Center for Big Data Research in Health and Medicine, Institute for Data Sciences, Tsinghua University, Beijing 100084, China; Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing 100084, China; Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Department of Computer Science and Technology, Tsinghua University, Beijing 100084, China.
China Standard Medical Information Research Center, Shenzhen 518054, China.
Sci Total Environ. 2020 May 1;715:136896. doi: 10.1016/j.scitotenv.2020.136896. Epub 2020 Jan 23.
Few studies have investigated the acute effects of fine particulate matter (PM) on the risk of stroke subtypes and transient ischemic attack (TIA) in low- and middle-income countries. The primary aim of this study was to assess the associations between short-term exposure to PM and daily hospital admissions for total cerebrovascular disease, ischemic and hemorrhagic strokes, and TIA in China. A total of 8,359,162 hospital admissions in 248 Chinese cities from 2013 to 2017 were identified from the Hospital Quality Monitoring System of China. Generalized additive models with quasi-Poisson regression were used to estimate the associations in each city, and random-effect meta-analyses were conducted to combine the city-specific estimates. We found that a 10 μg/m increase in PM concentration was significantly associated with a 0.19% (95% CI, 0.13% to 0.25%), 0.26% (95% CI, 0.17% to 0.35%), and 0.26% (95% CI, 0.13% to 0.38%) increase in same-day hospital admissions for total cerebrovascular disease, ischemic stroke, and TIA, respectively. In contrast, a non-significant negative association with PM was observed for hemorrhagic stroke in the main analyses (lag 0 day), which became statistically significant when using other single-day exposures (lag 1 or 2 days) or moving average exposures (lag 0-1, 0-2, or 0-3 days) as exposure metric. These associations were robust to adjustment for other criteria air pollutants in two-pollutant models. For ischemic stroke, the effect estimates were significantly larger in people aged 65-74 years, in cool season, and in cities with lower annual average PM concentrations. The exposure-response curves were nonlinear with a leveling off at high concentrations. These results contribute to the relatively limited literature on the PM-related risks of cerebrovascular events in low- and middle-income countries.
在中国，很少有研究调查细颗粒物（PM）对中低收入国家中风亚型和短暂性脑缺血发作（TIA）风险的急性影响。本研究的主要目的是评估短期 PM 暴露与总脑血管疾病、缺血性和出血性中风以及 TIA 的每日住院人数之间的关联。从中国医院质量监测系统中确定了 2013 年至 2017 年期间中国 248 个城市的 8359162 例住院病例。使用广义加性模型和拟泊松回归估计每个城市的相关性，并进行随机效应荟萃分析以合并城市特定的估计值。我们发现，PM 浓度每增加 10μg/m，总脑血管疾病、缺血性中风和 TIA 的当日住院人数分别显著增加 0.19%（95%CI，0.13%至 0.25%）、0.26%（95%CI，0.17%至 0.35%）和 0.26%（95%CI，0.13%至 0.38%）。相反，在主要分析中（lag0 天），PM 与出血性中风呈负相关，但当使用其他单日暴露（lag1 或 2 天）或移动平均暴露（lag0-1、0-2 或 0-3 天）作为暴露指标时，这种相关性具有统计学意义。在双污染物模型中，当调整其他标准空气污染物时，这些关联仍然稳健。对于缺血性中风，65-74 岁人群、凉爽季节和年平均 PM 浓度较低的城市的效应估计值较大。暴露-反应曲线是非线性的，在高浓度时趋于平稳。这些结果为中低收入国家中与 PM 相关的脑血管事件风险的相关文献相对较少做出了贡献。
