Associations Between Long-Term Air Pollutant Exposure and 30-Day All-Cause Hospital Readmissions in US Patients With Stroke.
Associations Between Long-Term Air Pollutant Exposure and 30-Day All-Cause Hospital Readmissions in US Patients With Stroke.
复制标题
美国中风患者长期接触空气污染物与 30 天全因医院再入院之间的关系。
DOI：
10.1161/strokeaha.122.042265
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发表时间：
2023
期刊：
影响因子：
8.3
通讯作者：
Lichtman,JudithH
中科院分区：
文献类型：
--
作者：
Tran,PhoebeM;Warren,JoshuaL;Leifheit,EricaC;Goldstein,LarryB;Lichtman,JudithH
研究背景长期暴露于空气污染物与脑卒中发病率、发病率和死亡率的增加有关;然而，缺乏关于污染物暴露与中风后再入院的关联的研究。方法我们评估了年平均一氧化碳（CO）、二氧化氮（NO2）、臭氧（O3）、颗粒物2.5，2014年至2015年因缺血性卒中住院的年龄≥65岁的美国按服务付费医疗保险受益人中二氧化硫（SO2）暴露和30天全因再次住院的情况。我们拟合考克斯模型来评估30天的再入院率作为这些污染物的函数，并根据患者和医院的特征以及环境温度进行调整。然后，根据医疗保险和医疗补助服务中心风险标准化的卒中后30天全因再入院指标对治疗医院的表现进行分层分析，以确定结果是否独立于表现：低（医疗保险和医疗补助服务中心的医院费率<全国费率的第25百分位），高结果448148例脑卒中患者中，12.5%在30天内再次入院。除对流层NO2（无国家标准）外，2年平均CO、O3、颗粒物2.5和SO2值均低于国家限值。CO、NO2、颗粒物2.5和SO2年均暴露量每增加一个SD，（95% CI，0.4-1.9%），3.6%（95% CI，2.9%-4.4%），1.2%（95%CI，0.2%-2.3%）和2.0%（95%CI，1.1%-3.0%）分别增加30天再入院的风险，O3降低0.7%（95%CI，0.0%-1.5%）。长期的空气污染物暴露和增加再入院之间的关联持续在整个医院的性能categorization.ConclusionsLong-term空气污染物暴露低于国家限制与增加30天再入院中风后，无论医院的性能类别。空气质量的改善是否会导致中风后再入院的减少还需要进一步的研究。
BackgroundLong-term exposure to air pollutants is associated with increased stroke incidence, morbidity, and mortality; however, research on the association of pollutant exposure with poststroke hospital readmissions is lacking.MethodsWe assessed associations between average annual carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), particulate matter 2.5, and sulfur dioxide (SO2) exposure and 30-day all-cause hospital readmission in US fee-for-service Medicare beneficiaries age ≥65 years hospitalized for ischemic stroke in 2014 to 2015. We fit Cox models to assess 30-day readmissions as a function of these pollutants, adjusted for patient and hospital characteristics and ambient temperature. Analyses were then stratified by treating hospital performance on the Centers for Medicare and Medicaid Services risk-standardized 30-day poststroke all-cause readmission measure to determine if the results were independent of performance: low (Centers for Medicare and Medicaid Services rate for hospital <25th percentile of national rate), high (>75th percentile), and intermediate (all others).ResultsOf 448 148 patients with stroke, 12.5% were readmitted within 30 days. Except for tropospheric NO2(no national standard), average 2-year CO, O3, particulate matter 2.5, and SO2values were below national limits. Each one SD increase in average annual CO, NO2, particulate matter 2.5, and SO2exposure was associated with an adjusted 1.1% (95% CI, 0.4–1.9%), 3.6% (95% CI, 2.9%–4.4%), 1.2% (95% CI, 0.2%–2.3%), and 2.0% (95% CI, 1.1%–3.0%) increased risk of 30-day readmission, respectively, and O3with a 0.7% (95% CI, 0.0%–1.5%) decrease. Associations between long-term air pollutant exposure and increased readmissions persisted across hospital performance categories.ConclusionsLong-term air pollutant exposure below national limits was associated with increased 30-day readmissions after stroke, regardless of hospital performance category. Whether air quality improvements lead to reductions in poststroke readmissions requires further research.