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Years of life lost from ischaemic and haemorrhagic stroke related to ambient nitrogen dioxide exposure: A multicity study in China.

ABSTRACT: Few multicity studies have been conducted in developing countries to distinguish the acute effects of ambient nitrogen dioxide (NO₂) on the years of life lost (YLL) from different subtypes of stroke. We aimed to differentiate the associations between NO₂ exposure and YLL from major pathological types of stroke in China, and estimate the relevant economic loss. A time-series study was conducted to explore the associations between short-term NO₂ exposure and YLL from ischaemic and haemorrhagic stroke from 2013 to 2017 in 48 Chinese cities. Daily NO₂ data and stroke mortality counts for each city were obtained from the National Urban Air Quality Real-time Publishing Platform and Chinese Center for Disease Control and Prevention, respectively. Generalized additive models were applied to estimate the cumulative effects of NO₂ in each city, and meta-analysis was used to combine the city-specific estimates. The relevant economic loss was estimated using the method of the value per statistical life year (VSLY). A 10 μg/m³ increase in ambient NO₂ concentration on the present day and previous day (lag 0-1) would lead to relatively higher increments in percentage change of YLL from ischaemic stroke (0.82%, 95% CI: 0.46%, 1.19%) than haemorrhagic stroke (0.46%, 95% CI: 0.09%, 0.84%). The association was significantly stronger in the low-education population than high-education population for ischaemic stroke. Furthermore, significantly higher association was found in South China than those in North China for both subtypes of stroke. Economic loss due to excess YLL from ischaemic stroke related to NO₂ exposure was higher than that for haemorrhagic stroke. Our study indicated higher association and economic loss of ischaemic than haemorrhagic stroke related to NO₂ exposure in China, which informed priorities for type-specific stroke prevention strategies related to NO₂ pollution and vulnerable population protection.

SUBMITTER: Li J

PROVIDER: S-EPMC8174774 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundAir pollution is a major risk factor for planetary health and has long been suspected of predisposing humans to respiratory diseases induced by pathogens like influenza viruses. However, epidemiological evidence remains elusive due to lack of longitudinal data from large cohorts.ObjectiveOur aim is to quantify the short-term association of influenza incidence with exposure to ambient air pollutants in Chinese cities.MethodsBased on air pollutant data and influenza surveillance data from 82 cities in China over a period of 5 years, we applied a two-stage time series analysis to assess the association of daily incidence of reported influenza cases with six common air pollutants [particulate matter with aerodynamic diameter ≤2.5μm (PM2.5), particulate matter with aerodynamic diameter ≤10μm (PM10), NO2, SO2, CO, and O3], while adjusting for potential confounders including temperature, relative humidity, seasonality, and holiday effects. We built a distributed lag Poisson model for one or multiple pollutants in each individual city in the first stage and conducted a meta-analysis to pool city-specific estimates in the second stage.ResultsA total of 3,735,934 influenza cases were reported in 82 cities from 2015 to 2019, accounting for 72.71% of the overall case number reported in the mainland of China. The time series models for each pollutant alone showed that the daily incidence of reported influenza cases was positively associated with almost all air pollutants except for ozone. The most prominent short-term associations were found for SO2 and NO2 with cumulative risk ratios of 1.094 [95% confidence interval (CI): 1.054, 1.136] and 1.093 (95% CI: 1.067, 1.119), respectively, for each 10 μg/m3 increase in the concentration at each of the lags of 1-7 d. Only NO2 showed a significant association with the daily incidence of influenza cases in the multipollutant model that adjusts all six air pollutants together. The impact of air pollutants on influenza was generally found to be greater in children, in subtropical cities, and during cold months.DiscussionIncreased exposure to ambient air pollutants, particularly NO2, is associated with a higher risk of influenza-associated illness. Policies on reducing air pollution levels may help alleviate the disease burden due to influenza infection. https://doi.org/10.1289/EHP12146.

Project description:BackgroundThe clinical epidemiology of stroke has been widely investigated in Caucasian populations, but the changes over time in the proportion of ischaemic to haemorrhagic strokes is less clear, especially in the Chinese population.AimsOur objective was to study the determinants and time trends for ischaemic and haemorrhagic stroke, in relation to age, in a large Chinese population cohort.MethodsUsing a medical insurance database in the southwest of China from 2001 to 2012, time trends in age-adjusted ischaemic and haemorrhagic stroke incidence and the contributing risk factors associated with age were investigated.ResultsAmong 425,901 individuals without prior stroke (52.4% male, median age 54), the rate of ischaemic stroke (per 1000 patient-years) decreased between 2002-2007, then remained broadly similar between 2008-2012. The rate of haemorrhagic stroke showed a similar trend, being approximately 1.3-1.9 from 2008-2012. Compared to patients age<65, ischaemic and haemorrhagic stroke incidences (rate, 95% confidential interval, CI) were higher in the elderly population (age <65 versus age ≥65: ischaemic: 3.64, 3.33-4.00, vs 14.33, 14.01-14.60; haemorrhagic: 1.09, 1.00-1.10 vs 2.52,2.40-2.70, respectively, both p<0.001). There were no significant differences in haemorrhagic stroke rates between the elderly and the very elderly population. Ischaemic and haemorrhagic stroke shared similar risk factors (age, hypertension, coronary artery disease (CAD), vascular disease, and diabetes mellitus) (all p<0.05). In subjects age<75 years, CAD (7.17, 4.14-12.37) and diabetes mellitus (3.27, 2.42-4.42) contributed most to the developing of haemorrhagic stroke (all p<0.001). Amongst the very elderly, vascular disease (2.24, 1.49-3.37) was an additional major risk factor for haemorrhagic stroke, together with CAD and diabetes mellitus (all p<0.001).ConclusionIn this large Chinese cohort, there was an increased risk of ischaemic stroke compared to haemorrhagic stroke with ageing. CAD, vascular disease, diabetes mellitus, and hypertension were major contributors to the development of hemorrhagic stroke in the very elderly Chinese population.

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Years of life lost from ischaemic and haemorrhagic stroke related to ambient nitrogen dioxide exposure: A multicity study in China.

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