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Abstract
Background and Objectives To characterize the association of ambient particulate matter (PM) pollution of different sizes (PM ≤1 µm in aerodynamic diameter [PM1], PM2.5, and PM10) with in-hospital case fatality among patients with stroke in China.
Methods We collected hospitalizations due to stroke in 4 provinces in China from 2013 to 2019. Seven-day and annual averages of PM prior to hospitalization were estimated using bilinear interpolation and residential addresses. Associations with in-hospital case fatality were estimated using random-effects logistic regression models. Potential reducible fraction and the number of fatalities attributed to PM were estimated using a counterfactual approach.
Results Among 3,109,634 stroke hospitalizations (mean age 67.23 years [SD 12.22]; 1,765,644 [56.78%] male), we identified 32,140 in-hospital stroke fatalities (case fatality rate 1.03%). Each 10 µg/m3 increase in 7-day average (short-term) exposure to PM was associated with increased in-hospital case fatality: odds ratios (ORs) were 1.058 (95% CI 1.047–1.068) for PM1, 1.037 (95% CI 1.031–1.043) for PM2.5, and 1.025 (95% CI 1.021–1.029) for PM10. Similar but larger ORs were observed for annual averages (long-term): 1.240 (95% CI 1.217–1.265) for PM1, 1.105 (95% CI 1.094–1.116) for PM2.5, and 1.090 (95% CI 1.082–1.099) for PM10. In counterfactual analyses, PM10 was associated with the largest potential reducible fraction in in-hospital case fatality (10% [95% CI 8.3–11.7] for short-term exposure and 21.1% [19.1%–23%] for long-term exposure), followed by PM1 and PM2.5.
Discussion PM pollution is a risk factor for in-hospital stroke-related deaths. Strategies that target reducing PM pollution may improve the health outcomes of patients with stroke.
Glossary
- CHAP=
- China High Air Pollutant;
- ICD-10=
- International Classification of Diseases, 10th Edition;
- LMIC=
- low- and middle-income country;
- OR=
- odds ratio;
- PM=
- particulate matter
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Brad Worrall, MD, MSc.
↵* These authors contributed equally to this work as co-corresponding authors.
Editorial, page 1003
- Received September 17, 2021.
- Accepted in final form March 2, 2022.
- © 2022 American Academy of Neurology
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