大气污染物短期暴露对老年人缺血性脑卒中住院的影响研究

Association of short-term exposure to ambient air pollution with hospital admission for ischemic stroke among older adults

目的定量评估大气污染物短期暴露对老年人缺血性脑卒中住院的影响。方法从国家卫生健康统计信息网络直报系统收集广州市2016—2019年124297名60岁以上因缺血性脑卒中住院的病例开展时间分层病例交叉研究,结合病例居住住址及其周边空气质量监测站数据,通过反距离权重插值法评估其病例日和对照日大气PM_(2.5)、PM_(10)、SO_(2)、NO_(2)、CO和O_(3)的暴露水平。采用条件logistic回归模型估算大气污染物短期暴露与缺血性脑卒中住院风险之间的暴露-反应关系。结果单污染物模型结果提示,PM_(2.5)、PM_(10)、SO_(2)、NO_(2)、CO和O_(3)短期暴露与缺血性脑卒中住院风险升高有关,其浓度每升高10μg/m^(3),住院风险分别升高0.46%(95%置信区间CI:0.10%~0.82%;lag 2d)、0.66%(0.35%~0.98%;lag 02d)、3.39%(1.63%~5.18%;lag 2d)、1.47%(1.09%~1.86%;lag 02d)、0.06%(0.02%~0.09%;lag 02d)和0.18%(0.03%~0.33%;lag 3d)。双污染物模型结果提示,在调整其它污染物后SO_(2)、NO_(2)和O_(3)短期暴露与缺血性脑卒中住院的正向关联仍保持稳定。结论大气污染物(尤其是SO_(2)、NO_(2)和O_(3))短期暴露与老年人因缺血性脑卒中住院的风险上升有关。

Objective To investigate the association between short-term exposure to ambient air pollution and hospital admission for ischemic stroke among older adults.Methods Using clinical monitoring data from China National Health Commission,we identified 124297 individuals from Guangzhou,Guangdong province,China who were 60 years or older and were admitted to hospital for ischemic stroke during 2016-2019.We used a time-stratified case-crossover design and employed the conditional logistic regression model to investigate the exposure-response association between short-term exposure to air pollution and hospital admission for ischemic stroke.Based on each subject′s residential address and pollutant data from its neighboring air quality monitoring stations,we used an inverse distance weighting method to assess individual-level exposure to PM_(2.5),PM_(10),SO_(2),NO_(2),CO and O_(3)on each of the case and control days.Results In single-pollutant models,each 10μg/m^(3)increase of PM_(2.5),PM_(10),SO_(2),NO_(2),CO and O_(3)was associated with a 0.46%(95%confidence interval(CI):0.10%-0.82%,lag 2 d),0.66%(0.35%-0.98%,lag 02 d),3.39%(1.63%-5.18%,lag 2 d),1.47%(1.09%-1.86%,lag 02 d),0.06%(0.02%-0.09%,lag 02 d),0.18%(0.03%-0.33%,lag 3 d)increase in odds of hospital admission,respectively.The results of 2-pollutant models showed that the association of exposure to SO_(2),NO_(2)and O_(3)with hospital admission for ischemic stroke remained stable with adjustment for each of the other air pollutants.Conclusions Short-term exposure to ambient air pollution,especially SO_(2),NO_(2)and O_(3),was associated with increased risk of hospital admission for ischemic stroke in older adults.