Associations between Air Pollution, Open Space and Chronic Kidney Disease

• Main Authors: Ya-Ru Yang, 楊雅茹
• Other Authors: 詹長權
• Format: Others
• Language: zh-TW
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/42623437218577779139

碩士 === 國立臺灣大學 === 職業醫學與工業衛生研究所 === 103 === Epidemiology studies have confirmed the association between air pollutions, especially particulate matters (PM), and morbidity and mortality of cardiovascular diseases. And several studies also found open space was associated with overweight, obesity and longevity. Yet, studies on the associations between air pollution, open space and chronic kidney disease (CKD) are still limited. The objective of the study was to investigate the associations between air pollution, open space, renal function, and CKD for adults in Taipei, Taiwan. Study subjects of this study were adults living in the metropolitan areas in New Taipei City in 2007-2009 and participated in the government-sponsored integrated health screening program. Health outcomes included estimated glomerular filtration rate (eGFR), CKD, inflammatory markers, proteinuria and early stage of CKD. eGFR was calculated by serum creatinine, age and gender through equations of Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, MDRD-Japan、CKD-EPI-Japan, IDMS-MDRD-Taiwan, CKD-EPI-Taiwan. CKD was defined by eGFR lower than 60 ml/min/1.73m2 or 250.4*, 274.1*, 283.11, 403.*1, 404.*2, 404.*3, 440.1, 442.1, 447.3, 572.4, 580-588, 642.1*, 646.2* in ICD-9 CM Code. Exposure variables were included air pollutions and open space. The individual exposures of air pollution were estimated by land use regression models for PM2.5, PM2.5Absorbance, PM10, PMCoarse, NO2 and NOx. Schools, recreation areas and parks were defined as open space. We applied generalized linear model (GLM) and logistic regression to estimate the associations between exposures and outcomes, adjusting for confounders of age, gender, fasting blood glucose, smoking, hypertension and overweight. The age of 21,656 subjects were 30-97, and the female to male ratio was approximately 2:1 in this study. We found increased long-term exposure of PM10, PMCoarse and NOx were associated with decreased eGFR and increased odds ratio of CKD. Using CKD-EPI-Taiwan as an example, a 10μg/m3 of PM10 increased was associated with 1.0 (95% CI：0.6-1.3) ml/min/1.73m2 decreased in eGFR and an odds ratio (OR) 1.1 (95% CI：1.0-1.3) of CKD. A 5μg/m3 of PMCoarse increased was associated with 0.7 (95% CI：0.5-0.9) ml/min/1.73m2 decreased in eGFR and an OR 1.1 (95% CI：1.0-1.2) of CKD. A 20μg/m3 of NOx increased was associated with 0.7 (95% CI：0.2-1.2) ml/min/1.73m2 decreased in eGFR for elderly who aged above 65. A 5μg/m3 of PM2.5 increased was associated with 0.03 (95% CI：0.005-0.05) 103/mL increased in WBC, an OR 1.2 (95% CI：1.1-1.4) of proteinuria and an OR 1.3 (95% CI：1.1-1.5) of early stage of CKD. A 10-5m-1 of PM2.5Absorbance increased was associated with 0.07 (95% CI：0.02-0.1) 103/mL increased in WBC, an OR 1.8 (95% CI：1.3-2.5) of proteinuria and an OR 1.8 (95% CI：1.2-2.8) of early stage of CKD. We also found increasing distance to open space among elderly who aged above 65 was associated with 0.6 (95% CI：0.1-1.1) ml/min/1.73m2 decreased in eGFR and an OR 1.1 (95% CI：1.0-1.2) of CKD. We concluded that PM (PM2.5, PM2.5Absorbance, PM10 and PMCoarse) and NOx were all associated with deterioration of renal function for adults above 30 years old. Increasing distance to open space among adults aged above 65 was associated with decreased eGFR and increased risk of chronic kidney disease.