Avellaneda-Gómez C, Vivanco-Hidalgo R M, Olmos S, Lazcano U, Valentin A, Milà C, Ambrós A, Roquer J, Tonne C
Neurology Department, IMIM-Hospital del Mar, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Complex Hospitalari Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain.
Neurology Department, IMIM-Hospital del Mar, Barcelona, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain.
Environ Int. 2022 Mar;161:107147. doi: 10.1016/j.envint.2022.107147. Epub 2022 Feb 15.
Evidence for the association between environmental exposures and ischemic stroke (IS) is limited and inconsistent. We aimed to assess the relationship between exposure to air pollutants, residential surrounding greenness, and incident IS, and to identify population subgroups particularly sensitive to these exposures.
We used data from administrative health registries of the public healthcare system in Catalonia, Spain to construct a cohort of individuals aged 18 years and older without a previous stroke diagnosis at 1st January 2016 (n = 3 521 274). We collected data on sociodemographic characteristics and cerebrovascular risk factors, and derived exposure at the participant's residence to ambient levels of fine particulate matter (PM), black carbon (BC), nitrogen dioxide (NO), and Normalized Difference Vegetation Index (NDVI) in a 300 m buffer as an indicator of greenness. The primary outcome was IS diagnosis at any point during the follow-up. We used Cox proportional hazards models to estimate associations between environmental exposures and incident IS and stratified analyses to investigate effect modification.
Between 1st January 2016 and 31st December 2017, 10 865 individuals were admitted to public hospitals with an IS diagnosis. Median exposure levels were: 17 µg/m PM, 35 µg/m NO, 2.28 µg/m BC and 0.27 NDVI. Individuals with higher residential exposure to air pollution were at greater risk of IS: HR 1·04 (95% CI:0·99-1·10) per 5 µg/m of PM; HR 1.05 (95% CI:1·00-1·10) per 1 µg/m of BC; HR 1·04 (95% CI:1·03-1·06) per 10 µg/m of NO. Conversely, individuals with higher residential surrounding green space, had lower risk of IS (HR 0·84; CI 95%:0·7-1.0). There was no evidence of effect modification by individual characteristics.
Higher incidence of IS was observed in relation to long-term exposures to air pollution, particularly NO, in a region that meets European health-based air quality standards. Residential surrounding greenness was associated with lower incidence of IS.
环境暴露与缺血性中风（IS）之间关联的证据有限且不一致。我们旨在评估空气污染物暴露、居住环境绿化程度与IS发病之间的关系，并确定对这些暴露特别敏感的人群亚组。
我们使用了西班牙加泰罗尼亚公共医疗系统行政健康登记处的数据，构建了一个2016年1月1日年龄在18岁及以上且既往无中风诊断的队列（n = 3521274）。我们收集了社会人口学特征和脑血管危险因素的数据，并得出参与者居住地址周围300米缓冲区内细颗粒物（PM）、黑碳（BC）、二氧化氮（NO）的环境水平以及归一化植被指数（NDVI）作为绿化程度的指标。主要结局是随访期间任何时间的IS诊断。我们使用Cox比例风险模型估计环境暴露与IS发病之间的关联，并进行分层分析以研究效应修正。
在2016年1月1日至2017年12月31日期间，10865人因IS诊断入住公立医院。中位暴露水平为：17μg/m³ PM、35μg/m³ NO、2.28μg/m³ BC和0.27 NDVI。居住环境空气污染暴露较高的个体患IS的风险更高：每5μg/m³ PM的HR为1.04（95%CI：0.99 - 1.10）；每1μg/m³ BC的HR为1.05（95%CI：1.00 - 1.10）；每10μg/m³ NO的HR为1.04（95%CI：1.03 - 1.06）。相反，居住环境绿化程度较高的个体患IS的风险较低（HR 0.84；95%CI：0.7 - 1.0）。没有证据表明个体特征会产生效应修正。
在一个符合欧洲基于健康的空气质量标准的地区，观察到长期暴露于空气污染，尤其是NO，会导致IS发病率更高。居住环境绿化程度与IS发病率较低相关。
