探討空氣汙染物暴露與葡萄膜炎相關之回顧性世代研究

先前的研究顯示眼睛表面疾病與空氣污染有關,然而,過去研究尚未關注於空氣污染與葡萄膜炎的風險性。因此,本研究將探討暴露於各空氣污染物濃度是否會增加葡萄膜炎的風險。並且串連台灣百萬歸人檔縱向健康保險數據庫(Longitudinal Health Insurance Database, LHID 2000)和台灣空氣質量監測數據庫 (Taiwan Air Quality Monitoring Database, TAQMD)進行了回顧性世代研究追蹤為期 11.5 年之研究。主要的研究結果是觀察長期暴露於各空氣污染物是否與葡萄膜炎之風險性有關。疾病的分類是以國際疾病分類標準第九版所定義。進一步使用單變量和多變量 Cox 比例風險回歸模型來計算調整後的風險值以及研究其葡萄膜炎的潛在風險因素與發生率。本研究共納入 175,489 名受試者,並且將空氣污染物濃度使用 IQR 方法分為四個級別進行分析,以及使用 chi-squared test 分析都市化程度與空氣污染物濃度之關係。本研究結果顯示一氧化碳(CO)空氣污染物濃度暴露於 Q3 級別與 Q4 級別其葡萄膜炎之風險值 aHR 分別為 1.41(95%信賴區間 CI=1.23–1.61)和 2.19(95%CI = 1.93–2.47)。暴露於空氣污染物濃度在 Q3 級別與 Q4 級別水平的一氧化氮(NO)可顯著增加葡萄膜炎之風險值 aHR 分別為 1.46(95%CI = 1.27-1.67)和 2.05(95%CI = 1.81-2.32);暴露於 Q2、Q3、Q4 級別的氮氧化物 (NOx)空氣污染物濃度其發生葡萄膜炎之風險值 aHR 分別為 1.27(95%CI = 1.11-1.44),1.34(95%CI = 1.16-1.53)和 1.85(95%CI = 1.63–1);在暴露於 Q2 級別,Q3 級別和 Q4 級別的總碳氫化合物(THC)空氣污染物濃度其葡萄膜炎之風險值 aHR 分別為 1.42(95%CI =1.15-1.75),3.80(95%CI =3.16-4.57)和 5.02(95%CI = 4.19- 6.02)。對於甲烷(CH4)空氣污染物濃度顯示暴露於 Q3 級別和 Q4 級別水平的風險值 aHRs 分別為 1.94(95%CI = 1.60–2.34)和 7.14(95%CI = 6.01-8.48),其結果顯示尤其是暴露於空氣污染物濃度較高之汙染物會顯著增加葡萄膜炎的風險性,本研究也透過 Kaplan-Meier 模式與 log-rank test 計算顯示各空氣污染物濃度對於葡萄膜炎的累積發生率分析。本研究也進一步使用敏感度分析(IDW 方法)與分層分析評估葡萄膜炎調整後的風險比(adjust hazard ratio, aHR),並且將年齡、性別、都市化程度與合併症納入分析。

關鍵字

葡萄膜炎；空氣污染物；都市化程度；風險因子；世代研究

並列摘要

Previous studies have revealed an association between ocular surface disorders and air pollution, few studies have focused on the risk of uveitis. We aimed to investigate whether air pollution increases the risk of uveitis. We used the Taiwan Longitudinal Health Insurance Database (LHID) and the Taiwan Air Quality Monitoring Database (TAQMD) to conduct a retrospective cohort study. Air pollutant concentrations, including those of carbon dioxide (CO2), were grouped into four levels according to quartiles. The outcome was the incidence of uveitis, as defined in the International Classification of Diseases, Ninth Revision. We used univariable and multivariable Cox proportional hazard regression models to calculate the adjusted hazard ratios (aHRs) and determine the potential risk factors of uveitis. Overall, 175,489 subjects were linked to their nearby air quality monitoring stations. We found that for carbon monoxide (CO), the aHRs of uveitis risk for the Q3 and Q4 levels were 1.41 (95% confidence interval (CI) = 1.23–1.61) and 2.19 (95% CI = 1.93–2.47), respectively, in comparison with those for the Q1 level. For nitric oxide (NO), the aHRs for the Q3 and Q4 levels were 1.46 (95% CI = 1.27–1.67) and 2.05 (95% CI = 1.81–2.32), respectively. For nitrogen oxide (NOx), the aHRs for the Q2, Q3, and Q4 levels were 1.27 (95% CI= 1.11–1.44), 1.34 (95% CI = 1.16–1.53), and 1.85 (95% CI = 1.63–2.09), respectively. For total hydrocarbon (THC), the aHRs for the Q2, Q3, and Q4 levels were 1.42 (95% CI = 1.15–1.75), 3.80 (95% CI = 3.16–4.57), and 5.02 (95% CI = 4.19–6.02), respectively. For methane (CH4), the aHRs for the Q3 and Q4 levels were 1.94 (95% CI = 1.60–2.34) and 7.14 (95% CI = 6.01–8.48), respectively. In conclusion, air pollution was significantly associated with incidental uveitis, especially at high THC and CH4 levels. During the follow-up period, the cumulative incidence of uveitis in those with higher air pollutant exposure was significantly higher than that in those with lower air pollutant exposure (p < 0.001).

並列關鍵字

air pollution ； uveitis ； risk factor ； urbanization ； cohort study

參考文獻

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探討空氣汙染物暴露與葡萄膜炎相關之回顧性世代研究

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