TY - JOUR
T1 - Ambient particulate matter pollution of different sizes associated with recurrent stroke hospitalization in China
T2 - A cohort study of 1.07 million stroke patients
AU - Cai, Miao
AU - Lin, Xiaojun
AU - Wang, Xiaojie
AU - Zhang, Shiyu
AU - Qian, Zhengmin (Min)
AU - McMillin, Stephen Edward
AU - Aaron, Hannah E.
AU - Lin, Hualiang
AU - Wei, Jing
AU - Zhang, Zilong
AU - Pan, Jay
N1 - Publisher Copyright:
© 2022 Elsevier B.V.
PY - 2023/1/15
Y1 - 2023/1/15
N2 - Background: To estimate the associations between ambient particulate matter (PM) pollution of different sizes (PM1, PM2.5, 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 PM2.5, 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 PM2.5, 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.
AB - Background: To estimate the associations between ambient particulate matter (PM) pollution of different sizes (PM1, PM2.5, 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 PM2.5, 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 PM2.5, 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.
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U2 - 10.1016/j.scitotenv.2022.159104
DO - 10.1016/j.scitotenv.2022.159104
M3 - Article
C2 - 36208745
AN - SCOPUS:85140137874
SN - 0048-9697
VL - 856
JO - Science of the Total Environment
JF - Science of the Total Environment
M1 - 159104
ER -