Long-term exposure to ambient fine particulate matter chemical composition and in-hospital case fatality among patients with stroke in China.
retrospective_cohort · Level III
Where this comes from
- Record sourced from PubMed, PMID 36785852.
- Also identified by DOI 10.1016/j.lanwpc.2022.100679 and PMC identifier 9918804.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
There is little evidence on the association between PM<sub>2.5</sub> chemical components and fatality among hospitalized stroke patients. This study used an inpatient discharge database from 2013 to 2019 in four provinces (Sichuan, Shanxi, Guangxi, and Guangdong) in China. Annual average exposure to PM<sub>2.5</sub> and its five chemical components [black carbon (BC), organic matter (OM), sulphate ( <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> <msubsup><mrow><mi>S</mi> <mi>O</mi></mrow> <mn>4</mn> <mrow><mn>2</mn> <mo>-</mo></mrow> </msubsup> </mrow> </math> ), nitrate ( <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> <msubsup><mrow><mi>N</mi> <mi>O</mi></mrow> <mn>3</mn> <mo>-</mo></msubsup> </mrow> </math> ), and ammonium ( <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> <msubsup><mrow><mi>N</mi> <mi>H</mi></mrow> <mn>4</mn> <mo>+</mo></msubsup> </mrow> </math> )] were estimated using bilinear interpolation at patient's residential address. Mixed-effects logistic regression models were conducted to estimate the odds ratios (ORs). Counterfactual analyses were used to estimate the population attributable burden (PAF). Among 3,069,093 hospitalized patients with stroke, each interquartile (IQR) increment in PM<sub>2.5</sub> and its chemical components was significantly associated with stroke fatality: the ORs were 1.137 [95% confidence interval (CI): 1.118-1.157; IQR: 15.14 μg/m<sup>3</sup>] for PM<sub>2.5</sub>, 1.108 (95% CI: 1.091-1.126; IQR: 0.71 μg/m<sup>3</sup>) for BC, 1.086 (95% CI: 1.069-1.104; IQR: 3.47 μg/m<sup>3</sup>) for OM, and 1.065 (95% CI: 1.048-1.083; IQR: 2.81 μg/m<sup>3</sup>) for <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> <msubsup><mrow><mi>S</mi> <mi>O</mi></mrow> <mn>4</mn> <mrow><mn>2</mn> <mo>-</mo></mrow> </msubsup> </mrow> </math> . We did not find significant associations for <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> <msubsup><mrow><mi>N</mi> <mi>O</mi></mrow> <mn>3</mn> <mo>-</mo></msubsup> </mrow> </math> (OR: 0.991, 95% CI: 0.975-1.008; IQR: 3.30 μg/m<sup>3</sup>). The associations were larger among patients with ischemic stroke than those with hemorrhagic stroke. The PAFs were 10.6% (95% CI: 9.1-12.2%) for BC, 9.9% (95% CI: 8.2-11.7%) for OM, and 6.6% (4.9-8.3%) for <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> <msubsup><mrow><mi>S</mi> <mi>O</mi></mrow> <mn>4</mn> <mrow><mn>2</mn> <mo>-</mo></mrow> </msubsup> </mrow> </math> . Ambient BC, OM, and <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> <msubsup><mrow><mi>S</mi> <mi>O</mi></mrow> <mn>4</mn> <mrow><mn>2</mn> <mo>-</mo></mrow> </msubsup> </mrow> </math> might be important risk factors for stroke fatality. The findings advocate the need to develop tailored guidelines for PM chemical components and curb the emissions of the most hazardous chemical components. Bill & Melinda Gates Foundation (INV-016826).