Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China (X.L., W.S., K.Y., Y.Z., S.S.).
Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China (W.C.).
Stroke. 2023 Dec;54(12):3038-3045. doi: 10.1161/STROKEAHA.123.044191. Epub 2023 Oct 30.
Daily exposure to ambient air pollution is associated with stroke morbidity and mortality; however, the association between hourly exposure to air pollutants and risk of emergency hospital admissions for stroke and its subtypes remains relatively unexplored.
We obtained hourly concentrations of fine particulate matter (PM), respirable particulate matter (PM), nitrogen dioxide (NO), sulfur dioxide (SO), ozone (O), and carbon monoxide (CO) from the China National Environmental Monitoring Center. We conducted a time-stratified case-crossover study among 86 635 emergency hospital admissions for stroke across 10 hospitals in 3 cities (Jinhua, Hangzhou, and Zhoushan) in Zhejiang province, China, between January 1, 2016 and December 31, 2021. Using a conditional logistic regression combined with a distributed lag linear model, we estimated the association between hourly exposure to multiple air pollutants and risk of emergency hospital admissions for total stroke, ischemic stroke, hemorrhagic stroke, and undetermined type.
Hourly exposure to PM, PM, NO, and SO was associated with an increased risk of hospital admissions for total stroke and ischemic stroke. The associations were most pronounced during the concurrent hour of exposure and lasted for ≈2 hours. We found that the risk was more pronounced among male patients or those aged <65 years old.
Our findings suggest that exposure to PM, PM, NO, and SO, but not CO and O, is associated with emergency hospital admissions for total stroke or ischemic stroke shortly after exposure. Implementing targeted pollution emission reduction measures may have significant public health implications in controlling and reducing the burden of stroke.
每日接触环境空气污染与中风发病率和死亡率有关；然而，污染物每小时暴露与中风及其亚型的急诊住院风险之间的关联仍相对未知。
我们从中国国家环境监测中心获得了细颗粒物 (PM)、可吸入颗粒物 (PM)、二氧化氮 (NO)、二氧化硫 (SO)、臭氧 (O) 和一氧化碳 (CO) 的每小时浓度。我们在中国浙江省金华、杭州和舟山的 10 家医院进行了一项时间分层病例交叉研究，共纳入了 86635 例中风急诊住院病例，时间为 2016 年 1 月 1 日至 2021 年 12 月 31 日。我们使用条件逻辑回归结合分布式滞后线性模型，估计了每小时暴露于多种空气污染物与总中风、缺血性中风、出血性中风和未确定类型的急诊住院风险之间的关联。
PM、PM、NO 和 SO 的每小时暴露与总中风和缺血性中风的住院风险增加有关。关联在暴露的同时小时最为明显，持续时间约为 2 小时。我们发现，这种风险在男性患者或年龄<65 岁的患者中更为明显。
我们的研究结果表明，PM、PM、NO 和 SO 的暴露与暴露后不久总中风或缺血性中风的急诊住院有关，但 CO 和 O 的暴露与急诊住院无关。实施有针对性的污染减排措施可能对控制和减轻中风负担具有重要的公共卫生意义。
