Pelgrims Ingrid, Devleesschauwer Brecht, Van der Heyden Johan, De Clercq Eva M
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.
BMC Med Res Methodol. 2025 Sep 2;25(1):209. doi: 10.1186/s12874-025-02661-8.
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.
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%.
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%).
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.
中风是比利时乃至全球死亡和残疾的主要原因。越来越多的证据表明空气污染是中风的一个重要风险因素。尽管在过去十年中比利时努力减轻空气污染，但仍有相当一部分人口暴露于超过世界卫生组织（WHO）空气质量指南的浓度之下。因此，量化进一步减少污染干预措施的有效性对于支持政策制定至关重要。本研究应用g计算方法，在多暴露背景下评估假设的空气污染减少情景对比利时中风患病率的益处。
将比利时健康访谈调查数据（2008/2013/2018，n = 27536）与参与者居住地址的环境数据相链接。基于2018年比利时健康检查调查的数据和随机森林多重插补，处理了与自我报告协变量相关的缺失数据和偏差。使用g计算方法计算空气污染减少情景对比利时中风患病率的潜在影响分数，并对社会人口学、环境和生活方式因素调整回归模型。情景包括将每年的细颗粒物（PM）和二氧化氮（NO）暴露水平降至WHO推荐的水平，并评估将PM、NO和黑碳（BC）暴露减少20%-80%的剂量反应效应。
中风与PM显著相关，而与NO和BC的关联接近显著。符合WHO关于PM和NO的空气质量指南将使中风风险分别降低0.88%（标准误：0.24）和0.33%（标准误：0.19），分别预防比利时67%和25%的中风病例。结果揭示了空气污染减少与中风患病率之间的剂量反应关联。空气污染暴露减少20%至80%显示出对中风的潜在影响分数增加：PM（29%、48%、61%、69%）、NO（10%、18%、25%、31%）和BC（8%、14%、20%、23%）。
本研究强调了空气污染对中风负担的重要性，并表明减少空气污染的干预措施可显著降低比利时的中风患病率。g计算方法是流行病学中一种直接的方法，可从观察数据中进行因果推断，同时也为政策制定者提供有用信息。
