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Lin W, Pan J, Li J, Zhou X, Liu X. Short-Term Exposure to Air Pollution and the Incidence and Mortality of Stroke: A Meta-Analysis. Neurologist 2024; 29:179-187. [PMID: 38048541 DOI: 10.1097/nrl.0000000000000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND The relationship between short-term exposure to various air pollutants [particulate matter <10 μm (PM 10 ), particulate matter <2.5 μm (PM 2.5 ), nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ), carbon monoxide, and ozone (O 3 )] and the incidence and mortality of stroke remain unclear. REVIEW SUMMARY We conducted a comprehensive search across databases, including PubMed, Web of Science, and others. A random-effects model was employed to estimate the odds ratios (OR) and their 95% CIs. Short-term exposure to PM 10 , PM 2.5 , NO 2 , SO 2 , and O 3 was associated with increased stroke incidence [per 10 μg/m 3 increase in PM 2.5 : OR = 1.005 (95% CI: 1.004-1.007), per 10 μg/m 3 increase in PM 10 : OR = 1.006 (95% CI: 1.004-1.009), per 10 μg/m 3 increase in SO 2 : OR = 1.034 (95% CI: 1.020-1.048), per 10 μg/m 3 increase in NO 2 : OR = 1.029 (95% CI: 1.015-1.043), and O 3 for per 10 μg/m 3 increase: OR: 1.006 (95% CI: 1.004-1.007)]. In addition, short-term exposure to PM 2.5 , PM 10 , SO 2, and NO 2 was correlated with increased mortality from stroke [per 10 μg/m 3 increase in PM 2.5 : OR = 1.010 (95% CI: 1.006-1.013), per 10 μg/m 3 increase in PM 10 : OR = 1.004 (95% CI: 1.003-1.006), per 10 μg/m 3 increase in SO 2 : OR = 1.013 (95% CI: 1.007-1.019) and per 10 μg/m 3 increase in NO 2 : OR = 1.012 (95% CI: 1.008-1.015)]. CONCLUSION Reducing outdoor air pollutant levels may yield a favorable outcome in reducing the incidence and mortality associated with strokes.
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Affiliation(s)
- Wenjian Lin
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine
- Tongji University School of Medicine, Shanghai, China
| | - Jie Pan
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine
| | - Jiahe Li
- Tongji University School of Medicine, Shanghai, China
| | - Xiaoyu Zhou
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine
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Sterpetti AV, Marzo LD, Sapienza P, Borrelli V, Cutti S, Bozzani A. Reduced atmospheric levels of PM2.5 and decreased admissions and surgery for Ischemic stroke in Italy. J Stroke Cerebrovasc Dis 2024; 33:107504. [PMID: 38057204 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107504] [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: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023] Open
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Oktay MM, Al B, Boğan M, Kul S, Gümüşboğa H, Bayram H. Impact of desert dust storms, PM 10 levels and daily temperature on mortality and emergency department visits due to stroke. Front Public Health 2023; 11:1218942. [PMID: 37780446 PMCID: PMC10540066 DOI: 10.3389/fpubh.2023.1218942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023] Open
Abstract
Objective It is known that the inhalation of air pollutants adversely affects human health. These air pollutants originated from natural sources such as desert storms or human activities including traffic, power generating, domestic heating, etc. This study aimed to investigate the impacts of desert dust storms, particulate matter ≤10 μm (PM10) and daily maximum temperature (MT) on mortality and emergency department (ED) visits due to stroke in the city of Gaziantep, Southeast Turkey. Method The data on mortality and ED visits due to stroke were retrospectively recruited from January 1, 2009, to March 31, 2014, in Gaziantep City Centre. Results PM10 levels did not affect ED visits or mortality due to stroke; however, MT increased both ED visits [adjusted odds ratio (OR) = 1.002, 95% confidence interval (CI) = 1.001-1.003] and mortality (OR = 1.006, 95% CI = 0.997-1.014) due to stroke in women. The presence of desert storms increased ED visits due to stroke in the total population (OR = 1.219, 95% CI = 1.199-1.240), and all subgroups. It was observed that desert dust storms did not have an increasing effect on mortality. Conclusion Our findings suggest that MT and desert dust storms can induce morbidity and mortality due to stroke.
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Affiliation(s)
- M. Murat Oktay
- Emergency Department, School of Medicine, Gaziantep Islam Science and Technology University, Gaziantep, Türkiye
- Department of Emergency Medicine, School of Medicine, Gaziantep University, Gaziantep, Türkiye
| | - Behcet Al
- Department of Emergency Medicine, School of Medicine, Gaziantep University, Gaziantep, Türkiye
- Emergency Department, School of Medicine, Istanbul Medeniyet University, Istanbul, Türkiye
| | - Mustafa Boğan
- Department of Emergency Medicine, School of Medicine, Gaziantep University, Gaziantep, Türkiye
- Emergency Department, School of Medicine, Düzce University, Düzce, Türkiye
| | - Seval Kul
- Biostatistics Department, School of Medicine, Gaziantep University, Gaziantep, Türkiye
| | - Hasan Gümüşboğa
- Department of Emergency Medicine, School of Medicine, Gaziantep University, Gaziantep, Türkiye
- Emergency Department, Şehitkamil State Hospital, Gaziantep, Türkiye
| | - Hasan Bayram
- Department of Pulmonary Medicine, School of Medicine, Koç University, Istanbul, Türkiye
- Department of Pulmonary Medicine, School of Medicine, Gaziantep University, Gaziantep, Türkiye
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Wang P, Feng W, Luo S, Cheng S, Gong M, Li Y, Liu Y. Cleaner outdoor air diminishes the overall risk of intracerebral hemorrhage but brings differential benefits to subpopulations: a time-stratified case-crossover study. BMC Public Health 2023; 23:1303. [PMID: 37420171 PMCID: PMC10327021 DOI: 10.1186/s12889-023-16232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 07/02/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Short-term air pollution exposure and intracerebral hemorrhage (ICH) risk are related. However, the impact of the pollutant levels decline on this relationship, which attributes to clean air policy implementation and the COVID-19 pandemic lockdown, is unclear. In the present research, we explored the influence of different pollutant levels on ICH risk during eight years in a southwestern China megacity. METHODS Our research used a time-stratified case-crossover design. We retrospectively analyzed ICH patients in a teaching hospital from January 1, 2014, to December 31, 2021, and divided 1571 eligible cases into two groups (1st group: 2014-2017; 2nd group: 2018-2021). We observed the trend of every pollutant in the entire study period and compared the pollution levels in each group, using air pollutants data (PM2.5, PM10, SO2, NO2, CO, and O3) documented by the local government. We further established a single pollutant model via conditional logistic regression to analyze the association between short-term air pollutants exposure and ICH risk. We also discussed the association of pollution levels and ICH risk in subpopulations according to individual factors and monthly mean temperature. RESULTS We found that five air pollutants (PM2.5, PM10, SO2, NO2, CO) exhibited a continuous downward trend for the whole duration, and the daily concentration of all six pollutants decreased significantly in 2018-2021 compared with 2014-2017. Overall, the elevation of daily PM2.5, SO2, and CO was associated with increased ICH risk in the first group and was not positively associated with risk escalation in the second group. For patients in subgroups, the changes in the influence of lower pollutant levels on ICH risk were diverse. In the second group, for instance, PM2.5 and PM10 were associated with lower ICH risk in non-hypertension, smoking, and alcohol-drinking participants; however, SO2 had associations with increased ICH risk for smokers, and O3 had associations with raised risk in men, non-drinking, warm month population. CONCLUSIONS Our study suggests that decreased pollution levels diminish the adverse effects of short-term air pollutants exposure and ICH risk in general. Nevertheless, the influence of lower air pollutants on ICH risk in subgroups is heterogeneous, indicating unequal benefits among subpopulations.
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Affiliation(s)
- Peng Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurosurgery, Cancer Prevention and Treatment Institute of Chengdu, Chengdu Fifth People's Hospital (The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Wentao Feng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Shuang Luo
- Department of Neurosurgery, Cancer Prevention and Treatment Institute of Chengdu, Chengdu Fifth People's Hospital (The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Shuwen Cheng
- Department of Neurosurgery, Cancer Prevention and Treatment Institute of Chengdu, Chengdu Fifth People's Hospital (The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Min Gong
- Department of Neurosurgery, Cancer Prevention and Treatment Institute of Chengdu, Chengdu Fifth People's Hospital (The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Yaxin Li
- West China Fourth Hospital/West China School of Public Health, Sichuan University, Chengdu, China
| | - Yanhui Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
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Song J, Lim Y, Ko I, Kim JY, Kim DK. Association between Air Pollutants and Initial Hospital Admission for Ischemic Stroke in Korea from 2002 to 2013. J Stroke Cerebrovasc Dis 2021; 30:106080. [PMID: 34496310 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES There is limited information regarding the association between air pollution exposure and stroke incidence. Therefore, this study aimed to assess the associations between short-term exposure to ambient air pollutants and initial hospital admission for ischemic stroke. MATERIALS AND METHODS From the Korea National Health Insurance Service-National Sample Cohort 2002-2013 database in South Korea, 55,852 first hospital admissions for ischemic stroke were identified. A generalized additive Poisson model was used to explore the association between air pollutants, including particulate matter, sulfur dioxide, nitrogen dioxide, and carbon monoxide and admissions for ischemic stroke. RESULTS All air pollutant models showed significant associations with ischemic stroke in the single lag model. In all air pollutant models excluding particulate matter 10 μm, a significant association was found between nitrogen dioxide exposure and initial admission for ischemic stroke after adjusting for other pollutants. An increment of 10 μg/m3 in nitrogen dioxide concentration at lag 0 and 14 days corresponded to a 0.259% (95% confidence interval, 0.231-0.287%) and 0.110% (95% confidence interval, 0.097-0.124) increase in initial admission for ischemic stroke, respectively. CONCLUSIONS The exposure-response relationship between nitrogen dioxide and initial admissions for ischemic stroke was approximately linear, with a sharper response at higher concentrations. Short-term exposure to nitrogen dioxide was positively associated with initial hospital admission for ischemic stroke.
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Affiliation(s)
- Jihye Song
- Department of Neurosurgery, Ajou College of Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Yong Lim
- Department of Neurosurgery, Ajou College of Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Inseok Ko
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Jong-Yeup Kim
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea; Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University, Daejeon, Republic of Korea.
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea; Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea.
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Li K, Wang L, Feng M. Relationship between built environments and risks of ischemic stroke based on meteorological factors: A case study of Wuhan's main urban area. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 769:144331. [PMID: 33736230 DOI: 10.1016/j.scitotenv.2020.144331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/14/2020] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
Ischemic stroke is one of the most common causes of death worldwide, and uncomfortable meteorological and built environments may increase its risk. Residents in different built environments are exposed to different risks of ischemic stroke in cold and hot weather. By using the data from 3547 patients hospitalized, a distributed lag non-linear model was established to compare the differences in the risk of ischemic stroke in urban areas with respect to different Building Height, Building Density, Normalized Differential Vegetation Index, and Distance to Water under the meteorological condition. The results showed that lower Building Height is related to the negative cold effects in winter, and higher Building Height is related to increased risks at high temperatures. Built environments with Building Heights of 10-15 m in hot weather and above 15 m in cold weather have low risks. Higher Building Density was found to be associated with reduced negative cold effects; however, the negative hot effects increased in summer. Built environments with a Building Density of more than 0.3 showed low risks, regardless of the weather conditions. Increasing NDVI seemed to mitigate negative effects in uncomfortable weather, and built environments with higher NDVI were found to be associated with lower risks of ischemic stroke. Built environments with shorter Distance to Water seemed to pose higher risks in summer, and longer Distance to Water was correlated with higher risks in winter. Built environments with Distance to Water in the range of 0.65-2.30 km showed low risks. The research results could have some implications for urban planners to form reasonable built environments under certain meteorological factors which can be beneficial for the mitigation of incidence of ischemic stroke.
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Affiliation(s)
- Kun Li
- School of Urban Design, Wuhan University, Wuhan, China.
| | - Lantao Wang
- School of Urban Design, Wuhan University, Wuhan, China.
| | - Maohui Feng
- Zhongnan Hospital of Wuhan University, Wuhan, China.
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Kuzmenko NV, Galagudza MM. Dependence of seasonal dynamics of hemorrhagic and ischemic strokes on the climate of a region: A meta-analysis. Int J Stroke 2021; 17:226-235. [PMID: 33724111 DOI: 10.1177/17474930211006296] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cardiovascular events occur more often in winter than in summer; however, the dependence of strokes on various meteorological factors remains unclear. AIMS The purpose of this meta-analysis was to determine the dependence of the circannual dynamics of hospitalizations for hemorrhagic stroke and ischemic stroke on seasonal fluctuations in meteorological factors. SUMMARY OF REVIEW AND CONCLUSIONS For our meta-analysis, we selected 20 and 26 publications examining the seasonal dynamics of hemorrhagic stroke and ischemic stroke, respectively . The meta-analysis showed that hemorrhagic stroke is less likely to occur in summer than in other seasons and does not depend on a region's climate. The seasonal dynamics of ischemic stroke are not clearly expressed and are determined by the characteristics of a region's climate. In a climate without pronounced seasonal dynamics of atmospheric pressure and in wet winters, the vector of ischemic stroke incidents will not be expressed or slightly shifted toward winter. Low atmospheric pressure in summer is associated with an increased likelihood of ischemic stroke during this season compared to winter. There was also a relation between ischemic stroke risk with high relative humidity and a significant decrease in ρO2 in summer, but there is not enough evidence regarding this association. We did not reveal dependence of the seasonal dynamics of strokes on the amplitude of annual fluctuations in air temperature.
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Affiliation(s)
- N V Kuzmenko
- Department for Experimental Physiology and Pharmacology, 123488Almazov National Medical Research Centre, St. Petersburg, Russia.,Laboratory of Biophysics of Blood Circulation, First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia
| | - M M Galagudza
- Department for Experimental Physiology and Pharmacology, 123488Almazov National Medical Research Centre, St. Petersburg, Russia
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Association between exposure to ambient air pollution and hospital admission, incidence, and mortality of stroke: an updated systematic review and meta-analysis of more than 23 million participants. Environ Health Prev Med 2021; 26:15. [PMID: 33499804 PMCID: PMC7839211 DOI: 10.1186/s12199-021-00937-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/10/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Previous studies have suggested that exposure to air pollution may increase stroke risk, but the results remain inconsistent. Evidence of more recent studies is highly warranted, especially gas air pollutants. METHODS We searched PubMed, Embase, and Web of Science to identify studies till February 2020 and conducted a meta-analysis on the association between air pollution (PM2.5, particulate matter with aerodynamic diameter less than 2.5 μm; PM10, particulate matter with aerodynamic diameter less than 10 μm; NO2, nitrogen dioxide; SO2, sulfur dioxide; CO, carbon monoxide; O3, ozone) and stroke (hospital admission, incidence, and mortality). Fixed- or random-effects model was used to calculate pooled odds ratios (OR)/hazard ratio (HR) and their 95% confidence intervals (CI) for a 10 μg/m3 increase in air pollutant concentration. RESULTS A total of 68 studies conducted from more than 23 million participants were included in our meta-analysis. Meta-analyses showed significant associations of all six air pollutants and stroke hospital admission (e.g., PM2.5: OR = 1.008 (95% CI 1.005, 1.011); NO2: OR = 1.023 (95% CI 1.015, 1.030), per 10 μg/m3 increases in air pollutant concentration). Exposure to PM2.5, SO2, and NO2 was associated with increased risks of stroke incidence (PM2.5: HR = 1.048 (95% CI 1.020, 1.076); SO2: HR = 1.002 (95% CI 1.000, 1.003); NO2: HR = 1.002 (95% CI 1.000, 1.003), respectively). However, no significant differences were found in associations of PM10, CO, O3, and stroke incidence. Except for CO and O3, we found that higher level of air pollution (PM2.5, PM10, SO2, and NO2) exposure was associated with higher stroke mortality (e.g., PM10: OR = 1.006 (95% CI 1.003, 1.010), SO2: OR = 1.006 (95% CI 1.005, 1.008). CONCLUSIONS Exposure to air pollution was positively associated with an increased risk of stroke hospital admission (PM2.5, PM10, SO2, NO2, CO, and O3), incidence (PM2.5, SO2, and NO2), and mortality (PM2.5, PM10, SO2, and NO2). Our study would provide a more comprehensive evidence of air pollution and stroke, especially SO2 and NO2.
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Qi X, Wang Z, Guo X, Xia X, Xue J, Jiang G, Gu Y, Han S, Yao Q, Cai Z, Wang X, Wang L, Leng SX, Li X. Short-term effects of outdoor air pollution on acute ischaemic stroke occurrence: a case-crossover study in Tianjin, China. Occup Environ Med 2020; 77:862-867. [PMID: 32855345 PMCID: PMC7677458 DOI: 10.1136/oemed-2019-106301] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 07/07/2020] [Accepted: 08/02/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Ambient air pollution is associated with ischaemic stroke incidence. However, most of the previous studies used stroke-related hospital admission rather than stroke onset itself. This study aimed to evaluate the relationship between ambient air pollutant exposures and acute ischaemic stroke based on the timing of symptom onset. METHODS A time-stratified, case-crossover analysis was performed among 520 patients who had ischaemic stroke admitted to the Second Hospital of Tianjin Medical University (Tianjin, China) between 1 April 2018 and 31 March 2019 (365 days). Daily air pollutant concentrations of particulate matter with aerodynamic diameter 2.5 µm, particulate matter with aerodynamic diameter 10 µm (PM10), sulfur dioxide, nitrogen dioxide, carbon monoxide and ozone were obtained from fixed-site monitoring stations. We used conditional logistic regression to estimate OR and 95% CI corresponding to an increase in IQR of each air pollutant after adjusting for the effects of temperature and relative humidity. RESULTS Overall, a higher risk of ischaemic stroke was found between April and September. During this period PM10 was associated with an increased risk of ischaemic stroke (1-day lag: OR=1.49, 95% CI 1.09 to 2.02; 3-day mean: OR=1.58, 95% CI 1.09 to 2.29) among patients between 34 and 70 years old. Positive associations were also observed between PM10 (1-day lag: OR=1.51, 95% CI 1.10 to 2.07; 3-day mean: OR=1.57, 95% CI 1.08 to 2.29), ozone (1-day lag: OR=1.83, 95% CI 1.16 to 2.87; 3-day mean: OR=1.90, 95% CI 1.06 to 3.42) and ischaemic stroke occurrence among those with hyperlipidaemia. CONCLUSION Our results suggest that air pollution is associated with a higher risk of ischaemic stroke in younger people or people with hyperlipidemia. These findings still need to be further investigated.
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Affiliation(s)
- Xuemei Qi
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhongyan Wang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaokun Guo
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Juanjuan Xue
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guojing Jiang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yumeng Gu
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Suqin Han
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research (CLAER/CMA-NKU), Tianjin Environmental Meteorology Center, Tianjin, China
| | - Qing Yao
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research (CLAER/CMA-NKU), Tianjin Environmental Meteorology Center, Tianjin, China
| | - Ziying Cai
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research (CLAER/CMA-NKU), Tianjin Environmental Meteorology Center, Tianjin, China
| | - Xiaojia Wang
- CMA-NKU Cooperative Laboratory for Atmospheric Environment-Health Research (CLAER/CMA-NKU), Tianjin Environmental Meteorology Center, Tianjin, China
| | - Lin Wang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Sean X Leng
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
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Byrne CP, Bennett KE, Hickey A, Kavanagh P, Broderick B, O’Mahony M, Williams DJ. Short-Term Air Pollution as a Risk for Stroke Admission: A Time-Series Analysis. Cerebrovasc Dis 2020; 49:404-411. [DOI: 10.1159/000510080] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/12/2020] [Indexed: 11/19/2022] Open
Abstract
Background: The harmful effects of outdoor air pollution on stroke incidence are becoming increasingly recognised. We examined the impact of different air pollutants (PM2.5, PM10, NO2, ozone, and SO2) on admission for all strokes in two Irish urban centres from 2013 to 2017. Methods: Using an ecological time series design with Poisson regression models, we analysed daily hospitalisation for all strokes and ischaemic stroke by residence in Dublin or Cork, with air pollution level monitoring data with a lag of 0–2 days from exposure. Splines of temperature, relative humidity, day of the week, and time were included as confounders. Analysis was also performed across all four seasons. Data are presented as relative risks (RRs) and 95% confidence intervals (95% CI) per interquartile range (IQR) increase in each pollutant. Results: There was no significant association between all stroke admission and any individual air pollutant. On seasonal analysis, during winter in the larger urban centre (Dublin), we found an association between all stroke cases and an IQR increase in NO2 (RR 1.035, 95% CI: 1.003–1.069), PM10 (RR 1.032, 95% CI: 1.007–1.057), PM2.5 (RR 1.024, 95% CI: 1.011–1.039), and SO2 (RR 1.035, 95% CI: 1.001–1.071). There was no significant association found in the smaller urban area of Cork. On meta-analysis, there remained a significant association between NO2 (RR 1.013, 95% CI: 1.001–1.024) and PM2.5 (1.009, 95% CI 1.004–1.014) per IQR increase in each. Discussion: Short-term air pollution in winter was found to be associated with hospitalisation for all strokes in a large urban centre in Ireland. As Ireland has relatively low air pollution internationally, this highlights the need to introduce policy changes to reduce air pollution in all countries.
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Pothirat C, Chaiwong W, Liwsrisakun C, Bumroongkit C, Deesomchok A, Theerakittikul T, Limsukon A, Tajarernmuang P, Phetsuk N. Acute effects of air pollutants on daily mortality and hospitalizations due to cardiovascular and respiratory diseases. J Thorac Dis 2019; 11:3070-3083. [PMID: 31463136 DOI: 10.21037/jtd.2019.07.37] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Chiang Dao is one of the districts in Chiang Mai, Thailand facing high level of seasonal air pollution every year, the exposure of community dwellers to outdoor air pollutants 24 hours a day during seasonal smog period because of their open-air housing style, and agricultural occupational hazard. In addition, Chiang Dao hospital is the only available hospital serving the community with open-air wards; therefore we could certainly to identify the association between air pollution and mortality of hospitalized patients. Thus, the aim of this study was to determine the association between daily average seasonal air pollutants and daily mortality of hospitalized patients and community dwellers as well as emergency and hospitalization visits for serious respiratory, cardiovascular, and cerebrovascular diseases. Methods This time series study was conducted between 1 March 2016 and 31 March 2017. The association of various air pollutant concentrations including particulate matter diameter less than 10 and 2.5 microns (PM10 and PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3) and daily mortality of hospitalized patients and community dwellers as well as relationship with frequencies of serious respiratory, cardiovascular, and cerebrovascular diseases were analyzed using a general linear model with Poisson distribution. Results Only PM2.5 was found to be associated with increased daily mortality of hospitalized patients (lag day 6, adjusted RR =1.153, 95% CI: 1.001-1.329), whereas PM10, PM2.5, NO2, and O3 were associated with increased daily non-accidental mortality of community dwellers (lag day 0-7, adjusted RR =1.006-1.040, 95% CI: 1.000-1.074). For acute serious respiratory events; PM10 and PM2.5 were associated with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), while SO2, CO, and O3 were associated with emergency visits for community-acquired pneumonia (CAP). O3 was associated with emergency visits for heart failure (HF), NO2 with emergency visits for myocardial infarction (MI), and SO2 with hospitalized visits for cerebrovascular accident (CVA). Conclusions Seasonal air pollutants were found to be associated with higher mortality among hospitalized patients and community dwellers with varying effects on severe acute respiratory, cardiovascular, and cerebrovascular diseases.
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Affiliation(s)
- Chaicharn Pothirat
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Warawut Chaiwong
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chalerm Liwsrisakun
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chaiwat Bumroongkit
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Athavudh Deesomchok
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Theerakorn Theerakittikul
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Atikun Limsukon
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pattraporn Tajarernmuang
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nittaya Phetsuk
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Royé D, Zarrabeitia MT, Riancho J, Santurtún A. A time series analysis of the relationship between apparent temperature, air pollutants and ischemic stroke in Madrid, Spain. ENVIRONMENTAL RESEARCH 2019; 173:349-358. [PMID: 30953949 DOI: 10.1016/j.envres.2019.03.065] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 03/23/2019] [Accepted: 03/25/2019] [Indexed: 05/04/2023]
Abstract
The understanding of the role of environment on the pathogenesis of stroke is gaining importance in the context of climate change. This study analyzes the temporal pattern of ischemic stroke (IS) in Madrid, Spain, during a 13-year period (2001-2013), and the relationship between ischemic stroke (admissions and deaths) incidence and environmental factors on a daily scale by using a quasi-Poisson regression model. To assess potential delayed and non-linear effects of air pollutants and Apparent Temperature (AT), a biometeorological index which represents human thermal comfort on IS, a lag non-linear model was fitted in a generalized additive model. The mortality rate followed a downward trend over the studied period, however admission rates progressively increased. Our results show that both increases and decreases in AT had a marked relationship with IS deaths, while hospital admissions were only associated with low AT. When analyzing the cumulative effects (for lag 0-14 days), with an AT of 1.7 °C (percentile 5%) a RR of 1.20 (95% CI, 1.05-1.37) for IS mortality and a RR of 1.09 (95% CI, 0.91-1.29) for morbidity is estimated. Concerning gender differences, men show higher risks of mortality in low temperatures and women in high temperatures. No significant relationship was found between air pollutant concentrations and IS morbi-mortality, but this result must be interpreted with caution, since there are strong spatial fluctuations of the former between nearby geographical areas that make it difficult to perform correlation analyses.
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Affiliation(s)
- Dominic Royé
- Department of Geography, University of Santiago de Compostela, Santiago de Compostela, Spain; Department of Geography, University of Porto, Porto, Portugal; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - María T Zarrabeitia
- Unit of Legal Medicine, Department of Physiology and Pharmacology, University of Cantabria, Santander, Spain
| | - Javier Riancho
- Department of Neurology, Hospital Sierrallana-Instituto de Investigación Sanitaria (IDIVAL), Centro Investigación Biomédica en Red Enfermedades (CIBERNED), Santander, Spain
| | - Ana Santurtún
- Unit of Legal Medicine, Department of Physiology and Pharmacology, University of Cantabria, Santander, Spain.
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Seasonal variation in the occurrence of ischemic stroke: A meta-analysis. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2019; 41:2113-2130. [PMID: 30848411 DOI: 10.1007/s10653-019-00265-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 02/11/2019] [Indexed: 02/05/2023]
Abstract
Stroke was demonstrated to correlate with seasonal variation. However, the relevant studies were incongruous. To better understand the rules of seasonal impact on ischemic stroke (IS) patients, we performed this meta-analysis. We systematically searched relevant observational studies in Pubmed, Web of science and Embase from January 1, 1980, to November 1, 2017, in English. Patients included in this study were adults who suffered from IS. Stata version 12.0 software was used to pool useful data and calculate incidence rate ratios (IRRs) and their 95% confidence intervals (CIs). We also performed heterogeneity and sensitivity analyses and evaluated publication bias. Thirty-three observational studies involving 234,196 participants were incorporated into the meta-analysis. Summer and December were regarded as reference, respectively. The IRRs were calculated showing: IRRWinter 1.05 (95% CI 1.04-1.07), IRRAutumn 1.03 (95% CI 1.02-1.04), IRRSpring 1.02 (95% CI 1.01-1.03). No obvious difference existed among 12 months. Stratified analyses on Köppen classification were also conducted. Between-study heterogeneity was discovered; however, predefined stratified analyses and meta-regression could not reduce this heterogeneity. Our meta-analysis has revealed very little seasonal variation in the overall study. Both cold and hot months may be high risky for IS after stratified by Köppen Climate Classification. Thus, a rationale to environmental setting of risky patient management could be provided. More studies with specific assessments are warranted for further comprehensive investigation.
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