Department of Emergency Medicine, Singapore General Hospital, Singapore.
Pre-hospital & Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore.
Int J Stroke. 2022 Oct;17(9):983-989. doi: 10.1177/17474930211066745. Epub 2022 Jan 4.
Air quality is an important determinant of cardiovascular health such as ischemic heart disease and acute ischemic stroke (AIS) with substantial mortality and morbidity reported across the globe. However, associations between air quality and AIS in the current literature remain inconsistent, with few studies undertaken in cosmopolitan cities located in the tropics.
We evaluated the associations between individual ambient air pollutants and AIS.
We performed a nationwide, population-based, time-stratified case-crossover analysis on all AIS cases reported to the Singapore Stroke Registry from 2009 to 2018. We estimated the incidence rate ratio (IRR) of AIS across different concentrations of each pollutant by quartiles (referencing the 25th percentile), in single-pollutant conditional Poisson models adjusted for time-varying meteorological effects. We stratified our analysis by predetermined subgroups deemed at higher risk.
A total of 51,675 episodes of AIS were included. Ozone (O) (IRR: 1.05, 95% confidence interval (CI): 1.01-1.08) and carbon monoxide (CO) (IRR: 1.05, 95% CI: 1.02-1.08, IRR: 1.07, 95% CI: 1.04-1.10, IRR: 1.07, 95% CI: 1.04-1.11) were positively associated with AIS incidence. The increased incidence of AIS due to O and CO persisted for 5 days after exposure. Those under 65 years of age were more likely to experience AIS when exposed to CO. Individuals with atrial fibrillation (AF) were more susceptible to exposure from O, CO, and PM. Current/ex-smokers were more vulnerable to the effect of O.
Air pollution increases the incidence of AIS, especially in those with AF and in those who are current or ex-smokers.
空气质量是心血管健康的一个重要决定因素，如缺血性心脏病和急性缺血性中风（AIS），在全球范围内都有大量的发病率和死亡率报告。然而，目前文献中空气质量与 AIS 之间的关联仍然不一致，在热带地区的国际化大都市进行的研究较少。
我们评估了个体环境空气污染物与 AIS 之间的关联。
我们对 2009 年至 2018 年期间向新加坡中风登记处报告的所有 AIS 病例进行了全国性、基于人群、时间分层的病例交叉分析。我们通过四分位数（参考第 25 百分位数）在单污染物条件泊松模型中估计了不同污染物浓度下 AIS 的发病率比（IRR），并在模型中调整了时变气象效应。我们根据被认为风险较高的预定亚组对分析进行了分层。
共纳入 51675 例 AIS 发作。臭氧（O）（IRR：1.05，95%置信区间（CI）：1.01-1.08）和一氧化碳（CO）（IRR：1.05，95% CI：1.02-1.08，IRR：1.07，95% CI：1.04-1.10，IRR：1.07，95% CI：1.04-1.11）与 AIS 发病率呈正相关。暴露后 5 天内，O 和 CO 暴露与 AIS 发病率的增加持续存在。65 岁以下的人在接触 CO 时更容易发生 AIS。患有心房颤动（AF）的人更容易受到 O、CO 和 PM 的影响。目前/曾经吸烟者更容易受到 O 的影响。
空气污染增加了 AIS 的发病率，尤其是在患有 AF 和目前/曾经吸烟者中。
