Frontiers in public health · 2026
Association between short-term air pollution exposure and the risk of fatal recurrence within 1 year in patients with first-episode acute hemorrhagic stroke: a time-stratified case-crossover study.
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Gu Xiaoyong, Liu Jianshu, Wang Hongyu, Hou Dong, Li Aihua, Xu Lu, He Jiajia
Аннотация
OBJECTIVE: To analyze the association between short-term exposure to air pollutants and the risk of fatal recurrence within 1 year in patients with first-episode acute hemorrhagic stroke, to provide scientific basis for health management and risk early warning of patients with hemorrhagic stroke in environmental dimension as well as pollution source control.
METHODS: Patients with acute hemorrhagic stroke who had their first onset in Zhenjiang City from 2020 to 2023 and experienced fatal recurrence within 1 year were selected as the study subjects. A time-stratified case-crossover study design was adopted, with each case day (the day of stroke fatal recurrence) matched with the date 1 week before, 2 weeks before, and 1 week after the case day as control days. Through conditional logistic regression analysis, the odds ratio of fatal recurrence risk caused by short-term exposure to air pollutants on case days and control days was compared. Based on the model fit results, statistically significant models were identified, followed by analyses of lag effects, dose-response relationships, and interactions among pollutants. Stratification was performed according to sex, age, and season to identify potential effect modifiers of the corresponding variables.
RESULTS: A total of 1,056 case days and 3,168 control days were included in this study. Using China's national ambient air quality standards as a reference, the average concentrations of PM2.5, PM10, and O3_8h in Zhenjiang City were close to the first-level concentration limits, while the concentrations of SO2, NO2, and CO were far better than the first-level concentration limits. The conditional logistic regression analysis revealed that short-term exposure to PM2.5, PM10, SO2, and NO2 was associated with an increased risk of fatal recurrence within 1 year in patients with first-episode acute hemorrhagic stroke (p < 0.05), whereas no statistically significant association was observed for CO and O3_8h (p > 0.05). The OR values corresponding to a 1 μg/m3 increase in air pollutant concentration for the 3-day moving average lag (lag02) were as follows: PM2.5 (1.010, 95% CI: 1.007-1.013), PM10 (1.018, 95% CI: 1.011-1.025), SO2 (1.044, 95% CI: 1.012-1.075), and NO2 (1.024, 95% CI: 1.013-1.035); for the 2-day lag (lag2), the OR values were PM10 (1.013, 95% CI: 1.008-1.017) and NO2 (1.017, 95% CI: 1.011-1.023). For each IQR increase in pollutant concentration, the OR value for SO2 (1.137, 95% CI: 1.006-1.274) was the highest among the pollutants in the lag02 model, while the OR value for NO2 (1.123, 95% CI: 1.021-1.224) was the highest among the pollutants in the lag2 model. The dose-response curves of the 3-day moving average lag (lag02) for all four pollutants were statistically significant at low concentration levels (p < 0.05), with the risk of fatal recurrence increasing as the concentration of air pollutants rose. The dose-response curves of PM10 and PM2.5 with a 2-day lag (lag2) was statistically significant at low concentration levels (p < 0.05), with the risk of fatal recurrence first increasing and then decreasing. In contrast, the dose-response curve of NO2 with a 2-day lag (lag2) was statistically significant at high concentration levels (p < 0.05), showing a rapid upward trend in the risk of fatal recurrence. Female sex, age ≥80 years, and autumn were significant effect modifiers, and PM10 attenuated the effect of gaseous pollutants on the risk of fatal recurrence.
CONCLUSION: Short-term exposure to air PM2.5, PM10, SO2, and NO2, even at low concentrations, can increase the risk of fatal recurrence within 1 year in patients with first-episode acute hemorrhagic stroke. Therefore, further strengthening the control and management of pollution sources and establishing tailored risk warning and control measures for different populations and air pollutants are crucial for the health management of current acute hemorrhagic stroke patients.
METHODS: Patients with acute hemorrhagic stroke who had their first onset in Zhenjiang City from 2020 to 2023 and experienced fatal recurrence within 1 year were selected as the study subjects. A time-stratified case-crossover study design was adopted, with each case day (the day of stroke fatal recurrence) matched with the date 1 week before, 2 weeks before, and 1 week after the case day as control days. Through conditional logistic regression analysis, the odds ratio of fatal recurrence risk caused by short-term exposure to air pollutants on case days and control days was compared. Based on the model fit results, statistically significant models were identified, followed by analyses of lag effects, dose-response relationships, and interactions among pollutants. Stratification was performed according to sex, age, and season to identify potential effect modifiers of the corresponding variables.
RESULTS: A total of 1,056 case days and 3,168 control days were included in this study. Using China's national ambient air quality standards as a reference, the average concentrations of PM2.5, PM10, and O3_8h in Zhenjiang City were close to the first-level concentration limits, while the concentrations of SO2, NO2, and CO were far better than the first-level concentration limits. The conditional logistic regression analysis revealed that short-term exposure to PM2.5, PM10, SO2, and NO2 was associated with an increased risk of fatal recurrence within 1 year in patients with first-episode acute hemorrhagic stroke (p < 0.05), whereas no statistically significant association was observed for CO and O3_8h (p > 0.05). The OR values corresponding to a 1 μg/m3 increase in air pollutant concentration for the 3-day moving average lag (lag02) were as follows: PM2.5 (1.010, 95% CI: 1.007-1.013), PM10 (1.018, 95% CI: 1.011-1.025), SO2 (1.044, 95% CI: 1.012-1.075), and NO2 (1.024, 95% CI: 1.013-1.035); for the 2-day lag (lag2), the OR values were PM10 (1.013, 95% CI: 1.008-1.017) and NO2 (1.017, 95% CI: 1.011-1.023). For each IQR increase in pollutant concentration, the OR value for SO2 (1.137, 95% CI: 1.006-1.274) was the highest among the pollutants in the lag02 model, while the OR value for NO2 (1.123, 95% CI: 1.021-1.224) was the highest among the pollutants in the lag2 model. The dose-response curves of the 3-day moving average lag (lag02) for all four pollutants were statistically significant at low concentration levels (p < 0.05), with the risk of fatal recurrence increasing as the concentration of air pollutants rose. The dose-response curves of PM10 and PM2.5 with a 2-day lag (lag2) was statistically significant at low concentration levels (p < 0.05), with the risk of fatal recurrence first increasing and then decreasing. In contrast, the dose-response curve of NO2 with a 2-day lag (lag2) was statistically significant at high concentration levels (p < 0.05), showing a rapid upward trend in the risk of fatal recurrence. Female sex, age ≥80 years, and autumn were significant effect modifiers, and PM10 attenuated the effect of gaseous pollutants on the risk of fatal recurrence.
CONCLUSION: Short-term exposure to air PM2.5, PM10, SO2, and NO2, even at low concentrations, can increase the risk of fatal recurrence within 1 year in patients with first-episode acute hemorrhagic stroke. Therefore, further strengthening the control and management of pollution sources and establishing tailored risk warning and control measures for different populations and air pollutants are crucial for the health management of current acute hemorrhagic stroke patients.