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\begin{document}

\title{Associations of Reproductive Risk Score and Joint Exposure to Ambient
Air Pollutants with Chronic Obstructive Pulmonary Disease: A cohort
study in UK Biobank}



\author[1]{Nan Li}%
\author[1]{Xiaowen Liu}%
\author[1]{Ninghao Huang}%
\author[1]{Ming Jin}%
\author[1]{Zhenhuang Zhuang}%
\author[1]{Wenxiu Wang}%
\author[1]{Yimin Zhao}%
\author[1]{Xiaojing Liu}%
\author[1]{Tao Huang}%
\affil[1]{Peking University School of Public Health Department of Epidemiology and Biostatistics}%


\vspace{-1em}



  
  \date{June 14, 2024}


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\begin{abstract}
\textbf{Objective:} To construct a reproductive risk score (RRS) and an
air pollution score (APS) and assess independent and joint associations
between the two with incident COPD risk. \textbf{Design:}
Population-based prospective cohort study. \textbf{Setting:} UK Biobank.
\textbf{Population:} 78,218 female participants aged 40--69 years
without baseline COPD recruited between 2006 to 2010. \textbf{Methods:}
RRS was constructed by 17 women's reproductive health-related items, and
APS incorporating PM \textsubscript{2.5}, PM \textsubscript{2.5-10}, PM
\textsubscript{10}, NO \textsubscript{2}, and NO \textsubscript{x} was
calculated to assess the joint exposure level. The associations of RRS
and APS with COPD were examined by Cox proportional hazards regression.
\textbf{Main Outcome Measures:} The outcome of the incident COPD was
identified through the in-patient hospital register. \textbf{Results:}
Higher RRS was associated with an increased risk of COPD (adjusted HR:
1.15, 95\% CI: 1.12-1.19, P trend \textless{} 0.001). A dose-response
manner can be observed between higher quintile APS and increased COPD
risk (P trend \textless{} 0.001). The RERI of 0.030 (95\% CI:
0.012-0.048) showed additive interaction between RRS and APS on COPD was
significant. In the joint analysis, the combinations of both higher RRS
and APS signified higher incident COPD risk. \textbf{Conclusions:} High
RRS and high APS were associated with increased COPD risks in a
dose-response pattern. Using comprehensive indicators to identify
women's reproductive risk factors, together with the control of air
pollution, is effective for COPD prevention.%
\end{abstract}%



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