绿地暴露和颗粒物暴露与缺血性脑卒中患者死亡关联的队列研究

Association of greenness exposure and particulate matter exposure with ischemic stroke patients mortality in a cohort study

目的 基于卫星遥感数据评估的绿地暴露和颗粒物暴露与缺血性脑卒中(ischemic stroke, IS)死亡的关联。方法 在山东5个县(区)收集2013―2019年患IS的个案病例,构建IS患者队列。根据每个患者的居住地址匹配归一化植被指数(normalized differential vegetation index, NDVI)夏季暴露值和PM2.5、PM10的年均暴露浓度。采用Cox比例风险回归模型探讨长期绿地暴露与PM2.5和PM10的联合暴露及其交互作用与IS患者死亡的关联,并且按性别、年龄和居住地进行分层分析。采用限制性立方样条函数分别评估绿地暴露、PM2.5和PM10与IS患者死亡风险的暴露-反应关系。结果 共纳入59 084人,因IS死亡4 726人(8.00%)。分析结果显示:在评估NDVI与PM2.5和PM10的联合暴露时发现NDVI与IS患者死亡风险呈负相关。交互作用结果表明:NDVI每增加0.1个单位,IS患者的死亡风险为0.74(95%CI:0.67~0.82),PM2.5每增加10μg/m3的IS患者的死亡风险为0.94(0.88~1.00),交互项为1.04 (1.02~1.07)。年龄、性别和居住地是影响NDVI与PM2.5和PM10的联合暴露及其交互作用与IS患者死亡关联的效应修饰因子。NDVI与IS患者死亡风险的暴露-反应关系曲线呈非线性趋势,PM2.5和PM10与IS患者死亡风险的暴露-反应关系曲线呈“U”型和“J”型。结论 绿地暴露可能降低IS患者的死亡风险,同时进行良好的绿地规划以及降低PM2.5和PM10的暴露浓度可能进一步降低该病的死亡风险。

Objective The interaction between greenness exposure and mortality from ischemic stroke(IS)was assessed based on satellite remote sensing data(NDVI).Methods Individual cases suffering from IS from 2013-2019 were collected in five counties in Shandong to construct a cohort of IS patients.NDVI summer exposure values and annual average exposure concentrations of PM2.5 and PM10 were matched according to the residential address of each patient.Cox proportional risk models were used to explore the association between long-term greenfield exposure and combined exposure to PM2.5 and PM10 and their interactions with ischemic stroke death,and the analyses were stratified by sex,age,and residence.Restricted cubic spline functions were used to assess the dose-response relationship between greenfield exposure,PM2.5 and PM10 and the risk of death in IS patients,respectively.Results The cohort included 59084 individuals and 4726(8.00%)deaths due to IS.The results of the model′s analysis showed that NDVI was negatively associated with the risk of death in patients with IS when assessing the combined exposure of NDVI with PM2.5 and PM10.The interaction results showed that the IS mortality hazard ratio(HR)for each 0.1-unit increase in NDVI was 0.74(95%CI:0.67-0.82),each 10μg/m3 increase in PM2.5 was 0.94(95%CI:0.88-1.00),and the interaction term was 1.04(95%CI:1.02-1.07).Age,sex,and residence were effect modifiers influencing the association of combined exposure to NDVI with PM2.5 and PM10 and its interaction with death in IS patients.NDVI was nonlinearly associated with IS death,and PM2.5 and PM10 were associated with IS death in a"U"and"J"pattern,respectively.Conclusions Greenness exposure may reduce the risk of death from IS,while the risk of death from the disease may be further reduced by practicing good greenness planning and by reducing exposure concentrations of PM2.5 and PM10.