Short-term exposure to air pollution and risk of ischemic stroke requiring intravenous thrombolysis: a population-level analysis in Poland from the EP-PARTICLES study.
Michał Święczkowski, Gregory Y H Lip, Anna Kurasz, Piotr Jemielita, Małgorzata Duzinkiewicz, Tomasz Januszko, Sławomir Dobrzycki, Łukasz Kuźma
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引用次数: 0
Abstract
Background: Air pollution is an important non-classical cardiovascular risk factor. Ischemic stroke (IS) is an increasing healthcare challenge, with the ageing population and associated presence of atrial fibrillation worldwide. In patients with IS, intravenous thrombolysis (IVT) is an effective treatment method within 4.5 hours from symptoms onset. Our aim was to assess the association between exposure to air pollution and IVT-treated IS, allowing for high temporal precision in exposure assessment.
Methods: We conducted a retrospective population-based cohort study including 5.4 million inhabitants in Eastern Poland in the Years 2011-20. IVT-treated IS patients were enrolled into this study based on ICD-10 and ICD-9 code (I63 with 99.101/99.102/99.103). To ensure high spatial resolution, we used the GEM-AQ model for air quality modeling. Generalized linear mixed model with a Poisson distribution and random intercepts were used to examine municipality-specific associations between short-term exposure to air pollutants and IVT-treated IS.
Results: We recorded 96,189 IS cases with a dominance of females (52.5%) and patients 65 years old and over (78.8%). 10,486 (10.9%) patients received IVT treatment. In this group there was lower share of women (51.3% vs. 52.7%, p < 0.001), fewer elderly individuals (76% vs. 79.1%, p < 0.001), and lower in-hospital mortality (13.6% vs. 15.5%, p < 0.001). The rate of IVT use increased significantly from 3.2% in 2011 to 18.3% in 2020 (Kendall's τ = 0.956, p < 0.001). Exposure to benzo(a)pyrene was associated with the highest negative effects, causing 10.3% and 13.5% increase in risk of IVT-treated IS on LAG 0 and LAG 0-6 in the overall population, respectively. There was also an association between increased PM2.5 and IVT-treated incidence across all analyzed populations. Exposure to NO2 significantly increased the risk of IVT-treated IS only in females. Increases in SO2 and O3 levels did not influence IVT-treated incidence. There were no age or sex differences in the effects of air pollution exposure.
Conclusions: Exposure to air pollution might serve as a trigger for IVT-treated IS, exerting a comparable effect across different sexes and age groups. The IVT-treated IS group was characterized by improved survival. Public health efforts should focus on reducing air pollution levels and ensuring rapid access to advanced IS treatment in high-risk, highly polluted areas.
背景：空气污染是重要的非经典心血管危险因素。缺血性卒中（IS）是一个越来越大的医疗保健挑战，人口老龄化和相关的房颤的存在在世界范围内。对于IS患者，在症状出现后4.5小时内静脉溶栓（IVT）是一种有效的治疗方法。我们的目的是评估暴露于空气污染和ivt治疗的IS之间的关系，允许暴露评估的高时间精度。方法：我们进行了一项基于人群的回顾性队列研究，包括2011- 2020年波兰东部540万居民。ivt治疗的IS患者根据ICD-10和ICD-9编码（I63, 99.101/99.102/99.103）纳入本研究。为了确保高空间分辨率，我们使用GEM-AQ模型进行空气质量建模。使用泊松分布和随机截距的广义线性混合模型来检查短期暴露于空气污染物与ivt处理的IS之间的城市特异性关联。结果：我们记录了96,189例IS病例，其中以女性（52.5%）和65岁及以上患者（78.8%）为主。10486例（10.9%）患者接受了IVT治疗。在该组中，女性的比例较低（51.3% vs. 52.7%）， p < 2显著增加了仅在女性中接受ivt治疗的IS的风险。SO2和O3水平的升高不影响ivt治疗的发生率。暴露在空气污染中的影响没有年龄或性别差异。结论：暴露于空气污染可能是ivt治疗的IS的触发因素，在不同性别和年龄组中产生类似的影响。ivt治疗IS组的特点是生存率提高。公共卫生工作应侧重于降低空气污染水平，并确保在高风险、高污染地区迅速获得先进的IS治疗。试验注册：ClinicalTrials.gov （NCT05198492）。
期刊介绍：
Environmental Health publishes manuscripts on all aspects of environmental and occupational medicine and related studies in toxicology and epidemiology.
Environmental Health is aimed at scientists and practitioners in all areas of environmental science where human health and well-being are involved, either directly or indirectly. Environmental Health is a public health journal serving the public health community and scientists working on matters of public health interest and importance pertaining to the environment.
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