背景:空气污染是中风死亡的最严重的环境风险之一。然而,关于不同的中风亚型存在值得注意的知识差距,死亡原因,中风患者的易感性,以及绿色在这种情况下的作用。
方法:我们分析了来自生态健康队列的数据,其中包括2013-2019年期间的334,261例年龄≥40岁的卒中患者(包括288,490例缺血性卒中和45,771例出血性卒中).我们使用具有时变暴露的Cox比例风险模型来估计风险比(HR)和95%置信区间(CI)来评估年平均细颗粒物(PM2.5)的关联。二氧化氮(NO2),和臭氧(O3)具有全因和特定原因的死亡率。此外,我们进行了分析,以检验绿色效应修饰,并通过亚组分析确定潜在的易感因素.
结果:在多变量调整模型中,长期暴露于PM2.5和NO2与全因死亡风险增加相关(对于PM2.5,HR:1.038,95%CI:1.029-1.047;对于缺血性卒中患者,对于NO2,HR:1.055,95%CI:1.026-1.085,每10μg/m3;对于出血性卒中患者相似).显示CVD死亡率和中风死亡率的效应大小逐渐增加。高植被暴露与低植被暴露时,死亡率的HR略弱。累积暴露增加了污染物相关死亡率的HR,更大的绿色降低了这种风险。两种亚型的中风患者表现出不同的获益模式。
结论:增加居住区的绿色可降低因慢性空气污染物导致缺血性和出血性中风的不同模式导致的死亡风险增加,为精确的三级预防中风策略提供有价值的见解。
BACKGROUND: Air pollution is one of the most serious environmental risks to mortality of stroke. However, there exists a noteworthy knowledge gap concerning the different stroke subtypes, causes of death, the susceptibility of stroke patient, and the role of greenness in this context.
METHODS: We analyzed data from an ecological health cohort, which included 334,261 patients aged ≥40 years with stroke (comprising 288,490 ischemic stroke and 45,771 hemorrhagic stroke) during the period 2013-2019. We used Cox proportional hazards models with time-varying exposure to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the associations of annual average fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) with both all-cause and cause-specific mortality. Additionally, we conducted analyses to examine the effect modification by greenness and identify potential susceptibility factors through subgroup analyses.
RESULTS: In multivariable-adjusted models, long-term exposure to PM2.5 and NO2 was associated with increased risk of all-cause mortality (HR: 1.038, 95% CI: 1.029-1.047 for PM2.5; HR: 1.055, 95% CI: 1.026-1.085 for NO2, per 10 μg/m3, for ischemic stroke patients; similar for hemorrhagic stroke patients). Gradually increasing effect sizes were shown for CVD mortality and stroke mortality. The HRs of mortality were slightly weaker with high versus low vegetation exposure. Cumulative exposures increased the HRs of pollutant-related mortality, and greater greenness decreased this risk. Two subtypes of stroke patients exhibited diverse patterns of benefit.
CONCLUSIONS: Increasing residential greenness attenuates the increased risk of mortality with different patterns due to chronic air pollutants for ischemic and hemorrhagic stroke, offering valuable insights for precise tertiary stroke prevention strategies.