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. |
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| 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] |
| Copyright of Atmospheric Environment is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
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| FullText | Text: Availability: 0 |
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| Header | DbId: 8gh DbLabel: GreenFILE An: 192840189 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Short-term exposure to nitrogen dioxide and risk of stroke-related re-admission: An analysis of the Taiwan National Health Insurance Research Database. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Yang%2C+Chen-Ting%22">Yang, Chen-Ting</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Lin%2C+Yu-hsiang%22">Lin, Yu-hsiang</searchLink><relatesTo>1</relatesTo> (AUTHOR)<i> 025211@tool.caaumed.org.tw</i><br /><searchLink fieldCode="AR" term="%22Lin%2C+Hung-Lin%22">Lin, Hung-Lin</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Chen%2C+Der-Cherng%22">Chen, Der-Cherng</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Chen%2C+Chun-Chung%22">Chen, Chun-Chung</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Cho%2C+Der-Yang%22">Cho, Der-Yang</searchLink><relatesTo>1</relatesTo> (AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Atmospheric+Environment%22">Atmospheric Environment</searchLink>. Jun2026, Vol. 374, pN.PAG-N.PAG. 1p. – Name: Subject Label: Subject Terms Group: Su Data: *<searchLink fieldCode="DE" term="%22Nitrogen+dioxide%22">Nitrogen dioxide</searchLink><br />*<searchLink fieldCode="DE" term="%22Air+pollution%22">Air pollution</searchLink><br />*<searchLink fieldCode="DE" term="%22Epidemiology%22">Epidemiology</searchLink><br /><searchLink fieldCode="DE" term="%22Patient+readmissions%22">Patient readmissions</searchLink><br /><searchLink fieldCode="DE" term="%22Secondary+prevention%22">Secondary prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Stroke%22">Stroke</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+risk+factors%22">Disease risk factors</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: 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] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Atmospheric Environment is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1016/j.atmosenv.2026.121968 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 1 StartPage: N.PAG Subjects: – SubjectFull: Nitrogen dioxide Type: general – SubjectFull: Air pollution Type: general – SubjectFull: Epidemiology Type: general – SubjectFull: Patient readmissions Type: general – SubjectFull: Secondary prevention Type: general – SubjectFull: Stroke Type: general – SubjectFull: Disease risk factors Type: general Titles: – TitleFull: Short-term exposure to nitrogen dioxide and risk of stroke-related re-admission: An analysis of the Taiwan National Health Insurance Research Database. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Yang, Chen-Ting – PersonEntity: Name: NameFull: Lin, Yu-hsiang – PersonEntity: Name: NameFull: Lin, Hung-Lin – PersonEntity: Name: NameFull: Chen, Der-Cherng – PersonEntity: Name: NameFull: Chen, Chun-Chung – PersonEntity: Name: NameFull: Cho, Der-Yang IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 06 Text: Jun2026 Type: published Y: 2026 Identifiers: – Type: issn-print Value: 13522310 Numbering: – Type: volume Value: 374 Titles: – TitleFull: Atmospheric Environment Type: main |
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