Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China.
Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, USA.
Ecotoxicol Environ Saf. 2024 Sep 15;283:116720. doi: 10.1016/j.ecoenv.2024.116720. Epub 2024 Jul 24.
Limited attention has been paid to the health effects of long-term PM exposure on stroke admission. Current investigations exploring the long-term PM exposure effect are largely based on observational studies, and PM generally is not allocated randomly to participants. Using traditional regression models might confuse messaging and hinder policy recommendations for pollution control and disease prevention policies.
We conducted a cohort study among 36,271 adults from one of the largest cities in China in 2015 and followed up through 2020. Hazard ratios of stroke admissions following long-term PM exposure were estimated via a causal inference approach, marginal structural time-varying Cox proportional hazard model, accounting for multiple confounders. Additionally, several sensitivity analyses and impact modification analyses were carried out.
Associations with 1 μg/m increase in long-term PM were identified for total (HR, 1.079; 95 %CI, 1.012-1.151) and ischemic stroke admissions (HR, 1.092; 95 %CI, 1.018-1.171). The harmful associations varied with exposure duration, initially increasing and then decreasing. The 2-3 years cumulative exposure was associated with a 3.3-5.4 % raised risk for total stroke. For every 1 μg/m³ increase in long-term PM exposure, females exhibited a higher risk of both total and ischemic stroke (13 % and 16 %) than men (4 % and 5 %). Low-exposure individuals (whose annual PM concentrations were under the third quartile among the annual concentrations for all the participants) exhibited greater sensitivity to PM effects (total stroke: 1.079 vs. 1.107; ischemic stroke: 1.092 vs. 1.116). The results underline the importance of safeguarding low-exposed people in highly polluted areas and suggest that long-term PM exposure may increase stroke admission risk, warranting attention to vulnerable groups.
人们对长期 PM 暴露对卒中入院的健康影响关注有限。目前，探索长期 PM 暴露影响的研究大多基于观察性研究，且 PM 通常不是随机分配给参与者。使用传统的回归模型可能会混淆信息，并阻碍污染控制和疾病预防政策的建议。
我们在中国最大的城市之一的 36271 名成年人中进行了一项队列研究，并在 2020 年之前进行了随访。通过因果推理方法、边缘结构时变 Cox 比例风险模型估计了长期 PM 暴露后卒中入院的风险比，该模型考虑了多个混杂因素。此外，还进行了几项敏感性分析和影响修饰分析。
与长期 PM 增加 1μg/m³相关的是总卒中（HR，1.079；95%CI，1.012-1.151）和缺血性卒中（HR，1.092；95%CI，1.018-1.171）的入院。有害关联随暴露持续时间而变化，最初增加，然后减少。2-3 年的累积暴露与总卒中风险增加 3.3-5.4%有关。对于长期 PM 暴露每增加 1μg/m³，女性的总卒中（13%和 16%）和缺血性卒中（13%和 16%）风险均高于男性（4%和 5%）。低暴露个体（其每年的 PM 浓度在所有参与者的年浓度中低于第三四分位数）对 PM 效应的敏感性更高（总卒中：1.079 比 1.107；缺血性卒中：1.092 比 1.116）。研究结果强调了保护高污染地区低暴露人群的重要性，并表明长期 PM 暴露可能会增加卒中入院风险，需要关注弱势群体。
