Czernych Radosław, Kozera Grzegorz, Badyda Artur Jerzy, Bieniaszewski Leszek, Zagożdżon Paweł
Department of Hygiene and Epidemiology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland.
Centre of Medical Simulations, Medical University of Gdańsk, 80-204 Gdańsk, Poland.
Biomedicines. 2024 Jul 15;12(7):1562. doi: 10.3390/biomedicines12071562.
(1) Background: Haemorrhagic strokes (HS), including intracerebral (ICH) and subarachnoid haemorrhages (SAH), account for approximately 10-15% of strokes worldwide but are associated with worse functional outcomes and higher rates of mortality, and financial burden than ischemic stroke. There is evidence that confirmed poor air quality may increase the incidence of haemorrhagic strokes. The aim of our study was to evaluate the association between individual ambient air pollutants and the risk of haemorrhagic stroke in an urban environment without high levels of air pollution. (2) Methods: A time-series cross-sectional study design was used. A daily air pollution concentration (Agency of Regional Air Quality Monitoring in the Gdansk Metropolitan Area) and incidence of haemorrhagic strokes (National Health Fund) were obtained and covered the time period from 1 January 2014 to 31 December 2018. A generalised additive model with Poisson regression was used to estimate the associations between 24-h mean concentrations of SO, NO, NO, NOx, CO, PM10, PM2.5, and O and a daily number of haemorrhagic strokes. (3) Results: The single-day lag model results showed that NO, NO and NO exposure was associated with increased risk of ICH (88% events) with RR of 1.059 (95% CI: 1.015-1.105 for lag0), 1.033 (95% CI: 1.007-1.060 for lag0) and 1.031 (95% CI: 1.005-1.056 for lag0), but not for SAH (12% events). Exposure to CO was related to a substantial and statistically significant increase in incidence for 1.031 (95% CI: 1.002-1.061 for lag0) but not for SAH. Higher SO, PM, PM, and O exposures were not significantly related to both ISC and SAH. (4) Conclusions: In this time-series cross-sectional study, we found strong evidence that supports the hypothesis that transient elevations in ambient NO, NO and CO are associated with a higher relative risk of intracerebral but not subarachnoid haemorrhage.
(1) 背景：出血性卒中（HS），包括脑出血（ICH）和蛛网膜下腔出血（SAH），占全球卒中病例的10%-15%，但与缺血性卒中相比，其功能预后更差，死亡率更高，经济负担更重。有证据表明，空气质量差可能会增加出血性卒中的发病率。我们研究的目的是评估在空气污染水平不高的城市环境中，个体环境空气污染物与出血性卒中风险之间的关联。(2) 方法：采用时间序列横断面研究设计。获取了格但斯克都会区区域空气质量监测机构的每日空气污染浓度以及国家卫生基金的出血性卒中发病率，时间跨度为2014年1月1日至2018年12月31日。使用泊松回归的广义相加模型来估计SO、NO、NO₂、NOₓ、CO、PM₁₀、PM₂.₅和O₃的24小时平均浓度与每日出血性卒中病例数之间的关联。(3) 结果：单日滞后模型结果显示，暴露于NO、NO₂和NOₓ与脑出血（88%的病例）风险增加相关，滞后0天的RR分别为1.059（95%CI：1.015-1.105）、1.033（95%CI：1.007-1.060）和1.031（95%CI：1.005-1.056），但与蛛网膜下腔出血（12%的病例）无关。暴露于CO与发病率显著大幅增加相关，滞后0天的RR为1.031（95%CI：1.002-1.061），但与蛛网膜下腔出血无关。较高的SO₂、PM₁₀、PM₂.₅和O₃暴露与脑出血和蛛网膜下腔出血均无显著关联。(4) 结论：在这项时间序列横断面研究中，我们发现有力证据支持以下假设：环境中NO、NO₂和CO的短暂升高与脑出血而非蛛网膜下腔出血的较高相对风险相关。
