Zhou Yonghong, Jin Yi, Zhang Zheng
Affiliated Renhe Hospital of Shanghai University (Renhe Hospital, Baoshan District), School of Medicine, Shanghai University.
Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University.
Environ Health Prev Med. 2024;29:67. doi: 10.1265/ehpm.24-00304.
The association between air pollution and an increased risk of cardiovascular diseases, including stroke, is well-established. However, it remains unclear how reductions in pollutant levels-resulting from clean air policies and the COVID-19 lockdown-affect this relationship.
A time-series study was conducted using data from Shanghai, China, spanning from 2013 to 2022, divided into two periods (2013-2019 and 2020-2022). Daily air pollution data were obtained from China's air quality platform, while stroke emergency department (ED) visits were sourced from Renhe Hospital. We employed quasi-Poisson regression to analyze the relationship between daily pollutant levels and stroke ED visits, with stratified analyses by sex, age, season, and period. The study identified significant reductions in six pollutants (PM, PM, PM, SO, NO, CO) during the 2020-2022 period compared to 2013-2019.
Significant reductions in six air pollutants (NO, PM, PM, PM, SO, CO) were observed during 2020-2022 compared to 2013-2019. Higher daily NO levels were associated with an increased risk of stroke and its subtypes throughout the study, with a stronger correlation observed in the 2020-2022 period (P < 0.001). Subgroup analyses indicated that females and individuals aged 65-74 experienced the highest risks. The elevated stroke risk was particularly pronounced in the summer during 2020-2022. A two-factor model demonstrated that combined exposure to NO and other pollutants increased stroke risk.
This study heightened that reduced NO levels generally mitigate the adverse effects of short-term exposure to air pollutants on stroke risk, although the benefits vary among subgroups. The persistent stroke risk despite lower pollutant levels underscores the complex factors influencing stroke risk, highlighting the need for comprehensive intervention strategies.
空气污染与包括中风在内的心血管疾病风险增加之间的关联已得到充分证实。然而，尚不清楚清洁空气政策和新冠疫情封锁导致的污染物水平降低如何影响这种关系。
利用中国上海2013年至2022年的数据进行了一项时间序列研究，分为两个时期（2013 - 2019年和2020 - 2022年）。每日空气污染数据来自中国空气质量平台，而中风急诊科就诊数据来自仁和医院。我们采用准泊松回归分析每日污染物水平与中风急诊科就诊之间的关系，并按性别、年龄、季节和时期进行分层分析。研究发现，与2013 - 2019年相比，2020 - 2022年期间六种污染物（PM、PM、PM、SO、NO、CO）显著减少。
与2013 - 2019年相比，2020 - 2022年期间观察到六种空气污染物（NO、PM、PM、PM、SO、CO）显著减少。在整个研究期间，每日较高的NO水平与中风及其亚型风险增加相关，在2020 - 2022年期间观察到更强的相关性（P < 0.001）。亚组分析表明，女性和65 - 74岁的个体风险最高。在2020 - 2022年夏季，中风风险升高尤为明显。双因素模型表明，同时暴露于NO和其他污染物会增加中风风险。
本研究强调，降低NO水平通常可减轻短期暴露于空气污染物对中风风险的不利影响，尽管各亚组的益处有所不同。尽管污染物水平较低，但中风风险持续存在，这凸显了影响中风风险的复杂因素，强调了综合干预策略的必要性。
