5 and mortality. The adjusted hazard ratio (aHR) per 10-μg/m3 increase of PM2.5 for mortality was 1.11 (95% confidence interval [CI] = 1.08–1.13). When analyzing PM2.5 exposure divided into quintiles, patients with mean PM2.5 exposure over 29.33 μg/m3, including level III (aHR 1.00, 95% CI = 0.94–1.07), level IV (aHR 1.09; 95% CI = 1.03–1.16), and level V (HR 1.11; 95% CI = 1.05–1.19), were at stepwise higher risks of mortality compared with level I. Spline analysis showed a non-linear concentration-response function between PM2.5 and mortality, with the lowest mortality aHR identified at a mean PM2.5 of 26 μg/m3, followed by a concentration interval with a gradual increase of aHR, and finally a steep rise of mortality risk when mean PM2.5 exceeded 37 μg/m3. Individuals with older age, those were male, with selected comorbidities, and with low socioeconomic status (SES) were at higher mortality risk. Male and non-diabetics participants were more sensitive to the effect of a 10-μg/m3 of PM2.5 increase on mortality than their counterparts. In conclusion, long-term exposure to PM2.5 exceeding a threshold was observed to be associated with increased risk of mortality among dialysis patients.
Date:	2023-01-01
Relation:	Environmental Pollution. 2023 Jan 1;316(Part 2):Article number 120606.
Link to:	http://dx.doi.org/10.1016/j.envpol.2022.120606
JIF/Ranking 2023:	http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=0269-7491&DestApp=IC2JCR
Cited Times(WOS):	https://www.webofscience.com/wos/woscc/full-record/WOS:000903742500008
Cited Times(Scopus):	https://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85141797554
Appears in Collections:	[Pau-Chung Chen] Periodical Articles

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