TY - JOUR
T1 - The association between ozone and ischemic stroke morbidity among patients with type 2 diabetes in Beijing, China
AU - Liu, Xiangtong
AU - Li, Zhiwei
AU - Zhang, Jie
AU - Guo, Moning
AU - Lu, Feng
AU - Xu, Xiaolin
AU - Deginet, Aklilu
AU - Liu, Mengmeng
AU - Dong, Zhaomin
AU - Hu, Yaoyu
AU - Liu, Mengyang
AU - Li, Yutong
AU - Wu, Mengqiu
AU - Luo, Yanxia
AU - Tao, Lixin
AU - Lin, Hualiang
AU - Guo, Xiuhua
N1 - Publisher Copyright:
© 2021 The Authors
PY - 2022/4/20
Y1 - 2022/4/20
N2 - Background: The association between ozone and ischemic stroke has been widely reported; however, the association among patients with type 2 diabetes (T2D) has remained largely unknown. Methods: The time series data of daily morbidity and concentrations of ozone from 2014 to 2018 were collected in Beijing, China. A time-stratified case-crossover study combined with a distributed lag nonlinear model was used to estimate the ozone effect on stroke morbidity among T2D patients. Based on principal diagnosis, ischemic stroke cases were identified according to the International Classification of Diseases (I63), and a history of T2D was coded as E12. Results: A total of 149,757 hospital admissions for ischemic stroke among T2D patients were recorded in Beijing. Approximately U-shaped exposure-response curves were observed for ozone and ischemic stroke morbidity among T2D patients. With a reference at 54.91 μg/m3, extreme-low (5th: 9.59 μg/m3) ozone was significantly associated with a decreased risk for ischemic stroke [RR = 0.88, 95% confidence interval (CI): 0.80–0.98]. Subgroup analysis showed that extremely low-ozone (5th) level only had a significant protective effect in males and elderly population, with a RR value of 0.86 (95% CI: 0.76–0.97) and 0.85 (95% CI: 0.75–0.96), respectively. Extreme-high ozone (99th: 157.06 μg/m3) was significantly associated with an increased risk for ischemic stroke (RR = 1.33, 95% CI: 1.12–1.57). The effect size was 1.34 (95% CI: 1.10–1.63) for males and 1.32 (95% CI: 1.07–1.63) for females, and the difference was not significant (Z = -0.29, P = 0.77). The effect size in younger adults was significantly higher than that in participants aged ≥65 years [1.52 (95% CI: 1.21–1.91) vs. 1.22 (95% CI: 1.01–1.47), Z = -1.62, P < 0.05]. Conclusions: U-shaped associations were observed between ozone and ischemic stroke morbidity in T2D patients. Men and elderly population are vulnerable to low-ozone level, and the younger adults are more susceptible to extremely high-ozone level than the elderly.
AB - Background: The association between ozone and ischemic stroke has been widely reported; however, the association among patients with type 2 diabetes (T2D) has remained largely unknown. Methods: The time series data of daily morbidity and concentrations of ozone from 2014 to 2018 were collected in Beijing, China. A time-stratified case-crossover study combined with a distributed lag nonlinear model was used to estimate the ozone effect on stroke morbidity among T2D patients. Based on principal diagnosis, ischemic stroke cases were identified according to the International Classification of Diseases (I63), and a history of T2D was coded as E12. Results: A total of 149,757 hospital admissions for ischemic stroke among T2D patients were recorded in Beijing. Approximately U-shaped exposure-response curves were observed for ozone and ischemic stroke morbidity among T2D patients. With a reference at 54.91 μg/m3, extreme-low (5th: 9.59 μg/m3) ozone was significantly associated with a decreased risk for ischemic stroke [RR = 0.88, 95% confidence interval (CI): 0.80–0.98]. Subgroup analysis showed that extremely low-ozone (5th) level only had a significant protective effect in males and elderly population, with a RR value of 0.86 (95% CI: 0.76–0.97) and 0.85 (95% CI: 0.75–0.96), respectively. Extreme-high ozone (99th: 157.06 μg/m3) was significantly associated with an increased risk for ischemic stroke (RR = 1.33, 95% CI: 1.12–1.57). The effect size was 1.34 (95% CI: 1.10–1.63) for males and 1.32 (95% CI: 1.07–1.63) for females, and the difference was not significant (Z = -0.29, P = 0.77). The effect size in younger adults was significantly higher than that in participants aged ≥65 years [1.52 (95% CI: 1.21–1.91) vs. 1.22 (95% CI: 1.01–1.47), Z = -1.62, P < 0.05]. Conclusions: U-shaped associations were observed between ozone and ischemic stroke morbidity in T2D patients. Men and elderly population are vulnerable to low-ozone level, and the younger adults are more susceptible to extremely high-ozone level than the elderly.
KW - Comorbidities
KW - Ischemic stroke
KW - Ozone
KW - Type 2 diabetes
UR - https://www.scopus.com/pages/publications/85119494661
U2 - 10.1016/j.scitotenv.2021.151733
DO - 10.1016/j.scitotenv.2021.151733
M3 - 文章
C2 - 34800453
AN - SCOPUS:85119494661
SN - 0048-9697
VL - 818
JO - Science of the Total Environment
JF - Science of the Total Environment
M1 - 151733
ER -
可持续发展目标 3 良好健康与福祉