中国不同粒径环境颗粒物污染与复发性卒中住院的相关性：一项 107 万卒中患者的队列研究。
Ambient particulate matter pollution of different sizes associated with recurrent stroke hospitalization in China: A cohort study of 1.07 million stroke patients.
机构信息
Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2rd Road, Yuexiu District, Guangzhou, Guangdong 510080, China.
HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China.
出版信息
Sci Total Environ. 2023 Jan 15;856(Pt 2):159104. doi: 10.1016/j.scitotenv.2022.159104. Epub 2022 Oct 5.
BACKGROUND
To estimate the associations between ambient particulate matter (PM) pollution of different sizes (PM, PM, and PM) and risk of rehospitalization among stroke patients, as well as the attributable burden in China.
METHODS
We built a cohort of 1,066,752 participants with an index stroke hospitalization in Sichuan, China from 2017 to 2019. Seven-day and annual average exposures to PM pollution prior to the date of the index hospitalization were linked with residential address using a bilinear interpolation approach. Cox proportional hazard models were constructed to assess the association between ambient PM and the risk of rehospitalization. The burden of stroke rehospitalization was estimated using a counterfactual approach.
RESULTS
245,457 (23.0 %) participants experienced rehospitalization during a mean of 1.15 years (SD: 0.90 years) of follow-up. Seven-day average concentrations of PM were associated with increased risk of rehospitalization: the hazard ratios (HRs) per 10 μg/m were 1.034 (95 % confidence interval [CI]: 1.029-1.038) for PM, 1.033 (1.031-1.036) for PM, and 1.030 (1.028-1.031) for PM; the hazard ratios were larger for annual average concentrations: 1.082 (1.074-1.090) for PM, 1.109 (1.104-1.114) for PM, and 1.103 (1.099-1.106) for PM. The associations were stronger in participants who were female, of minority ethnicity (non-Han Chinese), who suffered from an ischemic stroke, and those admitted under normal conditions. Population attributable fractions for stroke rehospitalization ranged from 4.66 % (95 % CI: 1.69 % to 7.63 %) for the 7-day average of PM to 17.05 % (14.27 % to 19.83 %) for the annual average of PM; the reducible average cost of rehospitalization per participant attributable to PM ranged from 492.09 (178.19 to 806) RMB for the 7-day average of PM to 1801.65 (1507.89 to 2095.41) RMB for the annual average of PM.
CONCLUSIONS
Ambient PM pollution may increase the risk of rehospitalization in stroke patients and is responsible for a significant burden of stroke rehospitalization.
背景
本研究旨在评估不同粒径的环境颗粒物（PM、PM 和 PM ）污染与卒中患者再住院风险之间的关联，并估计在中国的归因负担。
方法
我们建立了一个来自中国四川的 1066752 名索引卒中住院患者队列，从 2017 年至 2019 年进行了为期 1.15 年（标准差：0.90 年）的随访。采用双线性内插法将住院前 7 天和年平均暴露于 PM 污染与居住地址联系起来。使用比例风险 Cox 模型评估环境 PM 与再住院风险之间的关联。使用反事实方法估计卒中再住院的负担。
结果
在平均 1.15 年（标准差：0.90 年）的随访中，245457（23.0%）名参与者经历了再住院。PM 的 7 天平均浓度与再住院风险增加相关：每增加 10μg/m 的危害比（HR）为 1.034（95%置信区间[CI]：1.029-1.038），PM 为 1.033（1.031-1.036），PM 为 1.030（1.028-1.031）；年平均浓度的 HR 更大：PM 为 1.082（1.074-1.090），PM 为 1.109（1.104-1.114），PM 为 1.103（1.099-1.106）。在女性、少数民族（非汉族）、缺血性卒中患者和在普通条件下入院的患者中，关联更强。卒中再住院的人群归因分数范围为 7 天平均 PM 从 4.66%（95%CI：1.69%-7.63%）到 PM 年平均从 17.05%（14.27%-19.83%）；归因于 PM 的每个患者再住院的可减少平均费用范围为 7 天平均 PM 从 492.09（178.19 至 806）人民币到 PM 年平均从 1801.65（1507.89 至 2095.41）人民币。
结论
环境 PM 污染可能会增加卒中患者再住院的风险，并导致卒中再住院的负担显著增加。
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