Association of long-term nitrogen dioxide exposure with death in ischemic stroke patients and effect modification of greenness

ZHAO Ke; HU Yang; ZHANG Peiyao; LIU Chao; LIU Chengrong; SHI Chunxiang; WEI Jing; ZHANG Bingyin; LU Zilong; GUO Xiaolei; XUE Fuzhong; JIA Xianjie; MI Jing

doi:10.16462/j.cnki.zhjbkz.2024.05.010

Volume 28 Issue 5

May 2024

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Article Navigation > CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION > 2024 > 28(5): 554-560

ZHAO Ke, HU Yang, ZHANG Peiyao, LIU Chao, LIU Chengrong, SHI Chunxiang, WEI Jing, ZHANG Bingyin, LU Zilong, GUO Xiaolei, XUE Fuzhong, JIA Xianjie, MI Jing. Association of long-term nitrogen dioxide exposure with death in ischemic stroke patients and effect modification of greenness[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2024, 28(5): 554-560. doi: 10.16462/j.cnki.zhjbkz.2024.05.010

Citation:

ZHAO Ke, HU Yang, ZHANG Peiyao, LIU Chao, LIU Chengrong, SHI Chunxiang, WEI Jing, ZHANG Bingyin, LU Zilong, GUO Xiaolei, XUE Fuzhong, JIA Xianjie, MI Jing. Association of long-term nitrogen dioxide exposure with death in ischemic stroke patients and effect modification of greenness[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2024, 28(5): 554-560. doi: 10.16462/j.cnki.zhjbkz.2024.05.010

Citation:

ZHAO Ke, HU Yang, ZHANG Peiyao, LIU Chao, LIU Chengrong, SHI Chunxiang, WEI Jing, ZHANG Bingyin, LU Zilong, GUO Xiaolei, XUE Fuzhong, JIA Xianjie, MI Jing. Association of long-term nitrogen dioxide exposure with death in ischemic stroke patients and effect modification of greenness[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2024, 28(5): 554-560. doi: 10.16462/j.cnki.zhjbkz.2024.05.010

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Association of long-term nitrogen dioxide exposure with death in ischemic stroke patients and effect modification of greenness

doi: 10.16462/j.cnki.zhjbkz.2024.05.010

1.
Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical University, Bengbu 233030, China
2.
National Meteorological Information Center, Beijing 100081, China
3.
Department of Atmospheric and Oceanic Sciences, Earth System Sciences Interdisciplinary Center, University of Maryland, City of College Park 20742, U.S.A
4.
Department for Chronic and Non-communicable Diseases Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250014, China
5.
Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
6.
National Institute of Health Data Science of China, Jinan 250003, China

Funds:

Natural Science Research Projects in Anhui Universities KJ2021A0710

Graduate Student Innovation Program Projects Byycx22072

More Information

Corresponding author: MI Jing, E-mail: mijing@bbmc.edu.cn
Received Date: 2023-06-28
Rev Recd Date: 2023-10-30

Available Online: 2024-06-05

Publish Date: 2024-05-10

Abstract

Abstract

Objective This study aimed to investigate the association between long-term nitrogen dioxide (NO₂) exposure and the risk of death in ischemic stroke (ischemic stroke, IS) patients, as well as the modification of greenness on this association. Methods We conducted a longitudinal study on IS cases in 4 districts/counties in the northwest region of Shandong Province with relatively high NO₂ concentrations from 2013 to 2019. Participants were followed up until December 31, 2019, or the date of death. A time-dependent Cox proportional risk model was used to assess the hazard ratio (HR) and its 95% CI for stroke-related death in IS patients per IQR increase in NO₂. The exposure-response relationship between long-term NO₂ exposure and the risk of IS patient mortality was fitted using a restricted cubic spline function. We then explored the effect modification role of greenness exposure by incorporating an interaction term between NO₂ and normalized difference vegetation index (NDVI) levels. Finally, we conducted a series of sensitivity analyses and subgroup analyses based on different genders, age groups, and urban/rural areas. Results A total of 46 252 IS patients were included in the study and the annual mean concentration of NO₂ in the 4 districts/counties from 2013 to 2019 was (43.30±1.32) μg/m³. The results showed that the HR of death in IS patients were 1.22 (1.15-1.29) for each IQR increase in NO₂. The exposure-response relationship showed a non-linear relationship between long-term NO₂ exposure and the risk of IS patient mortality. The results of the interaction were found to be statistically significant (P_nolinear=0.005) with HRs of 1.23 (1.17-1.30), 1.21 (1.15-1.28), and 1.19 (1.12-1.26) for each IQR of NO₂ rise in patients with IS at the low, middle, and high levels of exposure to the greenness, respectively. Interaction effects between long-term NO₂ exposure and greenness exposure was found across different gender and age groups, as well as in rural areas (all P < 0.05). Conclusions Long-term exposure to NO₂ is considered a risk factor for mortality in IS patients, while greenness may potentially mitigate this detrimental effect.
- Ischemic stroke,
- Nitrogen dioxide,
- Greenness,
- Longitudinal study

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References(25)

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