目的:许多研究表明,短期接触细颗粒物(PM2.5)和粗颗粒物(PM2.5-10)与脑血管疾病风险升高有关。然而,关于PM2.5和PM2.5-10对各种类型的脑血管疾病的潜在差异影响知之甚少。
方法:我们收集了上海所有居民的个人脑血管死亡记录,中国从2005年到2021年。从卫星模型预测了住宅每日空气污染数据。颗粒物(PM)与脑血管死亡率之间的关系通过个人水平进行了调查,时间分层,案例交叉设计。采用条件logistic回归结合最大滞后7天的分布滞后模型对数据进行分析。此外,我们探索了按性别进行的效果修改,年龄和季节。
结果:共纳入388823例脑血管死亡。除出血性中风外,所有脑血管疾病的死亡率均呈单调增加。PM2.5上升10μg/m3与上升1.35%相关[95%置信区间(CI):1.04%,1.66%]在所有脑血管疾病的死亡率中,1.84%(95%CI:1.25%,2.44%)在缺血性中风中,1.53%(95%CI:1.07%,1.99%)的脑血管后遗症和1.56%(95%CI:1.08%,2.05%)在缺血性脑卒中后遗症中。PM2.5-10每上升10μg/m3的超额风险估计值为1.47%(95%CI:1.10%,1.84%),1.53%(95%CI:0.83%,2.24%),1.93%(95%CI:1.38%,2.49%)和2.22%(95%CI:1.64%,2.81%),分别。控制共污染物后,两种污染物与所有脑血管结局的关联都很强。女性的关联更大,个人>80岁,在温暖的季节。
结论:短期暴露于PM2.5和PM2.5-10可能会独立增加脑血管疾病的死亡风险,特别是缺血性中风和中风后遗症。
OBJECTIVE: Many studies suggested that short-term exposure to fine particulate matter (PM2.5) and coarse particulate matter (PM2.5-10) was linked to elevated risk of cerebrovascular disease. However, little is known about the potentially differential effects of PM2.5 and PM2.5-10 on various types of cerebrovascular disease.
METHODS: We collected individual cerebrovascular death records for all residents in Shanghai, China from 2005 to 2021. Residential daily air pollution data were predicted from a satellite model. The associations between particulate matters (PM) and cerebrovascular mortality were investigated by an individual-level, time-stratified,
case-crossover design. The data was analyzed by the conditional logistic regression combined with the distributed lag model with a maximum lag of 7 days. Furthermore, we explored the effect modifications by sex, age and season.
RESULTS: A total of 388,823 cerebrovascular deaths were included. Monotonous increases were observed for mortality of all cerebrovascular diseases except for hemorrhagic stroke. A 10 μg/m3 rise in PM2.5 was related to rises of 1.35% [95% confidence interval (CI): 1.04%, 1.66%] in mortality of all cerebrovascular diseases, 1.84% (95% CI: 1.25%, 2.44%) in ischemic stroke, 1.53% (95% CI: 1.07%, 1.99%) in cerebrovascular sequelae and 1.56% (95% CI: 1.08%, 2.05%) in ischemic stroke sequelae. The excess risk estimates per each 10 μg/m3 rise in PM2.5-10 were 1.47% (95% CI: 1.10%, 1.84%), 1.53% (95% CI: 0.83%, 2.24%), 1.93% (95% CI: 1.38%, 2.49%) and 2.22% (95% CI: 1.64%, 2.81%), respectively. The associations of both pollutants with all cerebrovascular outcomes were robust after controlling for co-pollutants. The associations were greater in females, individuals > 80 years, and during the warm season.
CONCLUSIONS: Short-term exposures to both PM2.5 and PM2.5-10 may independently increase the mortality risk of cerebrovascular diseases, particularly of ischemic stroke and stroke sequelae.