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Short-term exposure to nitrogen dioxide and risk of stroke-related re-admission: An analysis of the Taiwan National Health Insurance Research Database.

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Title: Short-term exposure to nitrogen dioxide and risk of stroke-related re-admission: An analysis of the Taiwan National Health Insurance Research Database.
Authors: Yang, Chen-Ting1 (AUTHOR), Lin, Yu-hsiang1 (AUTHOR) 025211@tool.caaumed.org.tw, Lin, Hung-Lin1 (AUTHOR), Chen, Der-Cherng1 (AUTHOR), Chen, Chun-Chung1 (AUTHOR), Cho, Der-Yang1 (AUTHOR)
Source: Atmospheric Environment. Jun2026, Vol. 374, pN.PAG-N.PAG. 1p.
Subject Terms: *Nitrogen dioxide, *Air pollution, *Epidemiology, Patient readmissions, Secondary prevention, Stroke, Disease risk factors
Abstract: Ambient nitrogen dioxide (NO 2) exposure has been linked to incident stroke and hospital admissions, but its impact on stroke-related re-admissions is unclear. This study aimed to evaluate the association between short-term NO 2 exposure and the risk of stroke-related hospital re-admission within 1 year after discharge. This was a nested case–control study using the 2-million-person sampling cohort of the Taiwan National Health Insurance Research Database (NHIRD), 2011 to 2021. Adult patients hospitalized for stroke were included. Cases were defined as patients readmitted for stroke via the emergency department within 1 year, while matched controls had no stroke re-admission during the same period. Individual-level exposure to NO 2 and co-pollutants was estimated using ordinary kriging based on 73 air quality monitoring stations. Short-term exposure was defined as the 7-day average concentration prior to re-admission or pseudo-event date. Multivariable logistic regression was used to assess associations. Among 7194 patients (1460 cases; 5734 controls), higher short-term NO 2 exposure was significantly associated with increased odds of stroke-related re-admission (adjusted odds ratio [aOR] for highest vs. lowest quartile: 1.43; 95% confidence interval [CI]: 1.10–1.86). The association remained after adjustment for demographics, comorbidities, medications, and meteorological variables. Subgroup analyses showed stronger associations in patients aged ≥65 years, those with ischemic stroke, and individuals with diabetes and chronic complications. In conclusions, Short-term NO 2 exposure is significantly associated with an elevated risk of stroke-related hospital re-admission. These findings underscore the importance of incorporating air quality considerations into secondary stroke prevention strategies and environmental health policy. • Short-term NO 2 exposure raises stroke readmission odds (aOR 1.43). • Association persists after adjusting for key medical and weather factors. • Stronger effect in elderly, ischemic stroke, and diabetic patients. • Highlights air quality's role in secondary stroke prevention. [ABSTRACT FROM AUTHOR]
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Abstract:Ambient nitrogen dioxide (NO 2) exposure has been linked to incident stroke and hospital admissions, but its impact on stroke-related re-admissions is unclear. This study aimed to evaluate the association between short-term NO 2 exposure and the risk of stroke-related hospital re-admission within 1 year after discharge. This was a nested case–control study using the 2-million-person sampling cohort of the Taiwan National Health Insurance Research Database (NHIRD), 2011 to 2021. Adult patients hospitalized for stroke were included. Cases were defined as patients readmitted for stroke via the emergency department within 1 year, while matched controls had no stroke re-admission during the same period. Individual-level exposure to NO 2 and co-pollutants was estimated using ordinary kriging based on 73 air quality monitoring stations. Short-term exposure was defined as the 7-day average concentration prior to re-admission or pseudo-event date. Multivariable logistic regression was used to assess associations. Among 7194 patients (1460 cases; 5734 controls), higher short-term NO 2 exposure was significantly associated with increased odds of stroke-related re-admission (adjusted odds ratio [aOR] for highest vs. lowest quartile: 1.43; 95% confidence interval [CI]: 1.10–1.86). The association remained after adjustment for demographics, comorbidities, medications, and meteorological variables. Subgroup analyses showed stronger associations in patients aged ≥65 years, those with ischemic stroke, and individuals with diabetes and chronic complications. In conclusions, Short-term NO 2 exposure is significantly associated with an elevated risk of stroke-related hospital re-admission. These findings underscore the importance of incorporating air quality considerations into secondary stroke prevention strategies and environmental health policy. • Short-term NO 2 exposure raises stroke readmission odds (aOR 1.43). • Association persists after adjusting for key medical and weather factors. • Stronger effect in elderly, ischemic stroke, and diabetic patients. • Highlights air quality's role in secondary stroke prevention. [ABSTRACT FROM AUTHOR]
ISSN:13522310
DOI:10.1016/j.atmosenv.2026.121968