Associations between short-term exposure to PM2.5, NO2 and O3 pollution and kidney-related conditions and the role of temperature-adjustment specification: A case-crossover study in New York state

Environ Pollut. 2023 Jul 1:328:121629. doi: 10.1016/j.envpol.2023.121629. Epub 2023 Apr 11.

Abstract

Epidemiologic evidence on the relationship between air pollution and kidney disease remains inconclusive. We evaluated associations between short-term exposure to PM2.5, NO2 and O3 and unplanned hospital visits for seven kidney-related conditions (acute kidney failure [AKF], urolithiasis, glomerular diseases [GD], renal tubulo-interstitial diseases, chronic kidney disease, dysnatremia, and volume depletion; n = 1,209,934) in New York State (2007-2016). We applied a case-crossover design with conditional logistic regression, controlling for temperature, dew point temperature, wind speed, and solar radiation. We used a three-pollutant model at lag 0-5 days of exposure as our main model. We also assessed the influence of model adjustment using different specifications of temperature by comparing seven temperature metrics (e.g., dry-bulb temperature, heat index) and five intraday temperature measures (e.g., daily mean, daily minimum, nighttime mean), according to model performance and association magnitudes between air pollutants and kidney-related conditions. In our main models, we adjusted for daytime mean outdoor wet-bulb globe temperature, which showed good model performance across all kidney-related conditions. We observed the odds ratios (ORs) for 5 μg/m3 increase in daily mean PM2.5 to be 1.013 (95% confidence interval [CI]: 1.001, 1.025) for AKF, 1.107 (95% CI: 1.018, 1.203) for GD, and 1.027 (95% CI: 1.015, 1.038) for volume depletion; and the OR for 5 ppb increase in daily 1-hour maximum NO2 to be 1.014 (95% CI; 1.008, 1.021) for AKF. We observed no associations with daily 8-hour maximum O3 exposure. Association estimates varied by adjustment for different intraday temperature measures: estimates adjusted for measures with poorer model performance resulted in the greatest deviation from estimates adjusted for daytime mean, especially for AKF and volume depletion. Our findings indicate that short-term exposure to PM2.5 and NO2 is a risk factor for specific kidney-related conditions and underscore the need for careful adjustment of temperature in air pollution epidemiologic studies.

Keywords: Kidney disease; NO(2); O(3); PM(2.5); Temperature adjustment.

MeSH terms

  • Air Pollutants* / analysis
  • Air Pollution* / analysis
  • Cross-Over Studies
  • Environmental Exposure / analysis
  • Humans
  • Kidney / chemistry
  • Kidney Diseases* / chemically induced
  • Kidney Diseases* / epidemiology
  • New York
  • Nitrogen Dioxide / analysis
  • Particulate Matter / analysis
  • Temperature

Substances

  • Nitrogen Dioxide
  • Air Pollutants
  • Particulate Matter