Huang Yi-Ping, Fan Wei-Dong, Feng Ying, Hukportie Daniel Nyarko, Jin Cui-Yi, Li Fu-Rong
Jieyang People's Hospital, Jieyang, China.
School of Public Health, Southern Medical University, Guangzhou, China.
J Stroke Cerebrovasc Dis. 2025 Aug;34(8):108379. doi: 10.1016/j.jstrokecerebrovasdis.2025.108379. Epub 2025 Jun 16.
To evaluate the independent and combined associations of secondhand smoke (SHS) exposure and maternal smoking during pregnancy with the risk of total stroke and its subtypes, including ischemic and hemorrhagic stroke, among nonsmokers.
To investigate the independent and combined associations of SHS exposure and maternal smoking during pregnancy with stroke risk in nonsmokers.
A prospective analysis was conducted using 336,640 nonsmoking participants from a nationwide cohort, free from pre-existing cardiovascular disease. SHS exposure was categorized based on hours per week (0, >0-4, >4), and maternal smoking was assessed via participant recall. Outcomes included total stroke, ischemic stroke, and hemorrhagic stroke, identified through hospital records. Cox regression models adjusted for demographic, behavioral, and clinical covariates were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs).
Over a median follow-up of 11.8 years, 5,051 participants experienced strokes. SHS exposure >4 hours/week was associated with increased incident stroke risk (HR 1.34, 95 % CI 1.18-1.52) compared to no exposure. Maternal smoking was associated with a 7 % increase in total stroke risk (HR 1.07, 95 % CI 1.02-1.14). Combined exposure to SHS >4 hours/week and maternal smoking conferred the highest stroke risk (HR 1.57, 95 % CI 1.29-1.90). Subgroup and sensitivity analyses confirmed these findings.
SHS exposure and maternal smoking was independently and jointly associated with higher stroke risk, underscoring the need for robust tobacco control policies to mitigate these exposures and their public health impact.
评估非吸烟者孕期二手烟暴露和母亲吸烟与总中风风险及其亚型（包括缺血性和出血性中风）的独立及联合关联。
调查非吸烟者孕期二手烟暴露和母亲吸烟与中风风险的独立及联合关联。
对来自全国队列的336,640名无既往心血管疾病的非吸烟参与者进行前瞻性分析。二手烟暴露根据每周小时数分类（0、>0 - 4、>4），母亲吸烟情况通过参与者回忆进行评估。结局包括通过医院记录确定的总中风、缺血性中风和出血性中风。使用针对人口统计学、行为和临床协变量进行调整的Cox回归模型来估计风险比（HRs）和95%置信区间（CIs）。
在中位随访11.8年期间，5,051名参与者发生中风。与无暴露相比，每周二手烟暴露>4小时与中风发病风险增加相关（HR 1.34, 95% CI 1.18 - 1.52）。母亲吸烟与总中风风险增加7%相关（HR 1.07, 95% CI 1.02 - 1.14）。每周二手烟暴露>4小时与母亲吸烟的联合暴露导致最高的中风风险（HR 1.57, 95% CI 1.29 - 1.90）。亚组分析和敏感性分析证实了这些发现。
二手烟暴露和母亲吸烟与较高的中风风险独立且共同相关，强调需要强有力的烟草控制政策来减少这些暴露及其对公众健康的影响。
