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Assessing the benefits of hypothetical air pollution reduction scenarios on stroke in belgium: a g-computation approach.

作者信息

Pelgrims Ingrid, Devleesschauwer Brecht, Van der Heyden Johan, De Clercq Eva M

机构信息

Department of Chemical and Physical Health Risks, Sciensano, rue Juliette Wytsman 14, Brussels, BE-1050, Belgium.

Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Krijgslaan 281, S9, Ghent, BE-9000, Belgium.

出版信息

BMC Med Res Methodol. 2025 Sep 2;25(1):209. doi: 10.1186/s12874-025-02661-8.


DOI:10.1186/s12874-025-02661-8
PMID:40898068
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12403417/
Abstract

BACKGROUND: Stroke is a leading cause of mortality and disability in Belgium and worldwide. Increasing evidence highlights air pollution as a significant stroke risk factor. Despite efforts in the past decade to mitigate air pollution in Belgium, a considerable part of the population remains exposed to concentrations exceeding the World Health Organization (WHO) Air Quality Guidelines. Therefore, quantifying the effectiveness of further pollution reduction interventions is crucial in supporting policymaking. This study applies a g-computation approach to assess the benefits of hypothetical air pollution reduction scenarios on stroke prevalence in Belgium within a multi-exposure context. METHODS: Belgian health interview survey data (2008/2013/2018, n = 27536) were linked to environmental data at the participant's residential address. Missing data and bias related to self-reported covariates were addressed based on data from the 2018 Belgian health examination survey and a random-forest multiple imputation. A g-computation approach was used to calculate the potential impact fractions of air pollution reduction scenarios on stroke prevalence in Belgium, with regression models adjusted for socio-demographic, environmental, and lifestyle factors. Scenarios included lowering annual exposure to fine particulate matter (PM) and nitrogen dioxide levels (NO) to levels recommended by WHO, and assessing dose-response effects of reducing exposure to PM, NO, and black carbon (BC) by 20-80%. RESULTS: Stroke was significantly associated with PM, while associations with NO and BC were borderline significant. Meeting WHO air quality guidelines for PM and NO would reduce stroke risk by 0.88% (SE: 0.24) and 0.33% (SE: 0.19), preventing 67% and 25% of stroke cases in Belgium, respectively. Results reveal a dose-response association between air pollution reduction and stroke prevalence. Reduction in air pollution exposure, ranging from 20% to 80% showed increasing potential impact fractions for stroke: PM (29%, 48%, 61%, 69%), NO (10%, 18%, 25%, 31%) and BC (8%, 14%, 20%, 23%). CONCLUSION: This study highlights the importance of air pollution on the stroke burden and demonstrates that air pollution reduction interventions could significantly decrease the prevalence of stroke in Belgium. The g-computation approach represents a straightforward approach in epidemiology for making causal inference from observational data while also providing useful information for policymakers.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8b7b/12403417/b2221bcb47b5/12874_2025_2661_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8b7b/12403417/2193a49c8b6a/12874_2025_2661_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8b7b/12403417/b2221bcb47b5/12874_2025_2661_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8b7b/12403417/2193a49c8b6a/12874_2025_2661_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8b7b/12403417/b2221bcb47b5/12874_2025_2661_Fig2_HTML.jpg

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Assessing the benefits of hypothetical air pollution reduction scenarios on stroke in belgium: a g-computation approach.

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本文引用的文献

[1]
Positive impact of the introduction of low-emission zones in Antwerp and Brussels on air quality, socio-economic disparities and health: a quasi-experimental study.

Environ Int. 2025-5

[2]
The Effects of Green Spaces and Noise Exposure on the Risk of Ischemic Stroke: A Case-Control Study in Lebanon.

Int J Environ Res Public Health. 2024-10-19

[3]
Green space and stroke: A scoping review of the evidence.

J Neurol Sci. 2024-2-15

[4]
Reconstructing individual-level exposures in cohort analyses of environmental risks: an example with the UK Biobank.

J Expo Sci Environ Epidemiol. 2024-11

[5]
Health effects of low emission and congestion charging zones: a systematic review.

Lancet Public Health. 2023-7

[6]
Concomitant exposure to air pollution, green space, and noise and risk of stroke: a cohort study from Denmark.

Lancet Reg Health Eur. 2023-5-26

[7]
Using random-forest multiple imputation to address bias of self-reported anthropometric measures, hypertension and hypercholesterolemia in the Belgian health interview survey.

BMC Med Res Methodol. 2023-3-25

[8]
Ambient Air Pollution and Stroke: An Updated Review.

Stroke. 2023-3

[9]
Long-term exposure to traffic-related air pollution and stroke: A systematic review and meta-analysis.

Int J Hyg Environ Health. 2023-1

[10]
The association of noise exposure with stroke incidence and mortality: A systematic review and dose-response meta-analysis of cohort studies.

Environ Res. 2022-12

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