Tszshan Ma , Mahdieh Danesh Yazdi , Joel Schwartz , Weeberb J. Réquia , Qian Di , Yaguang Wei , Howard H. Chang , Viola Vaccarino , Pengfei Liu , Liuhua Shi
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However, evidence is limited for the simultaneous effects of multiple air pollutants on stroke.</p></div><div><h3>Methods and results</h3><p>We constructed a nationwide population-based cohort study, using the Medicare Chronic Conditions Warehouse (2000–2017) and high-resolution air pollution data, to investigate the impact of long-term exposure to ambient PM<sub>2.5</sub>, NO<sub>2</sub>, and ground-level O<sub>3</sub> on incident stroke. Hazard ratios (HR) for stroke incidence were estimated using single-, bi-, and tri-pollutant Cox proportional hazards models. We identified ~2.2 million incident stroke cases among 17,443,900 fee-for-service Medicare beneficiaries. Per interquartile range (IQR) increase in the annual average PM<sub>2.5</sub> (3.7 μg/m<sup>3</sup>), NO<sub>2</sub> (12.4 ppb), and warm-season O<sub>3</sub> (6.5 ppb) one-year prior to diagnosis, the HRs were 1.022 (95% CI: 1.017–1.028), 1.060 (95% CI: 1.054–1.065), and 1.021 (95% CI: 1.017–1.024), respectively, from the tri-pollutant model. There was strong evidence of linearity in concentration-response relationships for all three air pollutants in single-pollutant models. This linear relationship remained robust for NO<sub>2</sub> and O<sub>3</sub> in tri-pollutant models while the effect of PM<sub>2.5</sub> attenuated at the lower end of concentrations.</p></div><div><h3>Conclusion</h3><p>Using a large nationwide cohort, our study suggests that long-term exposure to PM<sub>2.5</sub>, NO<sub>2</sub>, and O<sub>3</sub> may independently increase the risk of stroke among the US elderly, among which traffic-related air pollution plays a particularly crucial role.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/91/main.PMC9838077.pdf","citationCount":"13","resultStr":"{\"title\":\"Long-term air pollution exposure and incident stroke in American older adults: A national cohort study\",\"authors\":\"Tszshan Ma , Mahdieh Danesh Yazdi , Joel Schwartz , Weeberb J. 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引用次数: 13
摘要
中风是美国人死亡和残疾的主要原因,越来越多的证据表明,空气污染可能在其中起着重要作用。为了促进污染控制工作,美国国家科学院(National Academy of Sciences)和世界卫生组织(World Health Organization)已优先确定哪些空气污染物毒性最大。然而,多种空气污染物对中风的同时影响证据有限。方法和结果我们构建了一项基于全国人群的队列研究,使用医疗慢性病仓库(2000-2017)和高分辨率空气污染数据,调查长期暴露于环境PM2.5、NO2和地面O3对卒中事件的影响。卒中发生率的风险比(HR)使用单一、双、三种污染物的Cox比例风险模型估计。我们在17,443,900名按服务收费的医疗保险受益人中确定了约220万例突发中风病例。三污染物模型的年平均PM2.5 (3.7 μg/m3)、NO2 (12.4 ppb)和暖季O3 (6.5 ppb)每四分位数范围(IQR)增加,分别为1.022 (95% CI: 1.017-1.028)、1.060 (95% CI: 1.054-1.065)和1.021 (95% CI: 1.017-1.024)。有强有力的证据表明,在单一污染物模型中,所有三种空气污染物的浓度-响应关系呈线性。在三种污染物模型中,NO2和O3的线性关系保持强劲,而PM2.5的影响在浓度较低的一端减弱。通过对全国范围内的大型队列研究,我们的研究表明,长期暴露于PM2.5、NO2和O3可能单独增加美国老年人中风的风险,其中交通相关的空气污染起着特别重要的作用。
Long-term air pollution exposure and incident stroke in American older adults: A national cohort study
Aims
Stroke is a leading cause of death and disability for Americans, and growing evidence suggests that air pollution may play an important role. To facilitate pollution control efforts, the National Academy of Sciences and the World Health Organization have prioritized determining which air pollutants are most toxic. However, evidence is limited for the simultaneous effects of multiple air pollutants on stroke.
Methods and results
We constructed a nationwide population-based cohort study, using the Medicare Chronic Conditions Warehouse (2000–2017) and high-resolution air pollution data, to investigate the impact of long-term exposure to ambient PM2.5, NO2, and ground-level O3 on incident stroke. Hazard ratios (HR) for stroke incidence were estimated using single-, bi-, and tri-pollutant Cox proportional hazards models. We identified ~2.2 million incident stroke cases among 17,443,900 fee-for-service Medicare beneficiaries. Per interquartile range (IQR) increase in the annual average PM2.5 (3.7 μg/m3), NO2 (12.4 ppb), and warm-season O3 (6.5 ppb) one-year prior to diagnosis, the HRs were 1.022 (95% CI: 1.017–1.028), 1.060 (95% CI: 1.054–1.065), and 1.021 (95% CI: 1.017–1.024), respectively, from the tri-pollutant model. There was strong evidence of linearity in concentration-response relationships for all three air pollutants in single-pollutant models. This linear relationship remained robust for NO2 and O3 in tri-pollutant models while the effect of PM2.5 attenuated at the lower end of concentrations.
Conclusion
Using a large nationwide cohort, our study suggests that long-term exposure to PM2.5, NO2, and O3 may independently increase the risk of stroke among the US elderly, among which traffic-related air pollution plays a particularly crucial role.