Krasnov Helena, Sachdev Kshitij, Knobel Pablo, Colicino Elena, Yitshak-Sade Maayan
Department of Environmental Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Graduate Program in Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Chemosphere. 2025 Jun;378:144390. doi: 10.1016/j.chemosphere.2025.144390. Epub 2025 Apr 8.
Numerous studies linked fine particulate matter (PM) to ischemic stroke. However, only a few investigated the differential associations with specific PM components and sources. We utilized electronic health records (EHR) from the Mount Sinai Health System in the New York City metropolitan area during 2011-2019 and assessed the associations of PM components and sources with ischemic stroke. We used mixed-effect Poisson survival regressions to assess the single-exposure associations with the chemical components. We used multivariable regression to assess the simultaneous associations with source-apportioned PM exposures estimated using non-negative matrix factorization. Then, we assessed the sensitivity of our results to different specifications of EHR data continuity: (1) using a less strict definition of censorship year, (2) adjusting the model for EHR data continuity index, a validated algorithm measuring EHR-data continuity based on indicators of primary care service utilization. We observed higher risks for ischemic stroke (Risk ratio [95 % confidence intervals] per interquartile range increase) associated with higher exposure to nickel (1.080 [1.045; 1.116]), vanadium (1.070 [1.033; 1.109]), zinc (1.076 [1.031; 1.122]), and nitrate (1.084 [1.039; 1.132]). In the multivariate models we found higher risk for ischemic stroke associated with exposure to oil combustion sourced PM (1.061 [1.012; 1.113]). The results remained consistent under different model specifications accounting for EHR data continuity. In conclusion, we found an increased risk of ischemic stroke associated with specific PM components and sources. These findings were robust to different specifications of EHR-data continuity. Our findings can inform policy and interventions aimed at reducing cardiovascular disease burden.
众多研究将细颗粒物（PM）与缺血性中风联系起来。然而，只有少数研究调查了与特定PM成分和来源的差异关联。我们利用了2011 - 2019年纽约市大都市区西奈山医疗系统的电子健康记录（EHR），评估了PM成分和来源与缺血性中风的关联。我们使用混合效应泊松生存回归来评估与化学成分的单暴露关联。我们使用多变量回归来评估与使用非负矩阵分解估计的源分配PM暴露的同时关联。然后，我们评估了结果对EHR数据连续性不同规格的敏感性：（1）使用不太严格的审查年份定义，（2）针对EHR数据连续性指数调整模型，这是一种基于初级保健服务利用指标来测量EHR数据连续性的经过验证的算法。我们观察到，缺血性中风风险更高（每四分位数间距增加的风险比[95%置信区间]）与镍（1.080[1.045；1.116]）、钒（1.070[1.033；1.109]）、锌（1.076[1.031；1.122]）和硝酸盐（1.084[1.039；1.132]）的更高暴露有关。在多变量模型中，我们发现与暴露于石油燃烧源的PM相关的缺血性中风风险更高（1.061[1.012；1.113]）。在考虑EHR数据连续性的不同模型规格下，结果保持一致。总之，我们发现特定的PM成分和来源与缺血性中风风险增加有关。这些发现对于EHR数据连续性的不同规格具有稳健性。我们的发现可为旨在减轻心血管疾病负担的政策和干预措施提供参考。
