van den Brekel Lieke, Mackenbach Joreintje D, Grobbee Diederick E, Hoek Gerard, Vaartjes Ilonca, Koop Yvonne
Julius Center for Health Sciences and Primary Care, Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands.
Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
BMC Public Health. 2024 Dec 18;24(1):3476. doi: 10.1186/s12889-024-21032-4.
Air pollution is a major risk factor for cardiovascular diseases and contributes to health disparities, particularly among minority ethnic groups, who often face higher exposure levels. Knowledge on whether the effect of air pollution on cardiovascular diseases differs between ethnic groups is crucial for identifying mechanisms underlying health disparities, ultimately informing targeted public health strategies and interventions. We explored differences in associations between air pollution and ischemic stroke and ischemic heart disease (IHD) for the six largest ethnic groups in the Netherlands.
This nationwide analysis (2014-2019), linked residential-address concentrations of NO and PM to individual-level hospital and mortality data. To evaluate incident ischemic stroke, we created a cohort of residents ≥30 years and free of ischemic stroke at baseline and for incident IHD we created a cohort free of IHD. We performed Cox proportional hazard survival analyses in each cohort with 2014 average concentrations of PM or NO as determinants, stratified by ethnicity (Dutch, German, Indonesian, Surinamese, Moroccan, Turkish) and adjusted for age, sex, socioeconomic indicators and region.
Both cohorts included > 9.5 million people. During follow-up, 127,673 (1.3%) developed ischemic stroke and 156,517 (1.6%) developed IHD. For ischemic stroke, the p-values for the interaction between air pollution and ethnicity were 0.057 for NO and 0.055 for PM. The HR of 1 IQR increase (6.42 µg/m) of NO for ischemic stroke was lowest for Moroccans (0.92 [0.84-1.02], p-value = 0.032 difference with Dutch) and highest for Turks (1.09 [1.00-1.18], p-value = 0.157 difference with Dutch). PM results were similar. For IHD, higher exposure was unexpectedly associated with lower incidence. The p-values for the interaction with ethnicity were 1.7510 for NO and 1.0610 for PM. The HRs for IHD were lowest for Turks (NO: 0.88 [0.83-0.92], p-value = 2.010 difference with Dutch, PM: 0.86 [0.82-0.91], p-value = 1.310 difference with Dutch) and highest for Surinamese (NO: 1.02 [0.97-1.07], p-value = 0.014 difference with Dutch) and Dutch (PM: 0.96 [0.94-0.98]).
Associations between air pollutants and ischemic stroke or IHD differ notably between ethnic groups in the Netherlands. Policies to reduce air pollution and prevent ischemic stroke should target populations vulnerable to air pollution with a high cardiovascular disease risk.
空气污染是心血管疾病的主要风险因素，会导致健康差异，尤其是在少数族裔群体中，他们往往面临更高的暴露水平。了解空气污染对心血管疾病的影响在不同种族群体之间是否存在差异，对于确定健康差异背后的机制至关重要，最终可为有针对性的公共卫生策略和干预措施提供依据。我们探讨了荷兰六大种族群体在空气污染与缺血性中风和缺血性心脏病（IHD）之间关联的差异。
这项全国性分析（2014 - 2019年）将住宅地址的一氧化氮（NO）和颗粒物（PM）浓度与个体层面的医院和死亡率数据相联系。为评估缺血性中风的发病情况，我们创建了一个年龄≥30岁且基线时无缺血性中风的居民队列；对于缺血性心脏病，我们创建了一个无缺血性心脏病的队列。我们在每个队列中进行Cox比例风险生存分析，将2014年的PM或NO平均浓度作为决定因素，按种族（荷兰人、德国人、印度尼西亚人、苏里南人、摩洛哥人、土耳其人）分层，并对年龄、性别、社会经济指标和地区进行调整。
两个队列均包含超过950万人。在随访期间，127,673人（1.3%）发生了缺血性中风，156,517人（1.6%）发生了缺血性心脏病。对于缺血性中风，空气污染与种族之间相互作用的p值，NO为0.057，PM为0.055。缺血性中风时，NO每增加1个四分位间距（IQR，6.42μg/m³），摩洛哥人的风险比（HR）最低（0.92[0.84 - 1.02]，与荷兰人的p值差异为0.032），土耳其人的最高（1.09[1.00 - 1.18]，与荷兰人的p值差异为0.157）。PM的结果类似。对于缺血性心脏病，较高暴露水平意外地与较低发病率相关。与种族相互作用的p值，NO为1.75×10⁻³，PM为1.06×10⁻²。缺血性心脏病的HR，土耳其人最低（NO：0.88[0.83 - 0.92]，与荷兰人的p值差异为2.0×10⁻³，PM：0.86[0.82 - 0.91]，与荷兰人的p值差异为1.3×10⁻²），苏里南人（NO：1.02[0.97 - 1.07]，与荷兰人的p值差异为0.014）和荷兰人（PM：0.96[0.94 - 0.98]）最高。
在荷兰，不同种族群体中空气污染物与缺血性中风或缺血性心脏病之间的关联存在显著差异。减少空气污染和预防缺血性中风的政策应针对心血管疾病风险高且易受空气污染影响的人群。
