Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark.
Environ Int. 2020 Sep;142:105891. doi: 10.1016/j.envint.2020.105891. Epub 2020 Jun 24.
Ambient air pollution has been linked to stroke, but few studies have examined in detail stroke subtypes and confounding by road traffic noise, which was recently associated with stroke. Here we examined the association between long-term exposure to air pollution and incidence of stroke (overall, ischemic, hemorrhagic), adjusting for road traffic noise. In a nationwide Danish Nurse Cohort consisting of 23,423 nurses, recruited in 1993 or 1999, we identified 1,078 incident cases of stroke (944 ischemic and 134 hemorrhagic) up to December 31, 2014, defined as first-ever hospital contact. The full residential address histories since 1970 were obtained for each participant and the annual means of air pollutants (particulate matter with diameter < 2.5 µm and < 10 µm (PM and PM), nitrogen dioxide (NO), nitrogen oxides (NOx)) and road traffic noise were determined using validated models. Time-varying Cox regression models were used to estimate hazard ratios (HR) (95% confidence intervals (CI)) for the associations of one-, three, and 23-year running mean of air pollutants with stroke adjusting for potential confounders and noise. In fully adjusted models, the HRs (95% CI) per interquartile range increase in one-year running mean of PM and overall, ischemic, and hemorrhagic stroke were 1.12 (1.01-1.25), 1.13 (1.01-1.26), and 1.07 (0.80-1.44), respectively, and remained unchanged after adjustment for noise. Long-term exposure to ambient PM was associated with the risk of stroke independent of road traffic noise.
大气污染与中风有关，但很少有研究详细研究中风亚型和道路交通噪声的混杂作用，道路交通噪声最近与中风有关。在这里，我们研究了长期暴露于空气污染与中风（总体、缺血性、出血性）发病率之间的关系，并调整了道路交通噪声。在一项由 23423 名护士组成的全国性丹麦护士队列中，这些护士于 1993 年或 1999 年招募，我们确定了 1078 例中风（944 例缺血性和 134 例出血性）病例，直至 2014 年 12 月 31 日，定义为首次住院。为每位参与者获得了自 1970 年以来的完整居住地址历史记录，使用验证模型确定了年度空气污染物（直径<2.5μm 和<10μm 的颗粒物 (PM 和 PM)、二氧化氮 (NO)、氮氧化物 (NOx)) 和道路交通噪声的平均值。使用时变 Cox 回归模型估计了空气污染物（PM 和总体、缺血性和出血性中风）一年、三年和 23 年运行平均值与中风之间关联的风险比（HR）（95%置信区间（CI）），并调整了潜在混杂因素和噪声。在完全调整的模型中，PM 一年运行平均值每增加一个四分位间距，总体、缺血性和出血性中风的 HR（95%CI）分别为 1.12（1.01-1.25）、1.13（1.01-1.26）和 1.07（0.80-1.44），调整噪声后保持不变。长期暴露于环境 PM 与中风风险相关，独立于道路交通噪声。
