大气污染对淄博市缺血性脑卒中患者寿命损失年的短期影响及极端温度事件修饰效应

摘要/Abstract

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doi:10.6040/j.issn.1671-7554.0.2024.0579

摘要： 目的探讨大气污染短期暴露与缺血性脑卒中患者寿命损失年(year of life lost, YLL)的关联以及极端温度事件的修饰效应。方法收集2015年1月1日至2019年12月31日淄博市缺血性脑卒中患者死亡数据、同期气象数据和大气污染数据。采用标准寿命表计算逐日YLL。采用广义加性模型分析大气污染对缺血性脑卒中患者YLL的短期影响,并进行亚组分析以识别脆弱人群。同时,采用分层分析识别极端温度事件的修饰效应。结果暴露当天和累积滞后1 d的PM_2.5与缺血性脑卒中患者YLL呈正向关联,PM_2.5浓度每增加10 μg/m³, 缺血性脑卒中患者YLL的变化值分别为0.56(95%CI: 0.05~1.07)年和0.66(95%CI: 0.06~1.25)年。滞后4 d、累积滞后1、4、5 d的PM₁₀与缺血性脑卒中患者YLL呈正向关联,PM₁₀浓度每增加10 μg/m³, 缺血性脑卒中患者YLL的变化值分别为0.40(95%CI: 0.05~0.75)年、0.40(95%CI: 0.01~0.79)年、0.67(95%CI: 0.12~1.23)年和0.74(95%CI: 0.13~1.35)年。O₃与缺血性脑卒中患者YLL的关联在全人群中无统计学意义(P>0.05),但是女性和≥65岁人群更易受到O₃影响从而导致缺血性脑卒中患者YLL增加。SO₂、NO₂和CO与缺血性脑卒中患者YLL的关联在全人群和各亚组的效应均无统计学意义(P>0.05)。此外,在冷季(每年10月至次年3月),寒潮可能会掩盖PM_2.5的不利健康效应。在特定寒潮定义下,PM_2.5的不利健康效应在非寒潮天大于寒潮天,且差异有统计学意义(P<0.05)。结论短期暴露于PM₁₀和PM_2.5可增加本地区居民缺血性脑卒中患者YLL,其中PM_2.5在非寒潮日的不利健康影响更强,女性和≥65岁人群对O₃暴露更为敏感。改善空气质量有助于预防因缺血性脑卒中而导致的过早死亡,尤其需加强非寒潮日的防护和对脆弱人群的保护。

关键词: 缺血性脑卒中, 寿命损失年, 空气污染, 极端温度事件, 滞后效应

Abstract: Objective To investigate the relationships between short-term exposure to air pollutants and the year of life lost(YLL)due to ischemic stroke, and test the modifying effects of extreme temperature events. Methods Daily ischemic stroke mortality data, meteorological data, and air pollution data were collected from January 1, 2015, to December 31, 2019, in Zibo City. The YLL was calculated using standard life tables. Generalized additive models were adopted to test the effects of air pollutants on YLL. Subgroup analyses were conducted to identify vulnerable population. Stratified analyses were conducted to identify the modifying effects of extreme temperature events. Results PM_2.5 at lag0 and lag01 were significantly associated with an increase of YLL due to ischemic stroke, and for every 10 μg/m³ increase in PM_2.5 concentration, the increases in YLL due to ischemic stroke were 0.56(95%CI: 0.05-1.07)and 0.66(95%CI: 0.06-1.25), respectively. PM₁₀ at lag4, lag01, lag04, and lag05 also showed significant positive associations with YLL due to ischemic stroke, and for every 10 μg/m³ increase in PM₁₀ concentration, increases in YLL due to ischemic stroke were 0.40(95%CI: 0.05-0.75), 0.40(95%CI: 0.01-0.79), 0.67(95%CI: 0.12-1.23)and 0.74(95%CI: 0.13-1.35), respectively. No significant association was observed between O₃, and YLL in the overall population(P>0.05), however, females and those aged ≥ 65 years were more susceptible to O₃, leading to increased YLL in ischemic stroke patients. The associations of SO₂, NO₂, and CO with YLL due to ischemic stroke were not statistically significant(P>0.05). Furthermore, during cold seasons(from October to March each year), cold spells may mask the adverse health effects of PM_2.5. Under a specific cold wave definition, the adverse health effects of PM_2.5 on non-cold spell days were greater than on cold spell days, and this difference was statistically significant(P<0.05). Conclusion Short-term exposure to PM₁₀ and PM_2.5 increases the YLL due to ischemic stroke, and the harmful health effects of PM_2.5 are higher on non-cold spell days. Women and individuals aged ≥ 65 are more susceptible to O₃ exposure. Improving air quality helps prevent premature death due to ischemic stroke, particularly by strengthening protection on non-cold spell days and safeguarding vulnerable populations.

Key words: Ischemic stroke, Year of life lost, Air pollution, Extreme temperature event, Lag effects

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宋思豪,程传龙,李树芬,席睿,梁珂梦,倪志松,崔峰,李秀君. 大气污染对淄博市缺血性脑卒中患者寿命损失年的短期影响及极端温度事件修饰效应[J]. 山东大学学报 (医学版), 2025, 63(2): 84-94.

SONG Sihao, CHENG Chuanlong, LI Shufen, XI Rui, LIANG Kemeng, NI Zhisong, CUI Feng, LI Xiujun. Short-term effects of air pollution on the year of life lost due to ischemic stroke and the modifying effects of extreme temperature events in Zibo City[J]. Journal of Shandong University (Health Sciences), 2025, 63(2): 84-94.

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