Department of Biostatistics, School of Public Health, Healthcare Big Data Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, China; Department of Epidemiology and Statistics, Bengbu Medical College, Bengbu, China.
Shandong Center for Disease Control and Prevention, Jinan, China.
Environ Res. 2024 Jun 15;251(Pt 2):118512. doi: 10.1016/j.envres.2024.118512. Epub 2024 Mar 7.
Air pollution is one of the most serious environmental risks to mortality of stroke. However, there exists a noteworthy knowledge gap concerning the different stroke subtypes, causes of death, the susceptibility of stroke patient, and the role of greenness in this context.
We analyzed data from an ecological health cohort, which included 334,261 patients aged ≥40 years with stroke (comprising 288,490 ischemic stroke and 45,771 hemorrhagic stroke) during the period 2013-2019. We used Cox proportional hazards models with time-varying exposure to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the associations of annual average fine particulate matter (PM), nitrogen dioxide (NO), and ozone (O) with both all-cause and cause-specific mortality. Additionally, we conducted analyses to examine the effect modification by greenness and identify potential susceptibility factors through subgroup analyses.
In multivariable-adjusted models, long-term exposure to PM and NO was associated with increased risk of all-cause mortality (HR: 1.038, 95% CI: 1.029-1.047 for PM; HR: 1.055, 95% CI: 1.026-1.085 for NO, per 10 μg/m, for ischemic stroke patients; similar for hemorrhagic stroke patients). Gradually increasing effect sizes were shown for CVD mortality and stroke mortality. The HRs of mortality were slightly weaker with high versus low vegetation exposure. Cumulative exposures increased the HRs of pollutant-related mortality, and greater greenness decreased this risk. Two subtypes of stroke patients exhibited diverse patterns of benefit.
Increasing residential greenness attenuates the increased risk of mortality with different patterns due to chronic air pollutants for ischemic and hemorrhagic stroke, offering valuable insights for precise tertiary stroke prevention strategies.
空气污染是导致中风死亡率的最严重环境风险之一。然而，对于不同的中风亚型、死因、中风患者的易感性以及绿色空间在这方面的作用，仍存在显著的知识空白。
我们分析了一个生态健康队列的数据，该队列包括 2013 年至 2019 年期间年龄≥40 岁的 334261 例中风患者（包括 288490 例缺血性中风和 45771 例出血性中风）。我们使用时变暴露的 Cox 比例风险模型来估计风险比（HR）和 95%置信区间（CI），以评估年度平均细颗粒物（PM）、二氧化氮（NO）和臭氧（O）与全因和病因特异性死亡率的关联。此外，我们进行了分析，以通过亚组分析检验绿色空间的效应修饰作用，并确定潜在的易感性因素。
在多变量调整模型中，长期暴露于 PM 和 NO 与全因死亡率增加相关（PM：每 10μg/m，HR：1.038，95%CI：1.029-1.047；NO：HR：1.055，95%CI：1.026-1.085，缺血性中风患者；出血性中风患者类似）。心血管疾病死亡率和中风死亡率的效应大小逐渐增加。与低植被暴露相比，高植被暴露的死亡率 HR 略低。累积暴露增加了与污染物相关的死亡率的 HR，而较高的绿色空间降低了这种风险。两种中风亚型患者表现出不同的获益模式。
增加居住绿色空间可以减轻不同模式下慢性空气污染物对缺血性和出血性中风患者死亡率增加的风险，为精确的三级中风预防策略提供了有价值的见解。
