Xu Yenan, Chen Jarvis T, Holland Isabel, Yanosky Jeff D, Liao Duanping, Coull Brent A, Wang Dong, Rexrode Kathryn, Whitsel Eric A, Wellenius Gregory A, Laden Francine, Hart Jaime E
Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA.
Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA.
Environ Epidemiol. 2021 Nov 11;5(6):e178. doi: 10.1097/EE9.0000000000000178. eCollection 2021 Dec.
Stroke is a leading cause of mortality worldwide, and air pollution is the third largest contributor to global stroke burden. Existing studies investigating the association between long-term exposure to particulate matter (PM) and stroke incidence have been mixed and very little is known about the associations with medium-term exposures. Therefore, we wanted to evaluate these associations in an cohort of male health professionals.
We assessed the association of PM exposures in the previous 1 and 12 months with incident total, ischemic, and hemorrhagic stroke in 49,603 men in the prospective US-based Health Professionals' Follow-up Study 1988-2007. We used spatiotemporal prediction models to estimate monthly PM less than 10 (PM) and less than 2.5 (PM), and PM at all mailing addresses. We used time-varying Cox proportional hazards models adjusted for potential confounders based on previous literature to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for each 10-μg/m increase in exposure in the preceding 1 and 12 months. We explored possible effect modification by age, obesity, smoking, aspirin use, diet quality, physical activity, diabetes, and Census region.
We observed 1,467 cases of incident stroke. Average levels of 12-month PM, PM, and PM were 20.7, 8.4, and 12.3 µg/m, respectively. In multivariable adjusted models, we did not observe consistent associations between PM and overall or ischemic stroke. There was a suggestion of increased risk of hemorrhagic stroke (12-month PM multivariable HR: 1.13 [0.86, 1.48]; PM: 1.12 [0.78, 1.62]; PM:1.17 [0.76, 1.81], all per 10 µg/m). There was little evidence of effect modification.
We observed only weak evidence of an association between long-term exposure to PM and risks of overall incident stroke. There was a suggestion of increasing hemorrhagic stroke risk.
中风是全球主要的死亡原因之一，空气污染是全球中风负担的第三大促成因素。现有研究对长期接触颗粒物（PM）与中风发病率之间的关联结果不一，而对于中期接触的关联知之甚少。因此，我们想在一组男性健康专业人员中评估这些关联。
我们在美国前瞻性的健康专业人员随访研究（1988 - 2007年）中的49,603名男性中，评估了前1个月和12个月的PM暴露与新发的总体、缺血性和出血性中风之间的关联。我们使用时空预测模型来估计每月小于10微米（PM）和小于2.5微米（PM）的颗粒物以及所有邮寄地址的PM。我们使用基于先前文献对潜在混杂因素进行调整的时变Cox比例风险模型，来估计前1个月和12个月暴露每增加10微克/立方米时的风险比（HRs）和95%置信区间（CIs）。我们探讨了年龄、肥胖、吸烟、阿司匹林使用、饮食质量、身体活动、糖尿病和人口普查区域可能的效应修正作用。
我们观察到1467例新发中风病例。12个月的PM、PM和PM的平均水平分别为20.7、8.4和12.3微克/立方米。在多变量调整模型中，我们未观察到PM与总体或缺血性中风之间存在一致的关联。有迹象表明出血性中风风险增加（12个月的PM多变量HR：1.13 [0.86, 1.48]；PM：1.12 [0.78, 1.62]；PM：1.17 [0.76, 1.81]，均为每10微克/立方米）。几乎没有效应修正的证据。
我们仅观察到长期接触PM与总体新发中风风险之间存在微弱关联的证据。有迹象表明出血性中风风险增加。
