[Association between short-term exposure to ambient nitrogen dioxide and the risk of heart failure hospitalization].

Objective: To assess the association between short-term exposure level of nitrogen dioxide and the hospitalization risk of heart failure. Methods: Based on China-PEACE Retrospective Heart Failure Study, 117 364 hospitalized patients with heart failure were recruited from 92 hospitals in 62 cities throughout China between January 1, 2015 and December 31, 2015. The daily exposure level of nitrogen dioxide, temperature, and humidity in the same cities during the same period were also collected. We applied the generalized additive model and Bayesian hierarchical model to quantify the lagged effect and cumulative effect of short-term (0-3 days) exposure to ambient nitrogen dioxide on the hospitalization risk of heart failure. We further conducted stratified analyses by age, region, and season to identify any difference in the associations between short-term nitrogen dioxide exposure and heart failure among subgroups. Results: The mean age for participants in the analysis was (70.32±12.22) years. The median, minimum and maximum of daily nitrogen dioxide concentration in 62 cities from January 1, 2015 to December 31, 2015 was 26.4 μg/m3, 2.33 μg/m3 and 150.25 μg/m3, respectively. The exposure level of nitrogen dioxide at the same day was associated with the hospitalization risk of heart failure (OR=1.022, 95%CI: 1.012, 1.031). Significant effects were also observed in the moving average concentrations from lag 0-1 to lag 0-3 day (OR=1.020, 95%CI: 1.009, 1.030; OR=1.016, 95%CI: 1.004, 1.028; OR=1.013, 95%CI: 1.001, 1.026). Moreover, all of the associations between short-term exposure to nitrogen dioxide and the risk of heart failure hospitalization were statistically significant, with no significant difference in all subgroups stratified by age, region, and season. Conclusion: A higher level of short-term exposure to nitrogen dioxide could trigger more hospitalizations with heart failure.目的： 研究大气NO2短期暴露与心力衰竭住院风险的关联。 方法： 基于China-PEACE心力衰竭研究，将2015年1月1日至12月31日来自全国62个城市92家医院的117 364例心力衰竭住院患者纳入研究，并获取相应时间段的日均NO2暴露水平、温度和相对湿度等信息。采用广义可加模型和贝叶斯层次模型分析NO2短期暴露（滞后 0~3 d）与心力衰竭住院风险的关联，并比较不同亚组间NO2短期暴露与心力衰竭住院风险的关联。 结果： 研究对象年龄为（70.32±12.22）岁，2015年1月1日至12月31日，62个城市NO2全年365日日均暴露浓度的中位数为26.4 μg/m3，最小值为2.33 μg/m3，最大值为150.25 μg/m3。随着NO2暴露浓度每升高10 μg/m3，心力衰竭住院风险增加2.2%（OR=1.022，95%CI：1.012~1.031）。在住院日前0~1、0~2和0~3 d，NO2移动平均暴露水平与心力衰竭住院风险的关联均具有统计学意义［OR值分别为1.020（95%CI：1.009~1.030）、1.016（95%CI：1.004~1.028）和1.013（95%CI：1.001~1.026）］。不同年龄、不同区域、不同季节间NO2短期暴露水平与心力衰竭住院风险的关联均具有统计学意义（均P<0.05），但各组间差异无统计学意义（均P>0.05）。 结论： NO2短期暴露水平升高可增加心力衰竭住院风险。.