Short-term effects of ambient oxidation, and its interaction with fine particles on first-ever stroke: A national case-crossover study in China

• Published in: The Science of the total environment Vol. 907; p. 168017
• Main Authors: Jiang, Dongxia, Wang, Luyang, Han, Xueyan, Pan, Zhaoyang, Wang, Zhaokun, Wang, Yaqi, Li, Jing, Xue, Tao, Guo, Jian, Liu, Yuanli, Huang, Shaodan, Guan, Tianjia
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 10.01.2024
• Subjects: Ambient oxidation; Fine particle; First-ever stroke; Nitrogen dioxide; Ozone; First-ever stroke; Ozone; Ambient oxidation; Nitrogen dioxide; Fine particle
• ISSN: 0048-9697; 1879-1026
• DOI: 10.1016/j.scitotenv.2023.168017

Stroke is a significant global cause of disability and death, and its burden has been on the rise, while ambient air pollution has been conclusively linked to stroke incidence. However, knowledge about effects of atmospheric oxidation on stroke and its interactions with fine particles (PM2.5) are still limited. In this study, we investigated the short-term effects of ambient NO2, O3, and their combined oxidation (Owt) on first-ever stroke, based on data from the China National Stroke Screening Survey (CNSSS) conducted from 2013 to 2015. We found significant association between ambient NO2 exposure at lag0 day with first-ever stroke, with a 13.1 % (95 % CI: 3.5 %, 23.6 %) increase in the first-ever stroke risk per 10 μg/m3 exposure. We also found a significant interaction between NO2 and PM2.5 (p < 0.05): first-ever stroke risk increased 23.8 % (95 % CI: 9.6 %, 39.8 %) per 10 μg/m3 NO2 exposure in population exposed to higher PM2.5 concentrations, while no significant association was found in population exposed to lower PM2.5 concentrations. The results of stratified analyses indicated that physical inactivity enhanced the detrimental effects of O3 and Owt exposure, while smoking and transient ischemic attack (TIA) history enhanced the detrimental effects of NO2 exposure. However, TIA history appeared to mitigate the adverse effects of O3 exposure. This study is helpful to better understand the impact of ambient oxidation on stroke, as well as its interaction with PM2.5, and has implications for policies and standards for atmospheric protection and governance. [Display omitted] •Short-term effects of ambient oxidation on first-ever stroke were investigated in our study.•Our study revealed significantly positive association between lag0 NO2 exposure and first-ever stroke risk.•There was no significant association of O3 or combined oxidation of NO2 and O3 exposure with first-ever stroke risk.•We identified significant interaction between short-term NO2 and PM2.5.•Smoking, physical activity and TIA history modified the associations between ambient oxidation and first-ever stroke.