1
|
Hasnain MG, Garcia-Esperon C, Tomari YK, Walker R, Saluja T, Rahman MM, Boyle A, Levi CR, Naidu R, Filippelli G, Spratt NJ. Effect of short-term exposure to air pollution on daily cardio- and cerebrovascular hospitalisations in areas with a low level of air pollution. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:102438-102445. [PMID: 37668781 PMCID: PMC10567850 DOI: 10.1007/s11356-023-29544-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023]
Abstract
Exposure to air pollution is associated with increased cardio- and cerebrovascular diseases. However, the evidence regarding the short-term effect of air pollution on cardio- and cerebrovascular hospitalisations in areas with relatively low air pollution levels is limited. This study aims to examine the effect of short-term exposure to different air pollutants on hospital admissions due to cardio- and cerebrovascular diseases in rural and regional Australia with low air pollution. The study was conducted in five local Government areas of Hunter New England Local Health District (HNE-LHD). Hospitalisation data from January 2018 to February 2020 (820 days) were accessed from the HNE-LHD admitted patients' dataset. Poisson regression model was used to examine the association between the exposure (air pollutants) and outcome variables (hospitalisation due to cardio- and cerebrovascular disease). The concentrations of gaseous air pollutants, Sulphur Dioxide (SO2), Nitrogen Dioxide (NO2), Ozone (O3), Carbon Monoxide (CO), and Ammonia (NH3) were below national benchmark concentrations for every day of the study period. In single pollutant models, SO2 and NO2 significantly increased the daily number of cardio- and cerebrovascular hospitalisations. The highest cumulative effect for SO2 was observed across lag 0-3 days (Incidence Rate Ratio, IRR: 1.77; 95% Confidence Interval, CI: 1.18-2.65; p-value: 0.01), and for NO2, it was across lag 0-2 days (IRR: 1.13; 95% CI: 1.02-1.25; p-value: 0.02). In contrast, higher O3 was associated with decreased cardio- and cerebrovascular hospitalisations, with the largest effect observed at lag 0 (IRR: 0.94; 95% CI: 0.89-0.98; p-value: 0.02). In the multi-pollutant model, the effect of NO2 remained significant at lag 0 and corresponded to a 21% increase in cardio- and cerebrovascular hospitalisation (95% CI: 1-44%; p-value = 0.04). Thus, the study revealed that gaseous air pollutants, specifically NO2, were positively related to increased cardio- and cerebrovascular hospitalisations, even at concentrations below the national standards.
Collapse
Affiliation(s)
- Md Golam Hasnain
- College of Health, Medicine, and Wellbeing, The University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia.
- John Hunter Hospital, Hunter New England Local Health District, Lookout Road, New Lambton Heights, New South Wales, 2305, Australia.
- Hunter Medical Research Institute, Lookout Road, New Lambton Heights, New South Wales, 2305, Australia.
| | - Carlos Garcia-Esperon
- College of Health, Medicine, and Wellbeing, The University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia
- John Hunter Hospital, Hunter New England Local Health District, Lookout Road, New Lambton Heights, New South Wales, 2305, Australia
- Hunter Medical Research Institute, Lookout Road, New Lambton Heights, New South Wales, 2305, Australia
| | - Yumi Kashida Tomari
- College of Health, Medicine, and Wellbeing, The University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia
- John Hunter Hospital, Hunter New England Local Health District, Lookout Road, New Lambton Heights, New South Wales, 2305, Australia
- Hunter Medical Research Institute, Lookout Road, New Lambton Heights, New South Wales, 2305, Australia
| | - Rhonda Walker
- John Hunter Hospital, Hunter New England Local Health District, Lookout Road, New Lambton Heights, New South Wales, 2305, Australia
| | - Tarunpreet Saluja
- College of Health, Medicine, and Wellbeing, The University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia
- John Hunter Hospital, Hunter New England Local Health District, Lookout Road, New Lambton Heights, New South Wales, 2305, Australia
- Hunter Medical Research Institute, Lookout Road, New Lambton Heights, New South Wales, 2305, Australia
| | - Md Mijanur Rahman
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Andrew Boyle
- College of Health, Medicine, and Wellbeing, The University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia
- John Hunter Hospital, Hunter New England Local Health District, Lookout Road, New Lambton Heights, New South Wales, 2305, Australia
- Hunter Medical Research Institute, Lookout Road, New Lambton Heights, New South Wales, 2305, Australia
| | - Christopher R Levi
- College of Health, Medicine, and Wellbeing, The University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia
- John Hunter Hospital, Hunter New England Local Health District, Lookout Road, New Lambton Heights, New South Wales, 2305, Australia
- Hunter Medical Research Institute, Lookout Road, New Lambton Heights, New South Wales, 2305, Australia
| | - Ravi Naidu
- Global Centre for Environmental Remediation, College of Engineering Science and Environment, The University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia
- CRC for Contamination Assessment and Remediation of the Environment (crcCARE), The University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia
| | - Gabriel Filippelli
- Department of Earth Sciences, Indiana University, Indianapolis, IN, 46202, USA
| | - Neil J Spratt
- College of Health, Medicine, and Wellbeing, The University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia
- John Hunter Hospital, Hunter New England Local Health District, Lookout Road, New Lambton Heights, New South Wales, 2305, Australia
- Hunter Medical Research Institute, Lookout Road, New Lambton Heights, New South Wales, 2305, Australia
| |
Collapse
|
2
|
Lamorie-Foote K, Ge B, Shkirkova K, Liu Q, Mack W. Effect of Air Pollution Particulate Matter on Ischemic and Hemorrhagic Stroke: A Scoping Review. Cureus 2023; 15:e46694. [PMID: 37942398 PMCID: PMC10629995 DOI: 10.7759/cureus.46694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
Air pollution particulate matter (PM) exposure has been established as a risk factor for stroke. However, few studies have investigated the effects of PM exposure on stroke subtypes (ischemic and hemorrhagic stroke). Ischemic (IS) and hemorrhagic strokes (HS) involve distinctive pathophysiological pathways and may be differentially influenced by PM exposure. This review aims to characterize the effects of PM exposure on ischemic and hemorrhagic strokes. It also identifies subpopulations that may be uniquely vulnerable to PM toxicity. Pubmed was queried from 2000 to 2023 to identify clinical and epidemiological studies examining the association between PM exposure and stroke subtypes (ischemic and hemorrhagic stroke). Inclusion criteria were: 1) articles written in English 2) clinical and epidemiological studies 3) studies with a clear definition of stroke, IS, HS, and air pollution 4) studies reporting the effects of PM and 5) studies that included distinct analyses per stroke subtype. Two independent reviewers screened the literature for applicable studies. A total of 50 articles were included in this review. Overall, PM exposure increases ischemic stroke risk in both lightly and heavily polluted countries. The association between PM exposure and hemorrhagic stroke is variable and may be influenced by a country's ambient air pollution levels. A stronger association between PM exposure and stroke is demonstrated in older individuals and those with pre-existing diabetes. There is no clear effect of sex or hypertension on PM-associated stroke risk. Current literature suggests PM exposure increases ischemic stroke risk, with an unclear effect on hemorrhagic stroke risk. Older patients and those with pre-existing diabetes may be the most vulnerable to PM toxicity. Future investigations are needed to characterize the influence of sex and hypertension on PM-associated stroke risk.
Collapse
Affiliation(s)
| | - Brandon Ge
- Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, USA
| | - Kristina Shkirkova
- Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, USA
| | - Qinghai Liu
- Neurological Surgery, University of Southern California, Los Angeles, USA
| | - William Mack
- Neurological Surgery, University of Southern California, Los Angeles, USA
| |
Collapse
|
3
|
Assessment of Low-Level Air Pollution and Cardiovascular Incidence in Gdansk, Poland: Time-Series Cross-Sectional Analysis. J Clin Med 2023; 12:jcm12062206. [PMID: 36983207 PMCID: PMC10054494 DOI: 10.3390/jcm12062206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 03/18/2023] Open
Abstract
(1) Background: More than 1.8 million people in the European Union die every year as a result of CVD, accounting for 36% of all deaths with a large proportion being premature (before the age of 65). There are more than 300 different risk factors of CVD, known and air pollution is one of them. The aim of this study was to investigate whether daily cardiovascular mortality was associated with air pollutants and meteorological conditions in an urban environment with a low level of air pollution. (2) Methods: Data on daily incidence of strokes and myocardial infarctions in the city of Gdansk were obtained from the National Health Fund (NHF) and covered the period from 1 January 2014 to 31 December 2018. Data on the level of pollution, i.e., SO2, NO, NO2, NOx, CO, PM10, PM2.5, CO2, O3 and meteorological conditions came from the foundation: Agency of Regional Air Quality Monitoring in the Gdańsk metropolitan area (ARMAG). Using these data, we calculated mean values with standard deviation (SD) and derived the minimum and maximum values and interquartile range (IQR). Time series regression with Poisson distribution was used in statistical analysis. (4) Results: Stroke incidence is significantly affected by an increase in concentrations of NO, NO2 and NOx with RRs equal to 1.019 (95%CI: 1.001–1.036), 1.036 (95%CI: 1.008–1.064) and 1.017 (95%CI: 1.000–1.034) for every increase in IQR by 14.12, 14.62 and 22.62 μg/m3, respectively. Similarly, myocardial infarction incidence is significantly affected by an increase in concentrations of NO, NO2 and NOx with RRs equal to 1.030 (95%CI: 1.011–1.048), 1.053 (95%CI: 1.024–1.082) and 1.027 (95%CI: 1.010–1.045) for every increase in IQR by 14.12, 14.62 and 22.62 μg/m3, respectively. Both PM10 and PM2.5 were positively associated with myocardial infarction incidence. (5) Conclusions: In this time-series cross-sectional study, we found strong evidence that support the hypothesis that transient elevations in ambient PM2.5, PM10, NO2, SO2 and CO are associated with higher relative risk of ischemic stroke and myocardial infarction incidents.
Collapse
|
4
|
Gu J, Shi Y, Chen N, Wang H, Chen T. Ambient fine particulate matter and hospital admissions for ischemic and hemorrhagic strokes and transient ischemic attack in 248 Chinese cities. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 715:136896. [PMID: 32007884 DOI: 10.1016/j.scitotenv.2020.136896] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/11/2020] [Accepted: 01/22/2020] [Indexed: 05/18/2023]
Abstract
Few studies have investigated the acute effects of fine particulate matter (PM2.5) on the risk of stroke subtypes and transient ischemic attack (TIA) in low- and middle-income countries. The primary aim of this study was to assess the associations between short-term exposure to PM2.5 and daily hospital admissions for total cerebrovascular disease, ischemic and hemorrhagic strokes, and TIA in China. A total of 8,359,162 hospital admissions in 248 Chinese cities from 2013 to 2017 were identified from the Hospital Quality Monitoring System of China. Generalized additive models with quasi-Poisson regression were used to estimate the associations in each city, and random-effect meta-analyses were conducted to combine the city-specific estimates. We found that a 10 μg/m3 increase in PM2.5 concentration was significantly associated with a 0.19% (95% CI, 0.13% to 0.25%), 0.26% (95% CI, 0.17% to 0.35%), and 0.26% (95% CI, 0.13% to 0.38%) increase in same-day hospital admissions for total cerebrovascular disease, ischemic stroke, and TIA, respectively. In contrast, a non-significant negative association with PM2.5 was observed for hemorrhagic stroke in the main analyses (lag 0 day), which became statistically significant when using other single-day exposures (lag 1 or 2 days) or moving average exposures (lag 0-1, 0-2, or 0-3 days) as exposure metric. These associations were robust to adjustment for other criteria air pollutants in two-pollutant models. For ischemic stroke, the effect estimates were significantly larger in people aged 65-74 years, in cool season, and in cities with lower annual average PM2.5 concentrations. The exposure-response curves were nonlinear with a leveling off at high concentrations. These results contribute to the relatively limited literature on the PM2.5-related risks of cerebrovascular events in low- and middle-income countries.
Collapse
Affiliation(s)
- Jiangshao Gu
- Center for Big Data Research in Health and Medicine, Institute for Data Sciences, Tsinghua University, Beijing 100084, China; Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing 100084, China; Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Department of Computer Science and Technology, Tsinghua University, Beijing 100084, China
| | - Ying Shi
- China Standard Medical Information Research Center, Shenzhen 518054, China
| | - Ning Chen
- Center for Big Data Research in Health and Medicine, Institute for Data Sciences, Tsinghua University, Beijing 100084, China; Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing 100084, China; Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Department of Computer Science and Technology, Tsinghua University, Beijing 100084, China
| | - Haibo Wang
- China Standard Medical Information Research Center, Shenzhen 518054, China; Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Ting Chen
- Center for Big Data Research in Health and Medicine, Institute for Data Sciences, Tsinghua University, Beijing 100084, China; Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing 100084, China; Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Department of Computer Science and Technology, Tsinghua University, Beijing 100084, China.
| |
Collapse
|
5
|
Guo Y, Xie X, Lei L, Zhou H, Deng S, Xu Y, Liu Z, Bao J, Peng J, Huang C. Short-term associations between ambient air pollution and stroke hospitalisations: time-series study in Shenzhen, China. BMJ Open 2020; 10:e032974. [PMID: 32198300 PMCID: PMC7103818 DOI: 10.1136/bmjopen-2019-032974] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the association between ambient air pollution and stroke morbidity in different subgroups and seasons. METHODS We performed a time-series analysis based on generalised linear models to study the short-term exposure-response relationships between air pollution and stroke hospitalisations, and conducted subgroup analyses to identify possible sensitive populations. RESULTS For every 10 µg/m3 increase in the concentration of air pollutants, across lag 0-3 days, the relative risk of stroke hospitalisation was 1.029 (95% CI 1.013 to 1.045) for PM2.5, 1.054 (95% CI 1.031 to 1.077) for NO2 and 1.012 (95% CI 1.002 to 1.022) for O3. Subgroup analyses showed that statistically significant associations were found in both men and women, middle-aged and older populations, and both cerebral infarction and intracerebral haemorrhage. The seasonal analyses showed that statistically significant associations were found only in the winter. CONCLUSIONS Our study indicates that short-term exposure to PM2.5, NO2 and O3 may induce stroke morbidity, and the government should take actions to mitigate air pollution and protect sensitive populations.
Collapse
Affiliation(s)
- Yanfang Guo
- Department of Non-Communicable Disease Control and Prevention, Bao'an District Hospital for Chronic Diseases Prevention and Cure, Shenzhen, China
| | - Xiufang Xie
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lin Lei
- Department of Non-Communicable Disease Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Haibin Zhou
- Department of Non-Communicable Disease Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Shizhou Deng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ying Xu
- Department of Non-Communicable Disease Control and Prevention, Bao'an District Hospital for Chronic Diseases Prevention and Cure, Shenzhen, China
| | - Zheng Liu
- Department of Non-Communicable Disease Control and Prevention, Bao'an District Hospital for Chronic Diseases Prevention and Cure, Shenzhen, China
| | - Junzhe Bao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Shanghai Typhoon Institute, China Meteorological Administration, Shanghai, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ji Peng
- Department of Non-Communicable Disease Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Cunrui Huang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Shanghai Typhoon Institute, China Meteorological Administration, Shanghai, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China
- School of Public Health, Zhengzhou University, Zhengzhou, China
| |
Collapse
|
6
|
Sun S, Stewart JD, Eliot MN, Yanosky JD, Liao D, Tinker LF, Eaton CB, Whitsel EA, Wellenius GA. Short-term exposure to air pollution and incidence of stroke in the Women's Health Initiative. ENVIRONMENT INTERNATIONAL 2019; 132:105065. [PMID: 31382185 PMCID: PMC6754774 DOI: 10.1016/j.envint.2019.105065] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/26/2019] [Accepted: 07/28/2019] [Indexed: 05/07/2023]
Abstract
BACKGROUND Evidence of the association between daily variation in air pollution and risk of stroke is inconsistent, potentially due to the heterogeneity in stroke etiology. OBJECTIVES To estimate the associations between daily variation in ambient air pollution and risk of stroke and its subtypes among participants of the Women's Health Initiative, a large prospective cohort study in the United States. METHODS We used national-scale, log-normal ordinary kriging models to estimate daily concentrations of fine particulate matter (PM2.5), respirable particulate matter (PM10), nitrogen dioxide (NO2), nitrogen oxides (NOx), sulphur dioxide, and ozone at participant addresses. Stroke was adjudicated by trained neurologists and classified as ischemic or hemorrhagic. Ischemic strokes were further classified according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. We used a time-stratified case-crossover approach to estimate the odds ratio (OR) of the risk of stroke associated with an interquartile range (IQR) increase in concentrations of each air pollutant. We performed stratified analysis to examine whether associations varied across subgroups defined by age at stroke onset, US census region, smoking status, body mass index, and prior history of diabetes mellitus, hypertension, heart or circulation problems, or arterial fibrillation at enrollment. RESULTS Among 5417 confirmed strokes between 1993 and 2012, 4300 (79.4%) were classified as ischemic and 924 (17.1%) as hemorrhagic. No association was observed between day-to-day variation in any pollutant and risk of total stroke, ischemic stroke, or specific etiologies of ischemic stroke. We observed a positive association between risk of hemorrhagic stroke and NO2 and NOx in the 3 days prior to stroke with OR of 1.24 (95% CI: 1.01, 1.52) and 1.18 (95% CI: 1.03, 1.34) per IQR increase, respectively. The observed associations with hemorrhagic stroke were more pronounced among non-obese participants. CONCLUSIONS In this large cohort of post-menopausal US women, daily NO2 and NOx were associated with higher risk of hemorrhagic stroke, but ambient levels of four other air pollutants were not associated with higher risk of total stroke, ischemic stroke, or ischemic stroke subtypes.
Collapse
Affiliation(s)
- Shengzhi Sun
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA.
| | - James D Stewart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Melissa N Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA
| | - Jeff D Yanosky
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Duanping Liao
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Charles B Eaton
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA
| |
Collapse
|
7
|
Yang H, Li S, Sun L, Zhang X, Cao Z, Xu C, Cao X, Cheng Y, Yan T, Liu T, Wang Y. Smog and risk of overall and type-specific cardiovascular diseases: A pooled analysis of 53 cohort studies with 21.09 million participants. ENVIRONMENTAL RESEARCH 2019; 172:375-383. [PMID: 30825688 DOI: 10.1016/j.envres.2019.01.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/09/2018] [Accepted: 01/24/2019] [Indexed: 05/05/2023]
Abstract
The reported associations of smog with the risk of cardiovascular disease (CVD) and CVD subtypes were inconsistent. We systematically searched the Pubmed (Medline) and Embase databases (from the inception to April 25, 2018) to identify the cohort studies investigating the association between smog and CVD and specific types of CVD. We conducted a meta-analysis for different types of air pollutants (PM2.5, PM10, NO2, and O3) in smog with the risk of specific types of CVD separately. We summarized the study-specific effect estimates using both the fixed effect model and the random effect model. The meta-analysis included 35 publications with 53 cohort studies. Overall, the associations between per 10 μg/m3 increase in PM2.5 exposure and risk of CVD events, stroke events, ischemic heart disease(IHD) events were significant, with relative risks (RRs) of 1.11 (95% confidence interval: 1.07-1.15), 1.12 (95% CI: 1.08-1.16) and 1.14(95% CI: 1.08-1.21), respectively. PM2.5, PM10, NO2, and O3 exposure were associated with an increased risk of CVD mortality, with RRs of 1.11 (95% CI: 1.07-1.15), 1.09 (95% CI: 1.02-1.16), 1.23 (95% CI: 1.15-1.31) and 1.03 (95% CI: 1.02-1.05), respectively. Compared with PM10, NO2, and O3 exposure, PM2.5 exposure had a greater risk of stroke incidence and IHD incidence (RR 1.12, 95% CI 1.05-1.19 for stroke incidence; 1.19, 1.09-1.30 for IHD). However, no clear evidence for the associations of PM10 exposure with risk of CVD incidence, stroke incidence, and IHD incidence was observed. This meta-analysis confirms the evidence that PM2.5 exposure was significantly associated with increased risk of CVD, stroke, and IHD. PM2.5, PM10, NO2, and O3 exposure were separately associated with an increased risk of CVD mortality. There was a stronger association between PM2.5 exposure and the risk of stroke and IHD incidence. It urgently needs well-designed studies to further to elaborate the biological and epidemiological mechanisms that link smog with CVD. MAIN FINDINGS: Compared with PM10, NO2, and O3 exposures, PM2.5 exposure was positively associated with increased risk of stroke and IHD incidence. For air pollutants and CVD events, the association of NO2 with the risk CVD mortality is more significant.
Collapse
Affiliation(s)
- Hongxi Yang
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Shu Li
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Li Sun
- School of Public Health, Tianjin Medical University, Tianjin 300070, China; School of Nursing, Tianjin Medical University, Tianjin 300070, China
| | - Xinyu Zhang
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Zhi Cao
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Chenjie Xu
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Xinxi Cao
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Yangyang Cheng
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Tao Yan
- Department of Neurology, Tianjin Neurological and Gerontology Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin 300070, China.
| |
Collapse
|
8
|
Fisher JA, Puett RC, Laden F, Wellenius GA, Sapkota A, Liao D, Yanosky JD, Carter-Pokras O, He X, Hart JE. Case-crossover analysis of short-term particulate matter exposures and stroke in the health professionals follow-up study. ENVIRONMENT INTERNATIONAL 2019; 124:153-160. [PMID: 30641259 PMCID: PMC6692897 DOI: 10.1016/j.envint.2018.12.044] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/16/2018] [Accepted: 12/19/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND Stroke is a leading cause of morbidity and mortality in the United States. Associations between short-term exposures to particulate matter (PM) air pollution and stroke are inconsistent. Many prior studies have used administrative and hospitalization databases where misclassification of the type and timing of the stroke event may be problematic. METHODS In this case-crossover study, we used a nationwide kriging model to examine short-term ambient exposure to PM10 and PM2.5 and risk of ischemic and hemorrhagic stroke among men enrolled in the Health Professionals Follow-up Study. Conditional logistic regression models were used to obtain estimates of odds ratios (OR) and 95% confidence intervals (CI) associated with an interquartile range (IQR) increase in PM2.5 or PM10. Lag periods up to 3 days prior to the stroke event were considered in addition to a 4-day average. Stratified models were used to examine effect modification by patient characteristics. RESULTS Of the 727 strokes that occurred between 1999 and 2010, 539 were ischemic and 122 were hemorrhagic. We observed positive statistically significant associations between PM10 and ischemic stroke (ORlag0-3 = 1.26; 95% CI: 1.03-1.55 per IQR increase [14.46 μg/m3]), and associations were elevated for nonsmokers, aspirin nonusers, and those without a history of high cholesterol. However, we observed no evidence of a positive association between short-term exposure to PM and hemorrhagic stroke or between PM2.5 and ischemic stroke in this cohort. CONCLUSIONS Our study provides evidence that ambient PM10 may be associated with higher risk of ischemic stroke and highlights that ischemic and hemorrhagic strokes are heterogeneous outcomes that should be treated as such in analyses related to air pollution.
Collapse
Affiliation(s)
- Jared A Fisher
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA; Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA.
| | - Robin C Puett
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Francine Laden
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Amir Sapkota
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Duanping Liao
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jeff D Yanosky
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Olivia Carter-Pokras
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Xin He
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Jaime E Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
9
|
Guan T, Xue T, Liu Y, Zheng Y, Fan S, He K, Zhang Q. Differential Susceptibility in Ambient Particle-Related Risk of First-Ever Stroke: Findings From a National Case-Crossover Study. Am J Epidemiol 2018; 187:1001-1009. [PMID: 29351572 DOI: 10.1093/aje/kwy007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 01/08/2018] [Indexed: 01/02/2023] Open
Abstract
Different populations may respond differently to exposure to ambient fine particulate matter, defined as particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (PM2.5); however, less is known about the distribution of susceptible individuals among the entire population. We conducted a time-stratified case-crossover study to assess associations between stroke risk and exposure to PM2.5. During 2013-2015, 1,356 first-ever stroke events were derived from a large representative sample, the China National Stroke Screening Survey (CNSSS) database. Daily PM2.5 average exposures with a spatial resolution of 0.1° were estimated using a data assimilation approach combining satellite measurements, air model simulations, and monitoring values. The distribution of susceptibility was derived according to individual-specific associations with PM2.5 modified by different combinations of individual-level characteristics and their joint frequencies among all of the CNSSS participants (n = 1,292,010). We found that first-ever stroke was statistically significantly associated with PM2.5 (per 10-μg/m3 increment of exposure, odds ratio = 1.049, 95% confidence interval (CI): 1.038, 1.061). This association was modified by demographic (e.g., sex), lifestyle (e.g., overweight/obesity), and medical history (e.g., diabetes) variables. The combined association with PM2.5 varied from 0.966 (95% CI: 0.920, 1.013) to 1.145 (95% CI: 1.080, 1.215) per 10-μg/m3 increment in different subpopulations. We found that most of the CNSSS participants were at increased risk of PM2.5-related stroke, while only a small proportion were highly susceptible.
Collapse
Affiliation(s)
- Tianjia Guan
- Department of Environmental and Occupational Health, School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Xue
- Department of Earth System Science, School of Sciences, Tsinghua University, Beijing, China
| | - Yuanli Liu
- Department of Health Policy and Management, School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yixuan Zheng
- Department of Earth System Science, School of Sciences, Tsinghua University, Beijing, China
| | - Siyuan Fan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Kebin He
- Department of Earth System Science, School of Sciences, Tsinghua University, Beijing, China
| | - Qiang Zhang
- Department of Earth System Science, School of Sciences, Tsinghua University, Beijing, China
| |
Collapse
|
10
|
Yu Y, Dong H, Yao S, Ji M, Yao X, Zhang Z. Protective Effects of Ambient Ozone on Incidence and Outcomes of Ischemic Stroke in Changzhou, China: A Time-Series Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121610. [PMID: 29261153 PMCID: PMC5751026 DOI: 10.3390/ijerph14121610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/22/2017] [Accepted: 12/19/2017] [Indexed: 12/16/2022]
Abstract
The potential beneficial effect of ozone (O3) on stroke had been identified experimentally and clinically, but these effects remain controversial in population-based studies. This study aimed to explore the epidemiological association between O3 and risk of ischemic stroke. Ischemic stroke related health data and air pollution data were obtained from the Center for Disease Control and Prevention and Environmental Monitoring Center in Changzhou between 2015 and 2016, respectively. The associations between the short-term exposure to O3 and daily ischemic stroke onsets and deaths were examined based on time-series generalized additive Poisson model. During the study period, daily ischemic stroke onsets and deaths decreased 0.340% (95% confidence interval (CI) −0.559% to −0.120%) and 0.697% (95% CI −1.103% to −0.290%) with an interquartile range (IQR) (41.1 µg/m3) increase in levels of ambient O3, respectively. The protective effects of O3 were more significant in men and elders and in the cool season than those in women and young people and in the warm season, respectively. The negative association was independent of PM2.5, PM10, SO2, NO2 or CO exposure. Acute O3 exposure was associated with decreased risk of ischemic stroke. These findings will help provide new insights into the relationship between ischemic stroke and ambient O3 concentrations.
Collapse
Affiliation(s)
- Yongquan Yu
- Department of Occupational Medicine and Environmental Health, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China.
| | - Huibin Dong
- Department of Chronic Disease Control and Prevention, Changzhou Center for Disease Control and Prevention, 203 Taishan Road, Changzhou 213022, China.
| | - Shen Yao
- Department of Occupational Medicine and Environmental Health, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China.
| | - Minghui Ji
- Department of Occupational Medicine and Environmental Health, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China.
| | - Xingjuan Yao
- Department of Chronic Disease Control and Prevention, Changzhou Center for Disease Control and Prevention, 203 Taishan Road, Changzhou 213022, China.
| | - Zhan Zhang
- Department of Hygiene Analysis and Detection, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China.
| |
Collapse
|
11
|
Han MH, Yi HJ, Kim YS, Ko Y, Kim YS. Association between Diurnal Variation of Ozone Concentration and Stroke Occurrence: 24-Hour Time Series Study. PLoS One 2016; 11:e0152433. [PMID: 27015421 PMCID: PMC4807846 DOI: 10.1371/journal.pone.0152433] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 03/14/2016] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Increasing ozone concentrations have been known to damage human health and ecosystems. Although ozone tends to display diurnal variation, most studies have reported only on the association between daily ozone concentrations and ischemic stroke occurrence on the same day, or with a 1-day lag. We investigated the effect of the diurnal variation of ozone on ischemic stroke occurrence during the same day. Methods We included a consecutive series of 1,734 patients from January 1, 2008, to December 31, 2014, at a single tertiary hospital in Seoul, South Korea. We evaluated differences between temperature and pollutants at the time of stroke onset for each time interval and averaged those parameters across the 7-year study period. Results During the interval from 13:00 to 16:59, we found a positive association between ischemic stroke occurrence and ozone concentration relative to other time periods. Upper median ozone levels from 13:00 to 16:59 were positively correlated with ischemic stroke (odds ratio, 1.550; 95% confidence intervals, 1.220 to 1.970; P = <0.001) when compared with lower median levels. Conclusions The results show diurnal patterns of ischemic stroke occurrence based on upper and lower median ozone levels for a 24-hour period, which extends understanding of the association between stroke occurrence and environmental influences.
Collapse
Affiliation(s)
- Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471–701, Gyonggi-do, Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, 222–1, Wangsimni-ro, Seongdong-gu, Seoul, Korea
- * E-mail:
| | - Young-Seo Kim
- Department of Neurology, Hanyang University Medical Center, 222–1, Wangsimni-ro, Seongdong-gu, Seoul, Korea
| | - Yong Ko
- Department of Neurosurgery, Hanyang University Medical Center, 222–1, Wangsimni-ro, Seongdong-gu, Seoul, Korea
| | - Young-Soo Kim
- Department of Neurosurgery, Hanyang University Medical Center, 222–1, Wangsimni-ro, Seongdong-gu, Seoul, Korea
| |
Collapse
|
12
|
Montresor-López JA, Yanosky JD, Mittleman MA, Sapkota A, He X, Hibbert JD, Wirth MD, Puett RC. Short-term exposure to ambient ozone and stroke hospital admission: A case-crossover analysis. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2016; 26:162-6. [PMID: 26329139 DOI: 10.1038/jes.2015.48] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 06/04/2015] [Indexed: 05/13/2023]
Abstract
We evaluated the association between short-term exposure to ambient ozone air pollution and stroke hospital admissions among adult residents of South Carolina (SC). Data on all incident stroke hospitalizations from 2002 to 2006 were obtained from the SC Office of Research and Statistics. Ozone exposure data were obtained from the US Environmental Protection Agency's Hierarchical Bayesian Model. A semi-symmetric bidirectional case-crossover design was used to examine the association between ozone exposure on lag days 0-2 (0 to 2 days before admission) and stroke hospitalization. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). No significant associations were observed between short-term ozone exposure and hospitalization for all stroke (e.g., lag day 0: OR=0.98; 95% CI=0.96, 1.00) or ischemic stroke (lag day 0: OR=0.98; 95% CI=0.96, 1.01). Risk of hospitalization for hemorrhagic stroke appeared to be higher among African Americans than European Americans; however, the majority of these associations did not reach statistical significance. Among adults in SC from 2002 to 2006, there was no evidence of an association between ozone exposure and risk of hospitalization for all stroke or ischemic stroke; however, African Americans may have an increased risk of hemorrhagic stroke.
Collapse
Affiliation(s)
- Jessica A Montresor-López
- Department of Epidemiology and Biostatistics, Maryland Institute of Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Jeff D Yanosky
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Murray A Mittleman
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Department of Epidemiology, Harvard University School of Public Health, Boston, Massachusetts, USA
| | - Amir Sapkota
- Department of Epidemiology and Biostatistics, Maryland Institute of Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Xin He
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA
| | - James D Hibbert
- Center for Research and Nutrition and Health Disparities, University of South Carolina School of Public Health, Columbia, South Carolina, USA
| | - Michael D Wirth
- Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, University of South Carolina School of Public Health, Columbia, South Carolina, USA
| | - Robin C Puett
- Department of Epidemiology and Biostatistics, Maryland Institute of Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| |
Collapse
|
13
|
Goodman JE, Prueitt RL, Sax SN, Lynch HN, Zu K, Lemay JC, King JM, Venditti FJ. Weight-of-evidence evaluation of short-term ozone exposure and cardiovascular effects. Crit Rev Toxicol 2015; 44:725-90. [PMID: 25257961 DOI: 10.3109/10408444.2014.937854] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There is a relatively large body of research on the potential cardiovascular (CV) effects associated with short-term ozone exposure (defined by EPA as less than 30 days in duration). We conducted a weight-of-evidence (WoE) analysis to assess whether it supports a causal relationship using a novel WoE framework adapted from the US EPA's National Ambient Air Quality Standards causality framework. Specifically, we synthesized and critically evaluated the relevant epidemiology, controlled human exposure, and experimental animal data and made a causal determination using the same categories proposed by the Institute of Medicine report Improving the Presumptive Disability Decision-making Process for Veterans ( IOM 2008). We found that the totality of the data indicates that the results for CV effects are largely null across human and experimental animal studies. The few statistically significant associations reported in epidemiology studies of CV morbidity and mortality are very small in magnitude and likely attributable to confounding, bias, or chance. In experimental animal studies, the reported statistically significant effects at high exposures are not observed at lower exposures and thus not likely relevant to current ambient ozone exposures in humans. The available data also do not support a biologically plausible mechanism for CV effects of ozone. Overall, the current WoE provides no convincing case for a causal relationship between short-term exposure to ambient ozone and adverse effects on the CV system in humans, but the limitations of the available studies preclude definitive conclusions regarding a lack of causation. Thus, we categorize the strength of evidence for a causal relationship between short-term exposure to ozone and CV effects as "below equipoise."
Collapse
|
14
|
Shah ASV, Lee KK, McAllister DA, Hunter A, Nair H, Whiteley W, Langrish JP, Newby DE, Mills NL. Short term exposure to air pollution and stroke: systematic review and meta-analysis. BMJ 2015; 350:h1295. [PMID: 25810496 PMCID: PMC4373601 DOI: 10.1136/bmj.h1295] [Citation(s) in RCA: 467] [Impact Index Per Article: 51.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To review the evidence for the short term association between air pollution and stroke. DESIGN Systematic review and meta-analysis of observational studies DATA SOURCES Medline, Embase, Global Health, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science searched to January 2014 with no language restrictions. ELIGIBILITY CRITERIA Studies investigating the short term associations (up to lag of seven days) between daily increases in gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide, ozone) and particulate matter (<2.5 µm or <10 µm diameter (PM2.5 and PM10)), and admission to hospital for stroke or mortality. MAIN OUTCOME MEASURES Admission to hospital and mortality from stroke. RESULTS From 2748 articles, 238 were reviewed in depth with 103 satisfying our inclusion criteria and 94 contributing to our meta-estimates. This provided a total of 6.2 million events across 28 countries. Admission to hospital for stroke or mortality from stroke was associated with an increase in concentrations of carbon monoxide (relative risk 1.015 per 1 ppm, 95% confidence interval 1.004 to 1.026), sulphur dioxide (1.019 per 10 ppb, 1.011 to 1.027), and nitrogen dioxide (1.014 per 10 ppb, 1.009 to 1.019). Increases in PM2.5 and PM10 concentration were also associated with admission and mortality (1.011 per 10 μg/m(3) (1.011 to 1.012) and 1.003 per 10 µg/m(3) (1.002 to 1.004), respectively). The weakest association was seen with ozone (1.001 per 10 ppb, 1.000 to 1.002). Strongest associations were observed on the day of exposure with more persistent effects observed for PM(2·5). CONCLUSION Gaseous and particulate air pollutants have a marked and close temporal association with admissions to hospital for stroke or mortality from stroke. Public and environmental health policies to reduce air pollution could reduce the burden of stroke. SYSTEMATIC REVIEW REGISTRATION PROSPERO-CRD42014009225.
Collapse
Affiliation(s)
- Anoop S V Shah
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Kuan Ken Lee
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - David A McAllister
- Centre of Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Amanda Hunter
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Harish Nair
- Centre of Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - William Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jeremy P Langrish
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - David E Newby
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Nicholas L Mills
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| |
Collapse
|
15
|
Wang Y, Eliot MN, Wellenius GA. Short-term changes in ambient particulate matter and risk of stroke: a systematic review and meta-analysis. J Am Heart Assoc 2014; 3:jah3630. [PMID: 25103204 PMCID: PMC4310387 DOI: 10.1161/jaha.114.000983] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Stroke is a leading cause of death and long‐term disability in the United States. There is a well‐documented association between ambient particulate matter air pollution (PM) and cardiovascular disease morbidity and mortality. Given the pathophysiologic mechanisms of these effects, short‐term elevations in PM may also increase the risk of ischemic and/or hemorrhagic stroke morbidity and mortality, but the evidence has not been systematically reviewed. Methods and Results We provide a comprehensive review of all observational human studies (January 1966 to January 2014) on the association between short‐term changes in ambient PM levels and cerebrovascular events. We also performed meta‐analyses to evaluate the evidence for an association between each PM size fraction (PM2.5, PM10, PM2.5‐10) and each outcome (total cerebrovascular disease, ischemic stroke/transient ischemic attack, hemorrhagic stroke) separately for mortality and hospital admission. We used a random‐effects model to estimate the summary percent change in relative risk of the outcome per 10‐μg/m3 increase in PM. Conclusions We found that PM2.5 and PM10 are associated with a 1.4% (95% CI 0.9% to 1.9%) and 0.5% (95% CI 0.3% to 0.7%) higher total cerebrovascular disease mortality, respectively, with evidence of inconsistent, nonsignificant associations for hospital admission for total cerebrovascular disease or ischemic or hemorrhagic stroke. Current limited evidence does not suggest an association between PM2.5‐10 and cerebrovascular mortality or morbidity. We discuss the potential sources of variability in results across studies, highlight some observations, and identify gaps in literature and make recommendations for future studies.
Collapse
Affiliation(s)
- Yi Wang
- Department of Epidemiology, Brown University School of Public Health, Providence, RI (Y.W., M.N.E., G.A.W.) Department of Environmental Health Sciences, Indiana University Fairbanks School of Public Health, Indianapolis, IN (Y.W.)
| | - Melissa N Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI (Y.W., M.N.E., G.A.W.)
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI (Y.W., M.N.E., G.A.W.)
| |
Collapse
|
16
|
Impact of particulate matter exposition on the risk of ischemic stroke: epidemiologic evidence and putative mechanisms. J Cereb Blood Flow Metab 2014; 34:215-20. [PMID: 24301290 PMCID: PMC3915219 DOI: 10.1038/jcbfm.2013.212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 10/22/2013] [Accepted: 11/05/2013] [Indexed: 11/08/2022]
Abstract
Ambient particulate matter (PM) pollution is estimated to be responsible for 3.2 million deaths annually worldwide. Although many studies have demonstrated PM as a serious risk factor for cardiovascular diseases, less is known on its association with cerebrovascular events. Over the last decade, however, an increasing number of studies have provided data showing a relationship between PM exposure and ischemic stroke (IS). In this article, we will report on existing epidemiologic findings for an association between PM exposure and IS based on a systemic literature search. Thus, despite inconsistencies in the results, currently available data suggest that PM exposure is a risk factor for IS, especially in patients with preexisting illnesses. With regards to the mechanisms leading to PM-dependent vascular damage, in particular proinflammatory, prooxidative, as well as proatherogenic pathways have been suggested to be involved. Notably, to date there is only one study published, which demonstrates the influence of PM exposure on cerebrovascular function. We will discuss reasonable approaches for future neurovascular research in this field.
Collapse
|
17
|
Suissa L, Fortier M, Lachaud S, Staccini P, Mahagne MH. Ozone air pollution and ischaemic stroke occurrence: a case-crossover study in Nice, France. BMJ Open 2013; 3:e004060. [PMID: 24319276 PMCID: PMC3855570 DOI: 10.1136/bmjopen-2013-004060] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Relationship between low-level air pollution and stroke is conflicting. This study was conducted to document the relationship between outdoor air pollution and ischaemic stroke occurrence. DESIGN Time-stratified case-crossover analysis. SETTING University Hospital of Nice, France. PARTICIPANTS All consecutive patients with ischaemic stroke living in Nice admitted in the University Hospital of Nice (France) between January 2007 and December 2011. MAIN OUTCOME MEASURE Association (adjusted OR) between daily levels of outdoor pollutants (ozone (O3), nitrogen dioxide (NO2), particulate matter (PM10) and sulfur dioxide (SO2)) and ischaemic stroke occurrence. RESULTS 1729 patients with ischaemic stroke (mean age: 76.1±14.0 years; men: 46.7%) were enrolled. No significant association was found between stroke occurrence and short-term effects of all pollutants tested. In stratified analysis, we observed significant associations only between recurrent (n=280) and large artery ischaemic stroke (n=578) onset and short-term effect of O3 exposure. For an increase of 10 µg/m(3) of O3 level, recurrent stroke risk (mean D-1, D-2 and D-3 lag) was increased by 12.1% (95% CI 1.5% to 23.9%) and large artery stroke risk (mean D-3 and D-4 lag) was increased by 8% (95% CI 2.0% to 16.6%). Linear dose-response relationship for both subgroups was found. CONCLUSIONS Our results confirm the relationship between low-level O3 exposure and ischaemic stroke in high vascular risk subgroup with linear exposure-response relation, independently of other pollutants and meteorological parameters. The physiopathological processes underlying this association between ischaemic stroke and O3 exposure remain to be investigated.
Collapse
Affiliation(s)
- Laurent Suissa
- Stroke Center, University Hospital of Nice, Nice, France
| | - Mikael Fortier
- Department of Emergency Medicine, University Hospital of Nice, Nice, France
| | | | - Pascal Staccini
- Department of Medical Information, University Hospital of Nice, Nice, France
| | | |
Collapse
|
18
|
Wang Q, Gao C, Wang H, Lang L, Yue T, Lin H. Ischemic stroke hospital admission associated with ambient temperature in Jinan, China. PLoS One 2013; 8:e80381. [PMID: 24260379 PMCID: PMC3833907 DOI: 10.1371/journal.pone.0080381] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/08/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study estimated the effects of ambient temperature and relative humidity on hospital admissions for ischemic stroke during 1990-2009 in Jinan, China. METHODS To account for possible delayed effects and harvesting effect, we examined the impact of meteorological factors up to 30 days before each admission using a distributed lag non-linear model; we controlled for season, long-term trend, day of week and public holidays in the analysis. Stratified analyses were also done for summer and winter. RESULTS A total of 1,908 ischemic stroke hospital admissions were observed between 1990 and 2009. We found a strong non-linear acute effect of daily temperatures on ischemic stroke hospital admission. With the mean temperature 15°C as the reference, the relative risk (RR) was 1.43 (95% confidence interval (CI): 1.10-1.85) for 0°C daily temperature on the same day, and 0.43 (95% CI: 0.31-0.59) for 30°C daily temperature on the same day, respectively. The effect of ambient temperature was similar in summer and winter. No significant association was observed between relative humidity and ischemic stroke hospitalization. CONCLUSIONS Low temperature might be a risk factor for ischemic stroke, and high temperature might be protective factor of ischemic stroke occurrence in Jinan, China.
Collapse
Affiliation(s)
- Qinzhou Wang
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Cuilian Gao
- Qilu Hospital of Shandong University, Jinan, China
| | | | - Lingling Lang
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Tao Yue
- Cadre Health Care Department, Zibo Center Hospital, Zibo, China
| | - Hualiang Lin
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| |
Collapse
|