Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, South Korea.
Department of Occupational and Environmental Medicine, Ewha Womans University of Medicine, Seoul, South Korea.
Environ Res. 2021 Jun;197:111139. doi: 10.1016/j.envres.2021.111139. Epub 2021 Apr 18.
Although many studies have evaluated the effects of ambient particulate matter with diameters of less than 2.5 μm (PM) on stroke mortality in the general population, little is known about the mortality effects of PM in post-stroke populations. Therefore, a retrospective cohort was constructed using information from the health insurance database to evaluate whether exposure to PM is associated with increased mortality in aged stroke survivors residing in seven Korean metropolitan cities. A total of 45,513 older adults (≥65 years) who visited emergency rooms due to stroke and who were discharged alive between 2008 and 2016 were followed up. By using district-level modeled PM concentrations and a time-varying Cox proportional hazard model, associations between 1-month and 2-month moving average PM exposures and mortality in stroke survivors were evaluated. The annual average concentration of PM was 27.9 μg/m in the seven metropolitan cities, and 14,880 subjects died during the follow-up period. A 10 μg/m increase in the 1-month and 2-month moving average PM exposures was associated with mortality hazard ratios of 1.07 (95% confidence interval: 1.05, 1.09) and 1.06 (95% confidence interval: 1.03, 1.08), respectively. The effects of PM were similar across types of stroke (ischemic and hemorrhagic), age groups (65-74, 75-84, and ≥85), and income groups (low and high) but were greater in women than in men. This study highlights the adverse health effects of ambient PM in post-stroke populations. Active avoidance behaviors against PM are recommended for aged stroke survivors.
尽管许多研究已经评估了直径小于 2.5μm（PM）的环境颗粒物对一般人群中风死亡率的影响，但对于中风后人群中 PM 的死亡率影响知之甚少。因此，本研究利用健康保险数据库中的信息构建了回顾性队列，以评估暴露于 PM 是否与居住在韩国七个大都市的老年中风幸存者的死亡率增加有关。共纳入了 45513 名因中风而到急诊室就诊并于 2008 年至 2016 年期间存活出院的≥65 岁老年人，并进行随访。通过使用区级模型化 PM 浓度和时变 Cox 比例风险模型，评估了 1 个月和 2 个月移动平均 PM 暴露与中风幸存者死亡率之间的关系。七个大都市的 PM 年平均浓度为 27.9μg/m3，随访期间有 14880 人死亡。1 个月和 2 个月移动平均 PM 暴露增加 10μg/m3 与死亡率的危险比分别为 1.07（95%置信区间：1.05，1.09）和 1.06（95%置信区间：1.03，1.08）。PM 的影响在各种类型的中风（缺血性和出血性）、年龄组（65-74、75-84 和≥85 岁）和收入组（低和高）中相似，但在女性中大于男性。本研究强调了环境 PM 对中风后人群的不良健康影响。建议老年中风幸存者采取积极的避免 PM 行为。
