Associations of Long-term PM10 Exposure with Mortality in Dialysis Patients: A Population Based Cohort Study
Journal
Aerosol and Air Quality Research
Journal Volume
24
Journal Issue
7
Start Page
240028
ISSN
1680-8584
2071-1409
Date Issued
2024
Author(s)
Abstract
Exposure to PM_(2.5) has been observed to be associated with an increased risk of mortality in dialysis patients, while sporadic studies have hinted at the adverse effects of coarse particulate matter (PM_(10)) on kidney health. However, the impact of PM_(10) on survival in end-stage renal disease patients remains unclear. To address this gap, we conducted a retrospective cohort study, linking the Taiwan Air Quality-Monitoring Database (TAQMD) with the National Health Insurance Research Database (NHIRD) based on patients' zip codes. We included 34,088 adult dialysis patients living in areas with ambient measurements of PM_(10), NO_2, CO, and SO_2 between 1 January, 2000 and 31 December, 2013. We used a multivariate Cox proportional hazards model to estimate mortality risk and observed that each interquartile range (IQR) increase in the mean PM_(10) concentration during follow-up period was associated with a 13.2% higher risk of mortality (adjusted hazard ratio [aHR] = 1.132, 95% confidence interval [CI] = 1.097-1.169). Even in two-pollutant scenarios, the association between long-term exposure to PM_(10) and mortality remained significant. Spline analysis demonstrated a non-linear concentration-response relationship between PM_(10) and mortality, with an increase in aHR when the average PM_(10) exposure exceeded a threshold of 43 µg m^(-3). Stratification analysis revealed that male patients had a significantly higher increase in mortality risk per IQR increase in PM_(10) compared to female patients (aHR 1.185 vs. 1.074; p-interaction < 0.001). Our study demonstrated a significant association between long-term ambient PM_(10) exposure and mortality risk among dialysis patients, especially in males. A non-linear concentration-response relationship between PM_(10) and mortality was noted, with mortality risk increasing when the mean PM_(10) surpassed a specific threshold. The PM_(10)-mortality association persisted after considering co-exposures to other air pollutants. These findings strongly indicate a positive association between long-term ambient PM_(10) exposure and mortality among dialysis patients.
Subjects
Coarse particulate matter
TAQMD
NHIRD
Two-pollutant scenarios
Spline analysis
Publisher
Taiwan Association for Aerosol Research
Type
journal article