Yitshak Sade Maayan, Novack Victor, Ifergane Gal, Horev Anat, Kloog Itai
From the Department of Medicine, Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel (M.Y.S., V.N.); Clinical Research Center (M.Y.S., V.N.) and Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I., A.H.); and Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University, Beer Sheva, Israel (I.K.).
Stroke. 2015 Dec;46(12):3348-53. doi: 10.1161/STROKEAHA.115.010992. Epub 2015 Nov 3.
Studies have demonstrated consistent associations between cardiovascular illness and particulate matter (PM) <10 and <2.5 μm in diameter, but stroke received less attention. We hypothesized that air pollution, an inflammation progenitor, can be associated with stroke incidence in young patients in whom the usual risk factors for stroke are less prevalent. We aimed to evaluate the association between stroke incidence and exposure to PM <10 and <2.5 μm, in a desert area characterized by a wide range of PM.
We included all members of the largest health maintenance organization in Israel, who were admitted to a local hospital with stroke between 2005 and 2012. Exposure assessment was based on a hybrid model incorporating daily satellite remote sensing data at 1-km spatial resolution. We performed case-crossover analysis, stratified by personal characteristics and distance from main roads.
We identified 4837 stroke cases (89.4% ischemic stroke). Interquartile range of PM <10 and <2.5 μm was 36.3 to 54.7 and 16.7 to 23.3 μg/m(3), respectively. The subjects' average age was 70 years; 53.4% were males. Associations between ischemic stroke and increases of interquartile range average concentrations of particulate matter <10 or <2.5 μm at the day of the event were observed among subjects <55 years (odds ratio [95% confidence interval], 1.11 [1.02-1.20] and 1.10 [1.00-1.21]). Stronger associations were observed in subjects living within 75 m from a main road (1.22 [1.03-1.43] and 1.26 [1.04-1.51]).
We observed higher risk for ischemic stroke associated with PM among young adults. This finding can be explained by the inflammatory mechanism, linking air pollution and stroke.
研究表明心血管疾病与直径小于10微米及小于2.5微米的颗粒物（PM）之间存在持续关联，但中风受到的关注较少。我们推测，空气污染作为一种炎症诱发因素，可能与中风发病率较低的年轻患者相关。我们旨在评估在一个以广泛的颗粒物为特征的沙漠地区，中风发病率与暴露于直径小于10微米及小于2.5微米的颗粒物之间的关联。
我们纳入了以色列最大的健康维护组织中在2005年至2012年间因中风入住当地医院的所有成员。暴露评估基于一个混合模型，该模型纳入了空间分辨率为1公里的每日卫星遥感数据。我们进行了病例交叉分析，并按个人特征和与主要道路的距离进行分层。
我们确定了4837例中风病例（89.4%为缺血性中风）。直径小于10微米及小于2.5微米的颗粒物的四分位间距分别为36.3至54.7微克/立方米和16.7至23.3微克/立方米。受试者的平均年龄为70岁；53.4%为男性。在55岁以下的受试者中，观察到缺血性中风与事件发生当天直径小于10微米或小于2.5微米的颗粒物四分位间距平均浓度增加之间存在关联（优势比[95%置信区间]，1.11[1.02 - 1.20]和1.10[1.00 - 1.21]）。在距离主要道路75米以内居住的受试者中观察到更强的关联（1.22[1.03 - 1.43]和1.26[1.04 - 1.51]）。
我们观察到年轻人中缺血性中风与颗粒物相关的风险更高。这一发现可以通过空气污染与中风之间的炎症机制来解释。
