Guo Pi, Wang Yulin, Feng Wenru, Wu Jiagang, Fu Chuanxi, Deng Hai, Huang Jun, Wang Li, Zheng Murui, Liu Huazhang
Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China.
Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China.
Int J Environ Res Public Health. 2017 Sep 20;14(9):1091. doi: 10.3390/ijerph14091091.
Data on the association between air pollution and risk of ischemic stroke in China are still limited. This study aimed to investigate the association between short-term exposure to ambient air pollution and risk of ischemic strokes in Guangzhou, the most densely-populated city in south China, using a large-scale multicenter database of stroke hospital admissions. Daily counts of ischemic stroke admissions over the study years 2013-2015 were obtained from the Guangzhou Cardiovascular and Cerebrovascular Disease Event Surveillance System. Daily particulate matter <2.5 μm in diameter (PM), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), and meteorological data were collected. The associations between air pollutants and hospital admissions for stroke were examined using relative risks (RRs) and their corresponding 95% confidence intervals (CIs) based on time-series Poisson regression models, adjusting for temperature, public holiday, day of week, and temporal trends in stroke. Ischemic stroke admissions increased from 27,532 to 35,279 through 2013 to 2015, increasing by 28.14%. Parameter estimates for NO₂ exposure were robust regardless of the model used. The association between same-day NO₂ (RR = 1.0509, 95% CI: 1.0353-1.0668) exposure and stroke risk was significant when accounting for other air pollutants, day of the week, public holidays, temperature, and temporal trends in stroke events. Overall, we observed a borderline significant association between NO₂ exposure modeled as an averaged lag effect and ischemic stroke risk. This study provides data on air pollution exposures and stroke risk, and contributes to better planning of clinical services and emergency contingency response for stroke.
在中国，关于空气污染与缺血性中风风险之间关联的数据仍然有限。本研究旨在利用一个大规模的中风住院患者多中心数据库，调查中国南方人口最密集的城市广州短期暴露于环境空气污染与缺血性中风风险之间的关联。2013 - 2015年研究期间缺血性中风住院患者的每日计数数据来自广州心血管和脑血管疾病事件监测系统。收集了直径小于2.5微米的每日颗粒物（PM）、二氧化硫（SO₂）、二氧化氮（NO₂）、臭氧（O₃）以及气象数据。基于时间序列泊松回归模型，通过调整温度、公共假日、星期几以及中风的时间趋势，使用相对风险（RRs）及其相应的95%置信区间（CIs）来检验空气污染物与中风住院之间的关联。2013年至2015年，缺血性中风住院人数从27,532人增加到35,279人，增长了28.14%。无论使用何种模型，NO₂暴露的参数估计都是稳健的。在考虑其他空气污染物、星期几、公共假日、温度以及中风事件的时间趋势时，当日NO₂暴露（RR = 1.0509，95% CI：1.0353 - 1.0668）与中风风险之间的关联是显著的。总体而言，我们观察到以平均滞后效应建模后的NO₂暴露与缺血性中风风险之间存在临界显著关联。本研究提供了空气污染暴露与中风风险的数据，并有助于更好地规划中风的临床服务和应急响应。
