Long term exposure to ambient fine particulate matter and incidence of stroke: prospective cohort study from the China-PAR project.,The BMJ

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Long term exposure to ambient fine particulate matter and incidence of stroke: prospective cohort study from the China-PAR project.
The BMJ ( IF 93.6 ) Pub Date : 2019-12-30 , DOI: 10.1136/bmj.l6720
Keyong Huang _{1,

2} , Fengchao Liang ₁ , Xueli Yang ₁ , Fangchao Liu ₁ , Jianxin Li ₁ , Qingyang Xiao ₃ , Jichun Chen ₁ , Xiaoqing Liu ₄ , Jie Cao ₁ , Chong Shen ₅ , Ling Yu ₆ , Fanghong Lu ₇ , Xianping Wu ₈ , Liancheng Zhao ₁ , Xigui Wu ₁ , Ying Li ₁ , Dongsheng Hu ₉ , Jianfeng Huang ₁ , Yang Liu ₁₀ , Xiangfeng Lu ₁ , Dongfeng Gu _{2,

11}

Affiliation

Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, China.
Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, China.
School of Environment, Tsinghua University, Beijing, China.
Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China.
Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China.
Department of Cardiology, Fujian Provincial Hospital, Fuzhou, China.
Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China.
Center for Chronic and Noncommunicable Disease Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China.
Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China.
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, China

OBJECTIVE To study the effect of long term exposure to ambient fine particulate matter of diameter ≤2.5 μm (PM2.5) on the incidence of total, ischemic, and hemorrhagic stroke among Chinese adults. DESIGN Population based prospective cohort study. SETTING Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project carried out in 15 provinces across China. PARTICIPANTS 117 575 Chinese men and women without stroke at baseline in the China-PAR project. MAIN OUTCOME MEASURES Incidence of total, ischemic, and hemorrhagic stroke. RESULTS The long term average PM2.5 level from 2000 to 2015 at participants' residential addresses was 64.9 μg/m3, ranging from 31.2 μg/m3 to 97.0 μg/m3. During 900 214 person years of follow-up, 3540 cases of incident stroke were identified, of which 63.0% (n=2230) were ischemic and 27.5% (n=973) were hemorrhagic. Compared with the first quarter of exposure to PM2.5 (<54.5 μg/m3), participants in the highest quarter (>78.2 μg/m3) had an increased risk of incident stroke (hazard ratio 1.53, 95% confidence interval 1.34 to 1.74), ischemic stroke (1.82, 1.55 to 2.14), and hemorrhagic stroke (1.50, 1.16 to 1.93). For each increase of 10 μg/m3 in PM2.5 concentration, the increased risks of incident stroke, ischemic stroke, and hemorrhagic stroke were 13% (1.13, 1.09 to 1.17), 20% (1.20, 1.15 to 1.25), and 12% (1.12, 1.05 to 1.20), respectively. Almost linear exposure-response relations between long term exposure to PM2.5 and incident stroke, overall and by its subtypes, were observed. CONCLUSIONS This study provides evidence from China that long term exposure to ambient PM2.5 at relatively high concentrations is positively associated with incident stroke and its major subtypes. These findings are meaningful for both environmental and health policy development related to air pollution and stroke prevention, not only in China, but also in other low and middle income countries.

更新日期：2019-12-30

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