Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
Medical Informatics Center, Peking University, Beijing, China.
PLoS Med. 2018 Oct 4;15(10):e1002668. doi: 10.1371/journal.pmed.1002668. eCollection 2018 Oct.
Evidence of the short-term effects of ambient air pollution on the risk of ischemic stroke in low- and middle-income countries is limited and inconsistent. We aimed to examine the associations between air pollution and daily hospital admissions for ischemic stroke in China.
We identified hospital admissions for ischemic stroke in 2014-2016 from the national database covering up to 0.28 billion people who received Urban Employee Basic Medical Insurance (UEBMI) in China. We examined the associations between air pollution and daily ischemic stroke admission using a two-stage method. Poisson time-series regression models were firstly fitted to estimate the effects of air pollution in each city. Random-effects meta-analyses were then conducted to combine the estimates. Meta-regression models were applied to explore potential effect modifiers. More than 2 million hospital admissions for ischemic stroke were identified in 172 cities in China. In single-pollutant models, increases of 10 μg/m3 in particulate matter with aerodynamic diameter <2.5 μm (PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3) and 1 mg/m3 in carbon monoxide (CO) concentrations were associated with 0.34% (95% confidence interval [CI], 0.20%-0.48%), 1.37% (1.05%-1.70%), 1.82% (1.45%-2.19%), 0.01% (-0.14%-0.16%), and 3.24% (2.05%-4.43%) increases in hospital admissions for ischemic stroke on the same day, respectively. SO2 and NO2 associations remained significant in two-pollutant models, but not PM2.5 and CO associations. The effect estimates were greater in cities with lower air pollutant levels and higher air temperatures, as well as in elderly subgroups. The main limitation of the present study was the unavailability of data on individual exposure to ambient air pollution.
As the first national study in China to systematically examine the associations between short-term exposure to ambient air pollution and ischemic stroke, our findings indicate that transient increase in air pollution levels may increase the risk of ischemic stroke, which may have significant public health implications for the reduction of ischemic stroke burden in China.
关于环境空气污染对中低收入国家缺血性卒中风险的短期影响的证据有限且不一致。本研究旨在检验中国空气污染与每日缺血性卒中住院之间的关联。
我们从全国数据库中确定了 2014 年至 2016 年的缺血性卒中住院人数，该数据库覆盖了中国接受城镇职工基本医疗保险（UEBMI）的人数达 0.28 亿人。我们采用两阶段方法检验空气污染与每日缺血性卒中入院之间的关联。首先，我们使用泊松时间序列回归模型估计每个城市的空气污染效应。然后，我们进行随机效应荟萃分析以合并这些估计值。我们应用荟萃回归模型来探索潜在的效应修饰因子。在中国 172 个城市中，我们确定了超过 200 万例缺血性卒中住院患者。在单污染物模型中，空气中直径小于 2.5 μm 的颗粒物（PM2.5）、二氧化硫（SO2）、二氧化氮（NO2）和臭氧（O3）浓度每增加 10μg/m3，以及一氧化碳（CO）浓度每增加 1mg/m3，与同日缺血性卒中住院人数分别增加 0.34%（95%置信区间[CI]：0.20%-0.48%）、1.37%（1.05%-1.70%）、1.82%（1.45%-2.19%）、0.01%（-0.14%-0.16%）和 3.24%（2.05%-4.43%）有关。在双污染物模型中，SO2 和 NO2 关联仍然显著，但 PM2.5 和 CO 关联不显著。在空气污染水平较低和气温较高的城市以及老年亚组中，效应估计值更大。本研究的主要局限性在于缺乏环境空气中个体暴露数据。
作为中国首次系统检验短期暴露于环境空气污染与缺血性卒中之间关联的研究，本研究结果表明，空气污染水平的短暂升高可能会增加缺血性卒中的风险，这可能对降低中国缺血性卒中负担具有重要的公共卫生意义。
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