Ambient particulate matter pollution of different sizes associated with recurrent stroke hospitalization in China: A cohort study of 1.07 million stroke patients

Miao Cai; Xiaojun Lin; Xiaojie Wang; Shiyu Zhang; Zhengmin Min Qian; Stephen Edward McMillin; Hannah E Aaron; Hualiang Lin; Jing Wei; Zilong Zhang; Jay Pan

doi:10.1016/j.scitotenv.2022.159104

Ambient particulate matter pollution of different sizes associated with recurrent stroke hospitalization in China: A cohort study of 1.07 million stroke patients

Sci Total Environ. 2023 Jan 15;856(Pt 2):159104. doi: 10.1016/j.scitotenv.2022.159104. Epub 2022 Oct 5.

Authors

Affiliations

¹ Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2rd Road, Yuexiu District, Guangzhou, Guangdong 510080, China.
² HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China.
³ Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA.
⁴ School of Social Work, College for Public Health and Social Justice, Saint Louis University, Tegeler Hall, 3550 Lindell Boulevard, St. Louis, MO 63103, USA.
⁵ Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD 20740, USA. Electronic address: weijing_rs@163.com.
⁶ Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2rd Road, Yuexiu District, Guangzhou, Guangdong 510080, China. Electronic address: zhangzilong@mail.sysu.edu.cn.
⁷ HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; School of Public Administration, Sichuan University, No.24 South Section I, YihuanRoad, Chengdu, Sichuan 610065, China. Electronic address: panjie.jay@scu.edu.cn.

PMID: 36208745
DOI: 10.1016/j.scitotenv.2022.159104

Abstract

Background: To estimate the associations between ambient particulate matter (PM) pollution of different sizes (PM₁, PM_2.5, and PM₁₀) and risk of rehospitalization among stroke patients, as well as the attributable burden in China.

Methods: We built a cohort of 1,066,752 participants with an index stroke hospitalization in Sichuan, China from 2017 to 2019. Seven-day and annual average exposures to PM pollution prior to the date of the index hospitalization were linked with residential address using a bilinear interpolation approach. Cox proportional hazard models were constructed to assess the association between ambient PM and the risk of rehospitalization. The burden of stroke rehospitalization was estimated using a counterfactual approach.

Results: 245,457 (23.0 %) participants experienced rehospitalization during a mean of 1.15 years (SD: 0.90 years) of follow-up. Seven-day average concentrations of PM were associated with increased risk of rehospitalization: the hazard ratios (HRs) per 10 μg/m³ were 1.034 (95 % confidence interval [CI]: 1.029-1.038) for PM₁, 1.033 (1.031-1.036) for PM_2.5, and 1.030 (1.028-1.031) for PM₁₀; the hazard ratios were larger for annual average concentrations: 1.082 (1.074-1.090) for PM₁, 1.109 (1.104-1.114) for PM_2.5, and 1.103 (1.099-1.106) for PM₁₀. The associations were stronger in participants who were female, of minority ethnicity (non-Han Chinese), who suffered from an ischemic stroke, and those admitted under normal conditions. Population attributable fractions for stroke rehospitalization ranged from 4.66 % (95 % CI: 1.69 % to 7.63 %) for the 7-day average of PM₁ to 17.05 % (14.27 % to 19.83 %) for the annual average of PM₁₀; the reducible average cost of rehospitalization per participant attributable to PM ranged from 492.09 (178.19 to 806) RMB for the 7-day average of PM₁ to 1801.65 (1507.89 to 2095.41) RMB for the annual average of PM₁₀.

Conclusions: Ambient PM pollution may increase the risk of rehospitalization in stroke patients and is responsible for a significant burden of stroke rehospitalization.

Keywords: Air pollution; China; Hospital readmission; Particle size; Particulate matter; Stroke.

MeSH terms

Air Pollutants* / analysis
Air Pollution* / analysis
China / epidemiology
Cohort Studies
Environmental Exposure / analysis
Female
Hospitalization
Humans
Male
Particulate Matter / analysis
Stroke* / chemically induced
Stroke* / epidemiology

Substances

Particulate Matter
Air Pollutants