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Jia X, Zhang B, Yu Y, Xia W, Lu Z, Guo X, Xue F. Greenness mitigate cause-specific mortality associated with air pollutants in ischemic and hemorrhagic stroke patients: An ecological health cohort study. ENVIRONMENTAL RESEARCH 2024; 251:118512. [PMID: 38458591 DOI: 10.1016/j.envres.2024.118512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/24/2024] [Accepted: 02/15/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Air pollution is one of the most serious environmental risks to mortality of stroke. However, there exists a noteworthy knowledge gap concerning the different stroke subtypes, causes of death, the susceptibility of stroke patient, and the role of greenness in this context. METHODS We analyzed data from an ecological health cohort, which included 334,261 patients aged ≥40 years with stroke (comprising 288,490 ischemic stroke and 45,771 hemorrhagic stroke) during the period 2013-2019. We used Cox proportional hazards models with time-varying exposure to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the associations of annual average fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) with both all-cause and cause-specific mortality. Additionally, we conducted analyses to examine the effect modification by greenness and identify potential susceptibility factors through subgroup analyses. RESULT In multivariable-adjusted models, long-term exposure to PM2.5 and NO2 was associated with increased risk of all-cause mortality (HR: 1.038, 95% CI: 1.029-1.047 for PM2.5; HR: 1.055, 95% CI: 1.026-1.085 for NO2, per 10 μg/m3, for ischemic stroke patients; similar for hemorrhagic stroke patients). Gradually increasing effect sizes were shown for CVD mortality and stroke mortality. The HRs of mortality were slightly weaker with high versus low vegetation exposure. Cumulative exposures increased the HRs of pollutant-related mortality, and greater greenness decreased this risk. Two subtypes of stroke patients exhibited diverse patterns of benefit. CONCLUSION Increasing residential greenness attenuates the increased risk of mortality with different patterns due to chronic air pollutants for ischemic and hemorrhagic stroke, offering valuable insights for precise tertiary stroke prevention strategies.
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Affiliation(s)
- Xianjie Jia
- Department of Biostatistics, School of Public Health, Healthcare Big Data Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, China; Department of Epidemiology and Statistics, Bengbu Medical College, Bengbu, China
| | - Bingyin Zhang
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Ying Yu
- Department of Physiology, Bengbu Medical College, Bengbu, China
| | - Wanning Xia
- Department of Epidemiology and Statistics, Bengbu Medical College, Bengbu, China
| | - Zilong Lu
- Department of Physiology, Bengbu Medical College, Bengbu, China
| | - Xiaolei Guo
- Shandong Center for Disease Control and Prevention, Jinan, China.
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Healthcare Big Data Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Riggs DW, Baumgartner KB, Baumgartner R, Boone S, Judd SE, Bhatnagar A. Long-term exposure to air pollution and risk of stroke by ecoregions: The REGARDS study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 345:123367. [PMID: 38280465 PMCID: PMC10996890 DOI: 10.1016/j.envpol.2024.123367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/11/2024] [Accepted: 01/14/2024] [Indexed: 01/29/2024]
Abstract
Several cohort studies have found associations between long-term exposure to air pollution and stroke risk. However, it is unclear whether the surrounding ecology may modify these associations. This study evaluates associations of air pollution with stroke risk by ecoregions, which are areas of similar type, quality, and quantity of environmental resources in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. We assessed the incidence of stroke in 26,792 participants (45+ yrs) from the REGARDS study, a prospective cohort recruited across the contiguous United States. One-yr and 3-yr means of PM2.5, PM10, O3, NO2, SO2, and CO were estimated at baseline using data from the Center for Air, Climate, & Energy Solution, and assigned to participants at the census block group level. Incident stroke was ascertained through September 30, 2020. Relations of air pollutants with the risk of incident stroke were estimated using Cox proportional hazards models, adjusting for relevant demographics, behavioral risk factors, and neighborhood urbanicity. Models were stratified by EPA designated ecoregions. A 5.4 μg/m3 (interquartile range) increase in 1-yr PM10 was associated with a hazard ratio (95 %CI) for incident stroke of 1.07 (1.003, 1.15) in the overall study population. We did not find evidence of positive associations for PM2.5, O3, NO2, SO2, and CO in the fully adjusted models. In our ecoregion-specific analysis, associations of PM2.5 with stroke were stronger in the Great Plains ecoregion (HR = 1.44) than other ecoregions, while associations for PM10 were strongest in the Eastern Temperate Forests region (HR = 1.15). The associations between long-term exposure to air pollution and risk of stroke varied by ecoregion. Our results suggests that the type, quality, and quantity of the surrounding ecology can modify the effects of air pollution on risk of stroke.
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Affiliation(s)
- Daniel W Riggs
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, United States; Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, United States.
| | - Kathy B Baumgartner
- Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, United States
| | - Richard Baumgartner
- Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, United States
| | - Stephanie Boone
- Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, United States
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Aruni Bhatnagar
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, United States
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Carver A, Beare R, Knibbs LD, Mavoa S, Grocott K, Wheeler AJ, Srikanth V, Andrew NE. Exploring associations of greenery, air pollution and walkability with cardiometabolic health in people at midlife and beyond. Geriatr Gerontol Int 2024; 24 Suppl 1:208-214. [PMID: 38115171 DOI: 10.1111/ggi.14743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/25/2023] [Accepted: 11/04/2023] [Indexed: 12/21/2023]
Abstract
AIM To examine associations of neighborhood greenery, air pollution and walkability with cardiometabolic disease in adults aged ≥45 years in the Frankston-Mornington Peninsula region, Victoria, Australia. METHODS A cross-sectional, ecological study design was used. We assessed mean annual neighborhood greenery using the Normalized Difference Vegetation Index; air pollution (fine particulate matter of diameter ≤2.5 μm [PM2.5] and NO2) using land-use regression models; and walkability using Walk Score (possible values 0-100). Medically diagnosed diabetes (~95% type-2), heart disease and stroke were self-reported in the Australian Census (2021). Multivariable regression was used to model associations between environmental exposures and area-level (neighborhood) cardiometabolic disease prevalence (age group ≥45 years), with socioeconomic status, age and sex as covariates. Air pollution was examined as a mediator of associations between greenery and disease prevalence. RESULTS Our sample comprised 699 neighborhoods with the following mean (SD) values: Normalized Difference Vegetation Index 0.47 (0.09), PM2.5, 8.5 (0.6) μg/m3 and NO2, 5.2 (1.6) ppb. Disease prevalences were: heart disease, mean 8.9% (4.5%); diabetes, mean 10.3% (4.7%); and stroke, median 1.2% (range 0-10.9%). Greenery was negatively associated with diabetes (β = -5.85, 95% CI -9.53, -2.17) and stroke prevalence (β = -1.26, 95% CI -2.11, -0.42). PM2.5 and NO2 were positively associated with diabetes (β = 1.59, 95% CI 1.00, 2.18; β = 0.42, 95% CI 0.22, 0.62) and stroke prevalence (β = 0.15, 95% CI 0.01, 0.29; β = 0.06, 95% CI 0.01, 0.10). The association between greenery and diabetes was partially mediated by PM2.5 (mediated effect -5.38, 95% CI -7.84, -3.03). CONCLUSIONS Greenery and air pollutants were associated with lower and higher prevalence, respectively, of self-reported diabetes and, to a lesser extent, stroke. These ecological findings require further exploration with stronger, longitudinal study designs to inform public health policy and directions. Geriatr Gerontol Int 2024; 24: 208-214.
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Affiliation(s)
- Alison Carver
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
- Peninsula Clinical School, Central Clinical school, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
- Peninsula Health, Melbourne, Victoria, Australia
| | - Richard Beare
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
- Peninsula Clinical School, Central Clinical school, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
- Peninsula Health, Melbourne, Victoria, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Luke D Knibbs
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Suzanne Mavoa
- Environmental Protection Authority, Melbourne, Victoria, Australia
| | - Kaya Grocott
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Velandai Srikanth
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
- Peninsula Clinical School, Central Clinical school, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
- Peninsula Health, Melbourne, Victoria, Australia
| | - Nadine E Andrew
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
- Peninsula Clinical School, Central Clinical school, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
- Peninsula Health, Melbourne, Victoria, Australia
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Yang C, Lei L, Li Y, Huang C, Chen K, Bao J. Bidirectional modification effects on nonlinear associations of summer temperature and air pollution with first-ever stroke morbidity. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 272:116034. [PMID: 38310820 DOI: 10.1016/j.ecoenv.2024.116034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/06/2024]
Abstract
High temperature and air pollution may induce stroke morbidity. However, whether associations between high temperature and air pollution with stroke morbidity are modified by each other is still unclear. Data on 23,578 first-ever stroke patients in Shenzhen, China, during the summers of 2014-2018 were collected. Distributed lag nonlinear models were used to assess the modifying effects of air pollution stratified by the median for the associations between summer temperature and stroke morbidity at 0-3 lag days; modifying effects of temperature stratified by the minimum morbidity temperature on the associations between air pollution and stroke morbidity at the same lags were also estimated. The attributable risks of high temperature and high pollution on stroke morbidity were quantified. Stratified analyses of gender, age, migration type, and complication type were conducted to assess vulnerable population characteristics. Summer high temperature may induce stroke morbidity at high-level PM2.5, PM10, O3, SO2, and NO2 conditions, with attributable fraction (AF) of 2.982% (95% empirical confidence interval [eCI]: 0.943, 4.929), 3.113% (0.948, 5.200), 2.841% (0.943, 4.620), 3.617% (1.539, 5.470), and 2.048% (0.279, 3.637), respectively. High-temperature effects were statistically insignificant at corresponding low-level air pollution conditions. High-level PM2.5, PM10, and O3 may induce stroke morbidity at high-temperature conditions, with AF of 3.664% (0.036, 7.196), 4.129% (0.076, 7.963), and 4.574% (1.009, 7.762), respectively. High-level PM2.5, PM10, and O3 were not associated with stroke morbidity at low-temperature conditions. The effects of high temperature and high pollution on stroke morbidity were statistically significant among immigrants and patients with hypertension, dyslipidemia, or diabetes but insignificant among natives and patients without complications. The associations of summer temperature and air pollution with first-ever stroke morbidity may be enhanced bidirectionally. Publicity on the health risks of combined high temperature and high pollution events should be strengthened to raise protection awareness of relevant vulnerable populations.
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Affiliation(s)
- Chenlu Yang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Lin Lei
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Yike Li
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kai Chen
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Junzhe Bao
- College of Public Health, Zhengzhou University, Zhengzhou, China.
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Li P, Wang Y, Tian D, Liu M, Zhu X, Wang Y, Huang C, Bai Y, Wu Y, Wei W, Tian S, Li Y, Qiao Y, Yang J, Cao S, Cong C, Zhao L, Su J, Wang M. Joint Exposure to Ambient Air Pollutants, Genetic Risk, and Ischemic Stroke: A Prospective Analysis in UK Biobank. Stroke 2024; 55:660-669. [PMID: 38299341 DOI: 10.1161/strokeaha.123.044935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Our primary objective was to assess the association between joint exposure to various air pollutants and the risk of ischemic stroke (IS) and the modification of the genetic susceptibility. METHODS This observational cohort study included 307 304 British participants from the United Kingdom Biobank, who were stroke-free and possessed comprehensive baseline data on genetics, air pollutant exposure, alcohol consumption, and dietary habits. All participants were initially enrolled between 2006 and 2010 and were followed up until 2022. An air pollution score was calculated to assess joint exposure to 5 ambient air pollutants, namely particulate matter with diameters equal to or <2.5 µm, ranging from 2.5 to 10 µm, equal to or <10 µm, as well as nitrogen oxide and nitrogen dioxide. To evaluate individual genetic risk, a polygenic risk score for IS was calculated for each participant. We adjusted for demographic, social, economic, and health covariates. Cox regression models were utilized to estimate the associations between air pollution exposure, polygenic risk score, and the incidence of IS. RESULTS Over a median follow-up duration of 13.67 years, a total of 2476 initial IS events were detected. The hazard ratios (95% CI) of IS for per 10 µg/m3 increase in particulate matter with diameters equal to or <2.5 µm, ranging from 2.5 to 10 µm, equal to or <10 µm, nitrogen dioxide, and nitrogen oxide were 1.73 (1.33-2.14), 1.24 (0.88-1.70), 1.13 (0.89-1.33), 1.03 (0.98-1.08), and 1.04 (1.02-1.07), respectively. Furthermore, individuals in the highest quintile of the air pollution score exhibited a 29% to 66% higher risk of IS compared with those in the lowest quintile. Notably, participants with both high polygenic risk score and air pollution score had a 131% (95% CI, 85%-189%) greater risk of IS than participants with low polygenic risk score and air pollution score. CONCLUSIONS Our findings suggested that prolonged joint exposure to air pollutants may contribute to an increased risk of IS, particularly among individuals with elevated genetic susceptibility to IS.
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Affiliation(s)
- Panlong Li
- Department of Medical Imaging (P.L., Y.B., Y. Wu, W.W., M.W.), Henan Provincial People's Hospital and Zhengzhou University People's Hospital, China
- School of Electrical and Information Engineering, Zhengzhou University of Light Industry, China (P.L., X.Z., Yanfeng Wang, C.H.)
| | - Ying Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China (Ying Wang)
- School of Public Health, Zhengzhou University (Ying Wang)
| | - Dandan Tian
- Department of Hypertension (D.T., M.L.), Henan Provincial People's Hospital and Zhengzhou University People's Hospital, China
| | - Min Liu
- Department of Hypertension (D.T., M.L.), Henan Provincial People's Hospital and Zhengzhou University People's Hospital, China
| | - Xirui Zhu
- School of Electrical and Information Engineering, Zhengzhou University of Light Industry, China (P.L., X.Z., Yanfeng Wang, C.H.)
| | - Yanfeng Wang
- School of Electrical and Information Engineering, Zhengzhou University of Light Industry, China (P.L., X.Z., Yanfeng Wang, C.H.)
| | - Chun Huang
- School of Electrical and Information Engineering, Zhengzhou University of Light Industry, China (P.L., X.Z., Yanfeng Wang, C.H.)
| | - Yan Bai
- Department of Medical Imaging (P.L., Y.B., Y. Wu, W.W., M.W.), Henan Provincial People's Hospital and Zhengzhou University People's Hospital, China
- Laboratory of Brain Science and Brain-Like Intelligence Technology, Biomedical Research Institute, Henan Academy of Science, China (Y.B.)
| | - Yaping Wu
- Department of Medical Imaging (P.L., Y.B., Y. Wu, W.W., M.W.), Henan Provincial People's Hospital and Zhengzhou University People's Hospital, China
| | - Wei Wei
- Department of Medical Imaging (P.L., Y.B., Y. Wu, W.W., M.W.), Henan Provincial People's Hospital and Zhengzhou University People's Hospital, China
| | - Shan Tian
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China (S.T., Y.L., Y.Q., J.Y., S.C., C.C., L.Z., J.S.)
| | - Yuna Li
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China (S.T., Y.L., Y.Q., J.Y., S.C., C.C., L.Z., J.S.)
| | - Yuan Qiao
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China (S.T., Y.L., Y.Q., J.Y., S.C., C.C., L.Z., J.S.)
| | - Junting Yang
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China (S.T., Y.L., Y.Q., J.Y., S.C., C.C., L.Z., J.S.)
| | - Shanshan Cao
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China (S.T., Y.L., Y.Q., J.Y., S.C., C.C., L.Z., J.S.)
| | - Chaohua Cong
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China (S.T., Y.L., Y.Q., J.Y., S.C., C.C., L.Z., J.S.)
| | - Lei Zhao
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China (S.T., Y.L., Y.Q., J.Y., S.C., C.C., L.Z., J.S.)
| | - Jingjing Su
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China (S.T., Y.L., Y.Q., J.Y., S.C., C.C., L.Z., J.S.)
| | - Meiyun Wang
- Department of Medical Imaging (P.L., Y.B., Y. Wu, W.W., M.W.), Henan Provincial People's Hospital and Zhengzhou University People's Hospital, China
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Xie X, Wang L, Dong S, Ge S, Zhu T. Immune regulation of the gut-brain axis and lung-brain axis involved in ischemic stroke. Neural Regen Res 2024; 19:519-528. [PMID: 37721279 PMCID: PMC10581566 DOI: 10.4103/1673-5374.380869] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/11/2023] [Accepted: 06/12/2023] [Indexed: 09/19/2023] Open
Abstract
Local ischemia often causes a series of inflammatory reactions when both brain immune cells and the peripheral immune response are activated. In the human body, the gut and lung are regarded as the key reactional targets that are initiated by brain ischemic attacks. Mucosal microorganisms play an important role in immune regulation and metabolism and affect blood-brain barrier permeability. In addition to the relationship between peripheral organs and central areas and the intestine and lung also interact among each other. Here, we review the molecular and cellular immune mechanisms involved in the pathways of inflammation across the gut-brain axis and lung-brain axis. We found that abnormal intestinal flora, the intestinal microenvironment, lung infection, chronic diseases, and mechanical ventilation can worsen the outcome of ischemic stroke. This review also introduces the influence of the brain on the gut and lungs after stroke, highlighting the bidirectional feedback effect among the gut, lungs, and brain.
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Affiliation(s)
- Xiaodi Xie
- Institute of Neuroregeneration & Neurorehabilitation, Department of Pathophysiology, School of Basic Medicine, Qingdao University, Qingdao, Shandong Province, China
| | - Lei Wang
- Institute of Neuroregeneration & Neurorehabilitation, Department of Pathophysiology, School of Basic Medicine, Qingdao University, Qingdao, Shandong Province, China
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu Province, China
| | - Shanshan Dong
- Institute of Neuroregeneration & Neurorehabilitation, Department of Pathophysiology, School of Basic Medicine, Qingdao University, Qingdao, Shandong Province, China
- Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - ShanChun Ge
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu Province, China
| | - Ting Zhu
- Institute of Neuroregeneration & Neurorehabilitation, Department of Pathophysiology, School of Basic Medicine, Qingdao University, Qingdao, Shandong Province, China
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Whyte M, Douwes J, Ranta A. Green space and stroke: A scoping review of the evidence. J Neurol Sci 2024; 457:122870. [PMID: 38219382 DOI: 10.1016/j.jns.2024.122870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Global industrialisation and urbanisation has led to an increased interest in the link between the environment and health. Stroke is a major cause of morbidity and mortality, and there is increased evidence that environmental factors may affect both the incidence and severity of stroke. This review summarises the evidence for relationship between green space exposure and stroke incidence and outcomes. METHODS We conducted a literature search in Medline and Scopus until 1 August 2023, and screened references of relevant articles. Selected articles were appraised for their relevance, and critically reviewed. The findings were thematically categorised. RESULTS Of the 1342 papers identified, 27 were included. These involved a mix of study designs (cohort, cross-sectional, quasi-experimental, time stratified case crossover and ecological). There was consistent evidence indicating a protective association between green space exposure and disability and stroke-related death with mortality hazard ratios between 0.66 and 0.95. Most studies also showed that green space was inversely associated with stroke risk, with risk estimates from studies showing a protective effect ranging between 0.4 and 0.98; however, results were more mixed and some did not reach statistical significance. The moderating effects of green spaces on ambient temperatures, noise and air pollution, and psychosocial health plus greater enjoyment and opportunity for exercise and enrichment of the human microbiome may underly these associations. CONCLUSION There is likely some protective effect of green space on stroke, with the benefits most convincingly shown for post-stroke outcomes. More research is recommended to confirm the protective association between green space exposure and reduced stroke risk.
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Affiliation(s)
- Mina Whyte
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - Jeroen Douwes
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand
| | - Annemarei Ranta
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington 6242, New Zealand.
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Jiang D, Wang L, Han X, Pan Z, Wang Z, Wang Y, Li J, Guo J, Liu Y, Huang S, Guan T. Short-term effects of ambient oxidation, and its interaction with fine particles on first-ever stroke: A national case-crossover study in China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 907:168017. [PMID: 37879462 DOI: 10.1016/j.scitotenv.2023.168017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/30/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023]
Abstract
Stroke is a significant global cause of disability and death, and its burden has been on the rise, while ambient air pollution has been conclusively linked to stroke incidence. However, knowledge about effects of atmospheric oxidation on stroke and its interactions with fine particles (PM2.5) are still limited. In this study, we investigated the short-term effects of ambient NO2, O3, and their combined oxidation (Owt) on first-ever stroke, based on data from the China National Stroke Screening Survey (CNSSS) conducted from 2013 to 2015. We found significant association between ambient NO2 exposure at lag0 day with first-ever stroke, with a 13.1 % (95 % CI: 3.5 %, 23.6 %) increase in the first-ever stroke risk per 10 μg/m3 exposure. We also found a significant interaction between NO2 and PM2.5 (p < 0.05): first-ever stroke risk increased 23.8 % (95 % CI: 9.6 %, 39.8 %) per 10 μg/m3 NO2 exposure in population exposed to higher PM2.5 concentrations, while no significant association was found in population exposed to lower PM2.5 concentrations. The results of stratified analyses indicated that physical inactivity enhanced the detrimental effects of O3 and Owt exposure, while smoking and transient ischemic attack (TIA) history enhanced the detrimental effects of NO2 exposure. However, TIA history appeared to mitigate the adverse effects of O3 exposure. This study is helpful to better understand the impact of ambient oxidation on stroke, as well as its interaction with PM2.5, and has implications for policies and standards for atmospheric protection and governance.
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Affiliation(s)
- Dongxia Jiang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China
| | - Luyang Wang
- Beijing Key Lab of Indoor Air Quality Evaluation and Control, Beijing 100084, China
| | - Xueyan Han
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Zhaoyang Pan
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Zhaokun Wang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China
| | - Yaqi Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China
| | - Jing Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China
| | - Jian Guo
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Shaodan Huang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China.
| | - Tianjia Guan
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
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9
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Huang K, Jia J, Liang F, Li J, Niu X, Yang X, Chen S, Cao J, Shen C, Liu X, Yu L, Lu F, Wu X, Zhao L, Li Y, Hu D, Huang J, Liu Y, Gu D, Liu F, Lu X. Fine Particulate Matter Exposure, Genetic Susceptibility, and the Risk of Incident Stroke: A Prospective Cohort Study. Stroke 2024; 55:92-100. [PMID: 38018834 DOI: 10.1161/strokeaha.123.043812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/12/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Both genetic factors and environmental air pollution contribute to the risk of stroke. However, it is unknown whether the association between air pollution and stroke risk is influenced by the genetic susceptibilities of stroke and its risk factors. METHODS This prospective cohort study included 40 827 Chinese adults without stroke history. Satellite-based monthly fine particulate matter (PM2.5) estimation at 1-km resolution was used for exposure assessment. Based on 534 identified genetic variants from genome-wide association studies in East Asians, we constructed 6 polygenic risk scores for stroke and its risk factors, including atrial fibrillation, blood pressure, type 2 diabetes, body mass index, and triglyceride. The Cox proportional hazards model was applied to evaluate the hazard ratios and 95% CIs for the associations of PM2.5 and polygenic risk score with incident stroke and the potential effect modifications. RESULTS Over a median follow-up of 12.06 years, 3147 incident stroke cases were documented. Compared with the lowest quartile of PM2.5 exposure, the hazard ratio (95% CI) for stroke in the highest quartile group was 2.72 (2.42-3.06). Among individuals at high genetic risk, the relative risk of stroke was 57% (1.57; 1.40-1.76) higher than those at low genetic risk. Although no statistically significant interaction was found, participants with both the highest PM2.5 and high genetic risk showed the highest risk of stroke, with ≈4× that of the lowest PM2.5 and low genetic risk group (hazard ratio, 3.55 [95% CI, 2.84-4.44]). Similar upward gradients were observed in the risk of stroke when assessing the joint effects of PM2.5 and genetic risks of blood pressure, type 2 diabetes, body mass index, atrial fibrillation, and triglyceride. CONCLUSIONS Long-term exposure to PM2.5 was associated with a higher risk of incident stroke across different genetic susceptibilities. Our findings highlighted the great importance of comprehensive assessment of air pollution and genetic risk in the prevention of stroke.
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Affiliation(s)
- Keyong Huang
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Jiajing Jia
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Fengchao Liang
- School of Public Health and Emergency Management (F. Liang), Southern University of Science and Technology, Shenzhen, China
| | - Jianxin Li
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoge Niu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
- Department of Nephrology, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial People's Hospital and People's Hospital of Zhengzhou University, China (X.N.)
| | - Xueli Yang
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, China (X.Y.)
| | - Shufeng Chen
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Cao
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Chong Shen
- Research Units of Cohort Study on Cardiovascular Diseases and Cancers (C.S.), Chinese Academy of Medical Sciences, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, China (C.S.)
| | - Xiaoqing Liu
- Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X. Liu)
| | - Ling Yu
- Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.)
| | - Fanghong Lu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu)
| | - Xianping Wu
- Sichuan Center for Disease Control and Prevention, Chengdu, China (X.W.)
| | - Liancheng Zhao
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Li
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Dongsheng Hu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, China (D.H.)
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, China (D.H.)
| | - Jianfeng Huang
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Liu
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA (Y. Liu)
| | - Dongfeng Gu
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
- School of Medicine (D.G), Southern University of Science and Technology, Shenzhen, China
| | - Fangchao Liu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
| | - Xiangfeng Lu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (K.H., J.J., J.L., X.N., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu)
- Key Laboratory of Cardiovascular Epidemiology (K.H., J.J., J.L., S.C., J.C., L.Z., Y. Li, J.H., D.G., F. Liu, X. Lu), Chinese Academy of Medical Sciences, Beijing, China
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10
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Lv X, Shi W, Yuan K, Zhang Y, Cao W, Li C, Xu L, Wu L, Sun S, Hong F. Hourly Air Pollution Exposure and Emergency Hospital Admissions for Stroke: A Multicenter Case-Crossover Study. Stroke 2023; 54:3038-3045. [PMID: 37901948 DOI: 10.1161/strokeaha.123.044191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Daily exposure to ambient air pollution is associated with stroke morbidity and mortality; however, the association between hourly exposure to air pollutants and risk of emergency hospital admissions for stroke and its subtypes remains relatively unexplored. METHODS We obtained hourly concentrations of fine particulate matter (PM2.5), respirable particulate matter (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO) from the China National Environmental Monitoring Center. We conducted a time-stratified case-crossover study among 86 635 emergency hospital admissions for stroke across 10 hospitals in 3 cities (Jinhua, Hangzhou, and Zhoushan) in Zhejiang province, China, between January 1, 2016 and December 31, 2021. Using a conditional logistic regression combined with a distributed lag linear model, we estimated the association between hourly exposure to multiple air pollutants and risk of emergency hospital admissions for total stroke, ischemic stroke, hemorrhagic stroke, and undetermined type. RESULTS Hourly exposure to PM2.5, PM10, NO2, and SO2 was associated with an increased risk of hospital admissions for total stroke and ischemic stroke. The associations were most pronounced during the concurrent hour of exposure and lasted for ≈2 hours. We found that the risk was more pronounced among male patients or those aged <65 years old. CONCLUSIONS Our findings suggest that exposure to PM2.5, PM10, NO2, and SO2, but not CO and O3, is associated with emergency hospital admissions for total stroke or ischemic stroke shortly after exposure. Implementing targeted pollution emission reduction measures may have significant public health implications in controlling and reducing the burden of stroke.
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Affiliation(s)
- Xin Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China (X.L., W.S., K.Y., Y.Z., S.S.)
| | - Wanying Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China (X.L., W.S., K.Y., Y.Z., S.S.)
| | - Kun Yuan
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China (X.L., W.S., K.Y., Y.Z., S.S.)
| | - Yangchang Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China (X.L., W.S., K.Y., Y.Z., S.S.)
| | - Wangnan Cao
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China (W.C.)
| | - Chunrong Li
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China (C.L.)
| | - Lufei Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Human Resources, Peking University Cancer Hospital and Institute, China (L.X.)
| | - Lizhi Wu
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China (L.W.)
| | - Shengzhi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China (X.L., W.S., K.Y., Y.Z., S.S.)
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China (S.S., F.H.)
| | - Feng Hong
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China (S.S., F.H.)
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11
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Wang Y, Mahdieh DY, Wei Y, Schwartz J. Long-Term Exposure to Air Pollution Below Regulatory Standards and Cardiovascular Diseases Among US Medicare Beneficiaries: A Double Negative Control Approach. RESEARCH SQUARE 2023:rs.3.rs-3530201. [PMID: 38045234 PMCID: PMC10690329 DOI: 10.21203/rs.3.rs-3530201/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Growing evidence suggests that long-term air pollution exposure is a risk factor for cardiovascular mortality and morbidity. However, few studies have investigated air pollution below current regulatory limits, and causal evidence is limited. We used a double negative control approach to examine the association between long-term exposure to air pollution at low concentrations and three major cardiovascular events among Medicare beneficiaries aged ≥ 65 years across the contiguous United States between 2000 and 2016. We derived ZIP code-level estimates of ambient fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ), and warm-season ozone (O 3 ) from high-resolution spatiotemporal models. The outcomes of interest were hospitalizations for stroke, heart failure (HF), and atrial fibrillation and flutter (AF). The analyses were restricted to areas with consistently low pollutant levels on an annual basis (PM 2.5 <10 µg/m³, NO 2 < 45 or 40 ppb, warm-season O 3 < 45 or 40 ppb). For each 1 µg/m 3 increase in PM 2.5 , the hospitalization rates increased by 2.25% (95% confidence interval (CI): 1.96%, 2.54%) for stroke and 3.14% (95% CI: 2.80%, 3.94%) for HF. Each ppb increase in NO 2 increased hospitalization rates for stroke, HF, and AF by 0.28% (95% CI: 0.25%, 0.31%), 0.56% (95% CI: 0.52%, 0.60%), and 0.45% (95% CI: 0.41%, 0.49%), respectively. For each ppb increase in warm-season O 3 , there was a 0.32% (95% CI: 0.21%, 0.44%) increase in hospitalization rate for stroke. The associations for NO 2 and warm-season O 3 became stronger under a more restrictive upper threshold. Using an approach robust to omitted confounders, we concluded that long-term exposure to low-level PM 2.5 , NO 2 , and warm-season O 3 was associated with increased risks of cardiovascular diseases in the US elderly. Stricter national air quality standards should be considered.
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12
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Ranta A, Ozturk S, Wasay M, Giroud M, Béjot Y, Reis J. Environmental factors and stroke: Risk and prevention. J Neurol Sci 2023; 454:120860. [PMID: 37944211 DOI: 10.1016/j.jns.2023.120860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/01/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
Stroke is a leading cause of death and adult disability globally. In addition to traditional risk factors, environmental risk factors have emerged over the recent past and are becoming increasingly important. The disproportionate rise of stroke incidence in low- and middle-income countries has been attributed, at least in part, to environmental factors. This narrative review provides details on the interplay between the environment and health generally and stroke specifically, covering topics including air pollution, atmospheric brown clouds, desert dust storms, giant wildfires, chemical contamination, biological aggressors, urbanization, and climate change. It also covers some beneficial environmental effects such as can be harnessed from the exposure to green spaces. It concludes with a summary of pragmatic actions that can be taken to help address some of these challenges at individual, community, and political advocacy levels.
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Affiliation(s)
- Annemarei Ranta
- Department of Medicine, University of Otago, Wellington, New Zealand; Department of Neurology, Wellington Hospital, Wellington, New Zealand.
| | - Serefnur Ozturk
- Department of Neurology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Mohammad Wasay
- Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Maurice Giroud
- Department of Neurology, University Hospital of Dijon, France; Dijon Stroke Registry, Pathophysiology and Epidemiology of cerebrocardiovascular diseases (EA7460), University of Bourgogne, Dijon, France.
| | - Yannick Béjot
- Department of Neurology, University Hospital of Dijon, France; Dijon Stroke Registry, Pathophysiology and Epidemiology of cerebrocardiovascular diseases (EA7460), University of Bourgogne, Dijon, France.
| | - Jacques Reis
- Faculty of Medicine, University of Strasbourg, Strasbourg, France
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13
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Nizeyimana E, Hanyurwimfura D, Hwang J, Nsenga J, Regassa D. Prototype of Monitoring Transportation Pollution Spikes through the Internet of Things Edge Networks. SENSORS (BASEL, SWITZERLAND) 2023; 23:8941. [PMID: 37960640 PMCID: PMC10647557 DOI: 10.3390/s23218941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023]
Abstract
Air pollution is a critical problem in densely populated urban areas, with traffic significantly contributing. To mitigate the adverse effects of air pollution on public health and the environment, there is a growing need for the real-time monitoring and detection of pollution spikes in transportation. This paper presents a novel approach to using Internet of Things (IoT) edge networks for the real-time detection of air pollution peaks in transportation, specifically designed for innovative city applications. The proposed system uses IoT sensors in buses, cabs, and private cars. These sensors are equipped with air quality monitoring capabilities, including the measurement of pollutants such as particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), ozone (O3), sulfur dioxide (SO2), and carbon dioxide (CO2). The sensors continuously collect air quality data and transmit them to edge devices within the transportation infrastructure. The data collected by these sensors are analyzed, and alerts are generated when pollution levels exceed predefined thresholds. By deploying this system within IoT edge networks, transportation authorities can promptly respond to pollution spikes, improving air quality, public health, and environmental sustainability. This paper details the sensor technology, data analysis methods, and the practical implementation of this innovative system, shedding light on its potential for addressing the pressing issue of transportation-related pollution. The proposed IoT edge network for real-time air pollution spike detection in transportation offers significant advantages, including low-latency data processing, scalability, and cost-effectiveness. By leveraging the power of edge computing and IoT technologies, smart cities can proactively monitor and manage air pollution, leading to healthier and more sustainable urban environments.
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Affiliation(s)
- Eric Nizeyimana
- Africa Centre of Excellence in Internet of Things (ACEIoT), University of Rwanda (UR), Kigali P.O. Box 3900, Rwanda; (D.H.); (J.N.)
- Global R&D Center (GRC), Seoul National University, Seoul 08826, Republic of Korea;
| | - Damien Hanyurwimfura
- Africa Centre of Excellence in Internet of Things (ACEIoT), University of Rwanda (UR), Kigali P.O. Box 3900, Rwanda; (D.H.); (J.N.)
| | - Junseok Hwang
- Global R&D Center (GRC), Seoul National University, Seoul 08826, Republic of Korea;
| | - Jimmy Nsenga
- Africa Centre of Excellence in Internet of Things (ACEIoT), University of Rwanda (UR), Kigali P.O. Box 3900, Rwanda; (D.H.); (J.N.)
| | - Dereje Regassa
- Global R&D Center (GRC), Seoul National University, Seoul 08826, Republic of Korea;
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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.
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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
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15
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Yang M, Yoo H, Kim SY, Kwon O, Nam MW, Pan KH, Kang MY. Occupational Risk Factors for Stroke: A Comprehensive Review. J Stroke 2023; 25:327-337. [PMID: 37813670 PMCID: PMC10574301 DOI: 10.5853/jos.2023.01011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 10/11/2023] Open
Abstract
For primary prevention, it is important for public health and clinical medicine to identify and characterize modifiable risk factors of stroke. In existing literature, the impact of occupational variables on ischemic and hemorrhagic stroke has been extensively studied. This review summarizes the available data on the significance of occupational variables in stroke. The results of this review suggest that there is sufficient evidence for the relationship between increased risk of stroke and job stress, working in extreme temperatures, long working hours, and/or shift work. The association between long working hours and occupational exposure to noise and chemicals remains inconclusive although several studies have reported this finding. This review will act as a step toward future research and provide information that may serve as a baseline for developing targeted interventions to prevent stroke in the working population.
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Affiliation(s)
- Munyoung Yang
- Department of Occupational and Environmental Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyoungseob Yoo
- Department of Occupational and Environmental Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seo-Young Kim
- Department of Occupational and Environmental Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ohwi Kwon
- Department of Occupational and Environmental Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Woo Nam
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Kwang Hyun Pan
- Department of Neurology, Anam Hospital, Korea University, Seoul, Korea
| | - Mo-Yeol Kang
- Department of Occupational and Environmental Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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16
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Mendoza-Cano O, Trujillo X, Huerta M, Ríos-Silva M, Lugo-Radillo A, Bricio-Barrios JA, Rueda-Abad JC, Pérez-Rodríguez RY, Quintanilla-Montoya AL, Uribe-Ramos JM, Mendoza-Olivo VA, Murillo-Zamora E. Assessing the relationship between energy-related methane emissions and the burden of cardiovascular diseases: a cross-sectional study of 73 countries. Sci Rep 2023; 13:13515. [PMID: 37598225 PMCID: PMC10439906 DOI: 10.1038/s41598-023-40444-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023] Open
Abstract
The energy industry significantly contributes to anthropogenic methane emissions, which add to global warming and have been linked to an increased risk of cardiovascular diseases (CVD). This study aims to evaluate the relationship between energy-related methane emissions and the burden of CVD, measured in disability-adjusted life years (DALYs), in 2019. We conducted a cross-sectional analysis of datasets from 73 countries across all continents. The analyzed datasets included information from 2019 on environmental energy-related methane emissions, burden of DALYs due to CVD. The age-standardized prevalence of obesity in adults and life expectancy at birth were retrieved. The relationship between the variables of interest was evaluated using multiple linear regression models. In the multiple model, we observed a positive linear association between methane emissions and the log-transformed count of DALYs related to CVD. Specifically, for each unit increase in energy-related methane emissions, the burden of CVD increased by 0.06% (95% CI 0.03-0.09%, p < 0.001). The study suggests that reducing methane emissions from the energy industry could improve public health for those at risk of CVD. Policymakers can use these findings to develop strategies to reduce methane emissions and protect public health.
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Affiliation(s)
- Oliver Mendoza-Cano
- Faculty of Civil Engineering, University of Colima, km. 9 Colima-Coquimatlán Highway, 28400, Coquimatlán, Colima, Mexico
| | - Xóchitl Trujillo
- University Center for Biomedical Research, University of Colima, 25 de Julio Avenue 965, 28045, Colima, Colima, Mexico
| | - Miguel Huerta
- University Center for Biomedical Research, University of Colima, 25 de Julio Avenue 965, 28045, Colima, Colima, Mexico
| | - Mónica Ríos-Silva
- CONAHCyT-University of Colima, University Center for Biomedical Research, 25 de Julio Avenue 965, 28045, Colima, Colima, Mexico
| | - Agustin Lugo-Radillo
- CONAHCyT - Faculty of Medicine and Surgery, Universidad Autónoma Benito Juárez de Oaxaca, Ex Hacienda de Aguilera S/N, Carr. a San Felipe del Agua, 68020, Oaxaca, Oaxaca, Mexico
| | | | - José Clemente Rueda-Abad
- Climate Change Research Program, National Autonomous University of Mexico, Scientific Research S/N, University City, 04510, Mexico City, Mexico
| | - Rebeca Yasmín Pérez-Rodríguez
- Division of Natural and Exact Sciences, Department of Chemistry, University of Guanajuato, Noria Alta Unit, Col. Noria Alta S/N, 36050, Guanajuato, Guanajuato, Mexico
| | - Ana Luz Quintanilla-Montoya
- Faculty of Civil Engineering, University of Colima, km. 9 Colima-Coquimatlán Highway, 28400, Coquimatlán, Colima, Mexico
| | - Juan Manuel Uribe-Ramos
- Faculty of Civil Engineering, University of Colima, km. 9 Colima-Coquimatlán Highway, 28400, Coquimatlán, Colima, Mexico
| | | | - Efrén Murillo-Zamora
- Unit of Clinical Epidemiology Research, Mexican Institute of Social Security, Lapislázuli Avenue 250, 28984, Villa de Álvarez, Colima, Mexico.
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17
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Zhao G, Zhang F, Zhong Y, Zhang Y, Zhang X, Zhu S, Zhang X, Li T, Zhu W, Li D. Independent and interactive effects of ozone and thermal inversion exposure on the risk of gestational diabetes mellitus in Wuhan, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:91315-91323. [PMID: 37477814 DOI: 10.1007/s11356-023-28855-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023]
Abstract
The adverse effects of exposure to thermal inversion (TI) and ozone (O3) on human health have been reported; however, there are few studies have explored the independent and potential interactive effects of them on gestational diabetes mellitus (GDM). A total of 31,262 pregnant women from the Wuhan Children's Hospital covering the period from 2017 to 2021 were included in this study. The logistic regression adjusted for the covariates was applied to explore the independent effect of exposure to O3 and TI on GDM. The relative excess risk due to the interaction (RERI) analysis was applied to assess the possible interactive effect. Per 10 μg/m3 increased in O3 (OR = 1.069, 95% CI: 1.049, 1.089) during the first trimester and per 10 days increased in TI (OR = 1.041, 95% CI: 1.005, 1.080) in the second trimester were significantly associated with the risk of GDM. The synergistic effect of exposure to TI and O3 was larger than their sum effect (RERI = 0.330, 95% CI: 0.170, 0.476). This study added further support for public health-related policy to improve maternal health by curbing TI and O3.
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Affiliation(s)
- Gaichan Zhao
- Department of Obstetrics and Gynecology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
- Yuhua District Center for Disease Control and Prevebtion, Shijiazhuang, 050021, China
| | - Faxue Zhang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Yuanyuan Zhong
- Department of Obstetrics and Gynecology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Yan Zhang
- Department of Obstetrics and Gynecology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Xupeng Zhang
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Shijie Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Xiaowei Zhang
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Tianzhou Li
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Wei Zhu
- Department of Obstetrics and Gynecology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China.
| | - Dejia Li
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
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