Association of greenness exposure and particulate matter exposure with ischemic stroke patients mortality in a cohort study
Objective The interaction between greenness exposure and mortality from ischemic stroke(IS)was assessed based on satellite remote sensing data(NDVI).Methods Individual cases suffering from IS from 2013-2019 were collected in five counties in Shandong to construct a cohort of IS patients.NDVI summer exposure values and annual average exposure concentrations of PM2.5 and PM10 were matched according to the residential address of each patient.Cox proportional risk models were used to explore the association between long-term greenfield exposure and combined exposure to PM2.5 and PM10 and their interactions with ischemic stroke death,and the analyses were stratified by sex,age,and residence.Restricted cubic spline functions were used to assess the dose-response relationship between greenfield exposure,PM2.5 and PM10 and the risk of death in IS patients,respectively.Results The cohort included 59 084 individuals and 4 726(8.00％)deaths due to IS.The results of the model's analysis showed that NDVI was negatively associated with the risk of death in patients with IS when assessing the combined exposure of NDVI with PM2.5 and PM10.The interaction results showed that the IS mortality hazard ratio(HR)for each 0.1-unit increase in NDVI was 0.74(95％CI:0.67-0.82),each 10 µg/m3 increase in PM2.5 was 0.94(95％CI:0.88-1.00),and the interaction term was 1.04(95％CI:1.02-1.07).Age,sex,and residence were effect modifiers influencing the association of combined exposure to NDVI with PM2.5 and PM10 and its interaction with death in IS patients.NDVI was nonlinearly associated with IS death,and PM2.5 and PM10 were associated with IS death in a"U"and"J"pattern,respectively.Conclusions Greenness exposure may reduce the risk of death from IS,while the risk of death from the disease may be further reduced by practicing good greenness planning and by reducing exposure concentrations of PM2.5 and PM10.
Ischemic strokeGreenness exposureFine particulate matterInhaled particulate matterRetrospective cohort study
NETL
NSTL
万方数据
