Association of ambient PM1 with hospital admission and recurrence of stroke in China

Tao Liu; Yong Jiang; Jianxiong Hu; Zixiao Li; Yuming Guo; Xing Li; Jianpeng Xiao; Lixia Yuan; Guanhao He; Weilin Zeng; Haidong Kan; Zuhua Rong; Gongbo Chen; Jun Yang; Yongjun Wang; Wenjun Ma

doi:10.1016/j.scitotenv.2022.154131

Association of ambient PM₁ with hospital admission and recurrence of stroke in China

Sci Total Environ. 2022 Jul 1:828:154131. doi: 10.1016/j.scitotenv.2022.154131. Epub 2022 Feb 25.

Authors

Tao Liu¹, Yong Jiang², Jianxiong Hu³, Zixiao Li⁴, Yuming Guo⁵, Xing Li³, Jianpeng Xiao³, Lixia Yuan³, Guanhao He³, Weilin Zeng³, Haidong Kan⁶, Zuhua Rong³, Gongbo Chen⁷, Jun Yang⁸, Yongjun Wang⁹, Wenjun Ma¹⁰

Affiliations

¹ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 510632 Guangzhou, China; Disease Control and Prevention Institute of Jinan University, Jinan University, Guangzhou 510632, China.
² China National Clinical Research Center for Neurological Diseases, Beijing 100070, China.
³ Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China.
⁴ China National Clinical Research Center for Neurological Diseases, Beijing 100070, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 100070, China.
⁵ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3800, Australia.
⁶ School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China; Children's Hospital of Fudan University, National Center for Children's Health, Shanghai 200032, China.
⁷ Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
⁸ Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China.
⁹ China National Clinical Research Center for Neurological Diseases, Beijing 100070, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 100070, China. Electronic address: yongjunwang@ncrcnd.org.
¹⁰ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 510632 Guangzhou, China; Disease Control and Prevention Institute of Jinan University, Jinan University, Guangzhou 510632, China. Electronic address: mawj@gdiph.org.cn.

PMID: 35219663
DOI: 10.1016/j.scitotenv.2022.154131

Abstract

Background: Particulate matter (PM) pollution is a well-known risk factor of stroke. However, little is known about the association between PM₁ (aerodynamic diameter ≤ 1.0 μm) and stroke. We estimated the associations of short-term exposure to PM₁ with hospital admission and recurrence of stoke in China.

Methods: Stroke data were derived from the Chinese Stroke Center Alliance (CASA) program conducted in 1458 hospitals in 292 Chinese cities from 2015 to 2019. Daily air pollution and meteorological data were collected in the cities where studied hospitals were located. Daily PM₁ concentration was estimated by a generalized additive model (GAM) using PM_2.5 and meteorological variables. A time-stratified case-crossover design was applied to estimate the associations of short-term exposure to PM₁ with hospital admission of stroke. A GAM model was used to estimate the association between average PM₁ exposure during hospitalization and the recurrence of stroke.

Results: A total of 989,591 stroke cases were included in the study. Each 10 μg/m³ increase in PM₁ (lag06-day) was associated with a 0.53% (95%CI, 0.39%, 0.67%) increment in hospital admission for stroke. The adverse effects of PM₁ on ischemic stroke was stronger than on intracerebral hemorrhage. We found the associations were significant in Northeast (0.94%, 95%CI, 0.51%, 1.38%), North (0.47%, 95%CI, 0.20%, 0.75%), Central (0.57%, 95%CI, 0.30%, 0.85%), and East China (0.63%, 95%CI, 0.27%, 0.99%). Of all stroke cases, 62,988 (6.4%) had recurrent stoke attack during their hospitalization. Each 10 μg/m³ increase in PM₁ was associated with a 1.64% (95%CI, 1.28%, 2.01%) increment in recurrence of stroke during hospitalization.

Conclusions: Short-term exposure to PM₁ may increase the risk of incidence and recurrence of stroke in China, and the effects varied across different types of stroke and regions. Geographically targeted strategies and measures are needed to control air pollution for reducing the burden of stroke from PM₁.

Keywords: China; Hospital admission; PM(1); Recurrence; Stroke.

MeSH terms

Air Pollutants* / analysis
Air Pollution* / analysis
China / epidemiology
Environmental Exposure / analysis
Hospitalization
Hospitals
Humans
Particulate Matter / analysis
Stroke* / chemically induced
Stroke* / epidemiology

Substances

Air Pollutants
Particulate Matter