Combined effects of air pollution and extreme heat events among ESKD patients within the Northeastern United States

Autor: Richard V. Remigio, Hao He, Jochen G. Raimann, Peter Kotanko, Frank W. Maddux, Amy Rebecca Sapkota, Xin-Zhong Liang, Robin Puett, Xin He, Amir Sapkota
Rok vydání: 2022
Předmět:
Zdroj: Sci Total Environ
ISSN: 0048-9697
DOI: 10.1016/j.scitotenv.2021.152481
Popis: BACKGROUND: Increasing number of studies have linked air pollution exposure with renal function decline and disease. However, there is a lack of data on its impact among end-stage kidney disease (ESKD) patients and its potential modifying effect from extreme heat events (EHE). METHODS: Fresenius Kidney Care records from 28 selected northeastern US counties were used to pool daily all-cause mortality (ACM) and all-cause hospital admissions (ACHA) counts. County-level daily ambient PM(2.5) and ozone (O(3)) were estimated using a high-resolution spatiotemporal coupled climate-air quality model and matched to ESKD patients based on ZIP codes of treatment sites. We used time-stratified case-crossover analyses to characterize acute exposures using individual and cumulative lag exposures for up to 3 days (Lag 0–3) by using a distributed lag nonlinear model framework. We used a nested model comparison hypothesis test to evaluate for interaction effects between air pollutants and EHE and stratification analyses to estimate effect measures modified by EHE days. RESULTS: From 2001 to 2016, the sample population consisted of 43,338 ESKD patients. We recorded 5,217 deaths and 78,433 hospital admissions. A 10-unit increase in PM(2.5) concentration was associated with a 5% increase in ACM (rate ratio [RR(Lag0–3)]: 1.05, 95% CI: 1.00–1.10) and same-day O(3) (RR(Lag0): 1.02, 95% CI: 1.01–1.03) after adjusting for extreme heat exposures. Mortality models suggest evidence of interaction and effect measure modification, though not always simultaneously. ACM risk increased up to 8% when daily ozone concentrations exceeded National Ambient Air Quality Standards established by the United States, but the increases in risk were considerably higher during EHE days across lag periods. CONCLUSION: Our findings suggest interdependent effects of EHE and air pollution among ESKD patients for all-cause mortality risks. National level assessments are needed to consider the ESKD population as a sensitive population and inform treatment protocols during extreme heat and degraded pollution episodes.
Databáze: OpenAIRE
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