Liu Tao, Jiang Yong, Hu Jianxiong, Li Zixiao, Li Xing, Xiao Jianpeng, Yuan Lixia, He Guanhao, Zeng Weilin, Rong Zuhua, Zhu Sui, Ma Wenjun, Wang Yongjun
From the Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China.
Disease Control and Prevention Institute of Jinan University, Jinan University, Guangzhou 510632, China.
Epidemiology. 2023 Mar 1;34(2):282-292. doi: 10.1097/EDE.0000000000001581. Epub 2022 Dec 23.
Studies have estimated the associations of short-term exposure to ambient air pollution with ischemic stroke. However, the joint associations of ischemic stroke with air pollution as a mixture remain unknown.
We employed a time-stratified case-crossover study to investigate 824,808 ischemic stroke patients across China. We calculated daily mean concentrations of particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5), maximum 8-h average for O3 (MDA8 O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide (CO) across all monitoring stations in the city where the IS patients resided. We conducted conditional logistic regression models to estimate the exposure-response associations.
Results from single-pollutant models showed positive associations of hospital admission for ischemic stroke with PM2.5 (excess risk [ER] = 0.38%, 95% confidence interval [CI]: 0.29% to 0.47%, for 10 μg/m3), MDA8 O3 (ER = 0.29%, 95% CI: 0.18% to 0.40%, for 10 μg/m3), NO2 (ER = 1.15%, 95% CI: 0.92% to 1.39%, for 10 μg/m3), SO2 (ER = 0.82%, 95% CI: 0.53% to 1.11%, for 10 μg/m3) and CO (ER = 3.47%, 95% CI: 2.70% to 4.26%, for 1 mg/m3). The joint associations (ER) with all air pollutants (for interquartile range width increases in each pollutant) estimated by the single-pollutant model was 8.73% and was 4.27% by the multipollutant model. The joint attributable fraction of ischemic stroke attributable to air pollutants based on the multipollutant model was 7%.
Short-term exposures to PM2.5, MDA8 O3, NO2, SO2, and CO were positively associated with increased risks of hospital admission for ischemic stroke. The joint associations of air pollutants with ischemic stroke might be overestimated using single-pollutant models. See video abstract at, http://links.lww.com/EDE/C8.
已有研究估计了短期暴露于环境空气污染与缺血性中风之间的关联。然而，缺血性中风与空气污染混合物的联合关联仍不清楚。
我们采用时间分层病例交叉研究，对中国各地的824,808例缺血性中风患者进行调查。我们计算了缺血性中风患者所在城市所有监测站的空气动力学直径≤2.5μm的颗粒物（PM2.5）、臭氧的最大8小时平均值（MDA8 O3）、二氧化氮（NO2）、二氧化硫（SO2）和一氧化碳（CO）的每日平均浓度。我们进行了条件逻辑回归模型以估计暴露-反应关联。
单污染物模型的结果显示，缺血性中风住院与PM2.5（每增加10μg/m3，超额风险[ER]=0.38%，95%置信区间[CI]：0.29%至0.47%）、MDA8 O3（每增加10μg/m3，ER=0.29%，95%CI：0.18%至0.40%）、NO2（每增加10μg/m3，ER=1.15%，95%CI：0.92%至1.39%）、SO2（每增加10μg/m3，ER=0.82%，95%CI：0.53%至1.11%）和CO（每增加1mg/m3，ER=3.47%，95%CI：2.70%至4.26%）呈正相关。单污染物模型估计的所有空气污染物的联合关联（ER）（每种污染物四分位距宽度增加）为8.73%，多污染物模型为4.27%。基于多污染物模型，空气污染物导致缺血性中风的联合归因分数为7%。
短期暴露于PM2.5、MDA8 O3、NO2、SO2和CO与缺血性中风住院风险增加呈正相关。使用单污染物模型可能会高估空气污染物与缺血性中风的联合关联。见视频摘要：http://links.lww.com/EDE/C8 。
