Lin Hualiang, Guo Yanfei, Di Qian, Zheng Yang, Kowal Paul, Xiao Jianpeng, Liu Tao, Li Xing, Zeng Weilin, Howard Steven W, Nelson Erik J, Qian Zhengmin, Ma Wenjun, Wu Fan
From the Guangdong Provincial Institute of Public Health, Guangzhou, China (H.L., J.X., T.L., X.L., W.Z.,W.M.); Shanghai Municipal Centre for Disease Control and Prevention, China (Y.G., Y.Z., F.W.); Harvard T.H. Chan School of Public Health, Boston, MA (Q.D.); Department of Health Statistics and Information Systems, World Health Organization, WHO SAGE, Geneva, Switzerland (P.K.); University of Newcastle Research Centre on Gender, Health and Ageing, Australia (P.K.); Saint Louis University College for Public Health and Social Justice, Missouri (S.H., Z.Q.); Department of Epidemiology and Biostatistics, IU School of Public Health-Bloomington, Indiana (E.N.).
Stroke. 2017 May;48(5):1191-1197. doi: 10.1161/STROKEAHA.116.015739. Epub 2017 Apr 6.
Short-term exposure to ambient fine particulate pollution (PM) has been linked to increased stroke. Few studies, however, have examined the effects of long-term exposure.
A total of 45 625 participants were interviewed and included in this study, the participants came from the Study on Global Ageing and Adult Health, a prospective cohort in 6 low- and middle-income countries. Ambient PM levels were estimated for participants' communities using satellite data. A multilevel logistic regression model was used to examine the association between long-term PM exposure and stroke. Potential effect modification by physical activity and consumption of fruit and vegetables was assessed.
The odds of stroke were 1.13 (95% confidence interval, 1.04-1.22) for each 10 μg/m increase in PM. This effect remained after adjustment for confounding factors including age, sex, smoking, and indoor air pollution (adjusted odds ratio=1.12; 95% confidence interval, 1.04-1.21). Further stratified analyses suggested that participants with higher levels of physical activity had greater odds of stroke, whereas those with higher consumption of fruit and vegetables had lower odds of stroke. These effects remained robust in sensitivity analyses. We further estimated that 6.55% (95% confidence interval, 1.97%-12.01%) of the stroke cases could be attributable to ambient PM in the study population.
This study suggests that ambient PM may increase the risk of stroke and may be responsible for the astounding stroke burden in low- and middle-income countries. In addition, greater physical activity may enhance, whereas greater consumption of fruit and vegetables may mitigate the effect.
短期暴露于环境细颗粒物污染（PM）与中风风险增加有关。然而，很少有研究探讨长期暴露的影响。
本研究共纳入45625名参与者，他们来自全球老龄化与成人健康研究，这是一项在6个低收入和中等收入国家开展的前瞻性队列研究。利用卫星数据估算参与者所在社区的环境PM水平。采用多水平逻辑回归模型检验长期PM暴露与中风之间的关联。评估了身体活动以及水果和蔬菜摄入量对潜在影响的修正作用。
PM每增加10μg/m，中风几率为1.13（95%置信区间为1.04 - 1.22）。在对年龄、性别、吸烟和室内空气污染等混杂因素进行调整后，这一效应依然存在（调整后的优势比 = 1.12；95%置信区间为1.04 - 1.21）。进一步的分层分析表明，身体活动水平较高的参与者中风几率更高，而水果和蔬菜摄入量较高的参与者中风几率较低。在敏感性分析中，这些效应依然显著。我们进一步估计，在研究人群中，6.55%（95%置信区间为1.97% - 12.01%）的中风病例可能归因于环境PM。
本研究表明，环境PM可能会增加中风风险，并且可能是低收入和中等收入国家中风负担惊人的原因。此外，更多的身体活动可能会增强这种影响，而更多地食用水果和蔬菜可能会减轻这种影响。
