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Czernych R, Kozera G, Badyda AJ, Bieniaszewski L, Zagożdżon P. Air Pollution Increases Risk of Occurrence of Intracerebral Haemorrhage but Not of Subarachnoid Haemorrhage: Time-Series Cross-Sectional Study. Biomedicines 2024; 12:1562. [PMID: 39062135 DOI: 10.3390/biomedicines12071562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/03/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Haemorrhagic strokes (HS), including intracerebral (ICH) and subarachnoid haemorrhages (SAH), account for approximately 10-15% of strokes worldwide but are associated with worse functional outcomes and higher rates of mortality, and financial burden than ischemic stroke. There is evidence that confirmed poor air quality may increase the incidence of haemorrhagic strokes. The aim of our study was to evaluate the association between individual ambient air pollutants and the risk of haemorrhagic stroke in an urban environment without high levels of air pollution. (2) Methods: A time-series cross-sectional study design was used. A daily air pollution concentration (Agency of Regional Air Quality Monitoring in the Gdansk Metropolitan Area) and incidence of haemorrhagic strokes (National Health Fund) were obtained and covered the time period from 1 January 2014 to 31 December 2018. A generalised additive model with Poisson regression was used to estimate the associations between 24-h mean concentrations of SO2, NO, NO2, NOx, CO, PM10, PM2.5, and O3 and a daily number of haemorrhagic strokes. (3) Results: The single-day lag model results showed that NO2, NO and NOx exposure was associated with increased risk of ICH (88% events) with RR of 1.059 (95% CI: 1.015-1.105 for lag0), 1.033 (95% CI: 1.007-1.060 for lag0) and 1.031 (95% CI: 1.005-1.056 for lag0), but not for SAH (12% events). Exposure to CO was related to a substantial and statistically significant increase in incidence for 1.031 (95% CI: 1.002-1.061 for lag0) but not for SAH. Higher SO2, PM10, PM2.5, and O3 exposures were not significantly related to both ISC and SAH. (4) Conclusions: In this time-series cross-sectional study, we found strong evidence that supports the hypothesis that transient elevations in ambient NO2, NO and CO are associated with a higher relative risk of intracerebral but not subarachnoid haemorrhage.
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Affiliation(s)
- Radosław Czernych
- Department of Hygiene and Epidemiology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Grzegorz Kozera
- Centre of Medical Simulations, Medical University of Gdańsk, 80-204 Gdańsk, Poland
| | - Artur Jerzy Badyda
- Department of Informatics and Environment Quality Research, Faculty of Building Services, Hydro- and Environmental Engineering, Warsaw University of Technology, 01-604 Warsaw, Poland
| | - Leszek Bieniaszewski
- Centre of Medical Simulations, Medical University of Gdańsk, 80-204 Gdańsk, Poland
| | - Paweł Zagożdżon
- Department of Hygiene and Epidemiology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
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Elser H, Kruse CFG, Schwartz BS, Casey JA. The Environment and Headache: a Narrative Review. Curr Environ Health Rep 2024; 11:184-203. [PMID: 38642284 DOI: 10.1007/s40572-024-00449-4] [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] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE OF REVIEW In this narrative review, we summarize the peer-reviewed literature published between 2017 and 2022 that evaluated ambient environmental risk factors for primary headache disorders, which affect more than half of the population globally. Primary headache disorders include migraine, tension-type headache (TTH), and trigeminal and autonomic cephalalgias (TAC). RECENT FINDINGS We identified 17 articles that met the inclusion criteria via PubMed or Google Scholar. Seven studies (41%) relied on data from US populations. The remaining studies were conducted in China, Taiwan, Germany, Ghana, Japan, the Netherlands, South Korea, and Turkey. Air pollution was the most frequently assessed environmental risk factor. Most studies were cross-sectional and focused on all-cause or migraine headaches; one study included TTH, and none included TAC. Short-term exposure to fine particulate matter (PM2.5) was not consistently associated with headache endpoints, but long-term exposure to PM2.5 was associated with migraine headache prevalence and severity across multiple studies. Elevated ambient temperature, changes in weather, oil and gas well exposure, and less natural greenspace, but not noise pollution, were also associated with headache. No studies considered water pollution, metal exposure, ultrafine particulate matter, or wildfire smoke exposure. There is a need for ongoing research focused on headache and the environment. Study designs with the greatest explanatory power may include longitudinal studies that capture the episodic nature of headache and case-crossover analysis, which control for time-invariant individual-level confounders by design. There is also a clear need for research that considers comorbid psychiatric illness and socioeconomic position as powerful modifiers of the effect of the environment on headache.
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Affiliation(s)
- Holly Elser
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Caroline F G Kruse
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Brian S Schwartz
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joan A Casey
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
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Assessment of Low-Level Air Pollution and Cardiovascular Incidence in Gdansk, Poland: Time-Series Cross-Sectional Analysis. J Clin Med 2023; 12:jcm12062206. [PMID: 36983207 PMCID: PMC10054494 DOI: 10.3390/jcm12062206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 03/18/2023] Open
Abstract
(1) Background: More than 1.8 million people in the European Union die every year as a result of CVD, accounting for 36% of all deaths with a large proportion being premature (before the age of 65). There are more than 300 different risk factors of CVD, known and air pollution is one of them. The aim of this study was to investigate whether daily cardiovascular mortality was associated with air pollutants and meteorological conditions in an urban environment with a low level of air pollution. (2) Methods: Data on daily incidence of strokes and myocardial infarctions in the city of Gdansk were obtained from the National Health Fund (NHF) and covered the period from 1 January 2014 to 31 December 2018. Data on the level of pollution, i.e., SO2, NO, NO2, NOx, CO, PM10, PM2.5, CO2, O3 and meteorological conditions came from the foundation: Agency of Regional Air Quality Monitoring in the Gdańsk metropolitan area (ARMAG). Using these data, we calculated mean values with standard deviation (SD) and derived the minimum and maximum values and interquartile range (IQR). Time series regression with Poisson distribution was used in statistical analysis. (4) Results: Stroke incidence is significantly affected by an increase in concentrations of NO, NO2 and NOx with RRs equal to 1.019 (95%CI: 1.001–1.036), 1.036 (95%CI: 1.008–1.064) and 1.017 (95%CI: 1.000–1.034) for every increase in IQR by 14.12, 14.62 and 22.62 μg/m3, respectively. Similarly, myocardial infarction incidence is significantly affected by an increase in concentrations of NO, NO2 and NOx with RRs equal to 1.030 (95%CI: 1.011–1.048), 1.053 (95%CI: 1.024–1.082) and 1.027 (95%CI: 1.010–1.045) for every increase in IQR by 14.12, 14.62 and 22.62 μg/m3, respectively. Both PM10 and PM2.5 were positively associated with myocardial infarction incidence. (5) Conclusions: In this time-series cross-sectional study, we found strong evidence that support the hypothesis that transient elevations in ambient PM2.5, PM10, NO2, SO2 and CO are associated with higher relative risk of ischemic stroke and myocardial infarction incidents.
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Liu J, Wang M, Zhao Y, Chen H, Liu H, Yang B, Shan H, Li H, Shi Y, Wang L, Wang G, Han C. Associations between short-term exposure to ambient PM 2.5 and incident cases of cerebrovascular disease in Yantai, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:21970-21977. [PMID: 36282388 DOI: 10.1007/s11356-022-23626-0] [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: 06/20/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
There are limited studies examining the association between PM2.5 exposure and incident cerebrovascular disease (CD) cases in China. In this study, daily counts of incident CD cases and daily PM2.5 concentrations were obtained in Yantai, Shandong Province, China from 2014 to 2019. We used a combination of the Poisson-distribution generalized linear model (GLM) and a distributed lag nonlinear model (DLNM) to examine the association of short-term exposure to ambient PM2.5 and incident cases of CD. The results revealed that for every 10 μg/m3 increment of PM2.5 would increase the incident CD cases by 0.216% (RR:1.00216, 95%CI:1.0016-1.0028) at lag4. The stratified analysis demonstrated that the females and residents aged 65 years or above presented higher short-term PM2.5-associated CD risks than the males and aged below 65 years. Targeted prevention strategies should be adopted to reduce the PM2.5-related CD burden, especially for the susceptible population in China.
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Affiliation(s)
- Junyan Liu
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Maobo Wang
- Yantai Center for Disease Control and Prevention, Yantai, 264003, Shandong, China
| | - Yang Zhao
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China
| | - Haotian Chen
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Haiyun Liu
- Department of Public Health, Shandong College of Traditional Chinese Medicine, 264199, Yantai, China
| | - Baoshun Yang
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Haifeng Shan
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Hongyu Li
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Yukun Shi
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Luyang Wang
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Guangcheng Wang
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Chunlei Han
- School of Public Health and Management, Binzhou Medical University, Yantai, 264003, Shandong, China.
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Short-term associations between ambient air pollution and emergency department visits for Alzheimer's disease and related dementias. ENVIRONMENTAL EPIDEMIOLOGY (PHILADELPHIA, PA.) 2022; 7:e237. [PMID: 36777523 PMCID: PMC9915954 DOI: 10.1097/ee9.0000000000000237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022]
Abstract
Dementia is a seriously disabling illness with substantial economic and social burdens. Alzheimer's disease and its related dementias (AD/ADRD) constitute about two-thirds of dementias. AD/ADRD patients have a high prevalence of comorbid conditions that are known to be exacerbated by exposure to ambient air pollution. Existing studies mostly focused on the long-term association between air pollution and AD/ADRD morbidity, while very few have investigated short-term associations. This study aims to estimate short-term associations between AD/ADRD emergency department (ED) visits and three common air pollutants: fine particulate matter (PM2.5), nitrogen dioxide (NO2), and warm-season ozone. Methods For the period 2005 to 2015, we analyzed over 7.5 million AD/ADRD ED visits in five US states (California, Missouri, North Carolina, New Jersey, and New York) using a time-stratified case-crossover design with conditional logistic regression. Daily estimated PM2.5, NO2, and warm-season ozone concentrations at 1 km spatial resolution were aggregated to the ZIP code level as exposure. Results The most consistent positive association was found for NO2. Across five states, a 17.1 ppb increase in NO2 concentration over a 4-day period was associated with a 0.61% (95% confidence interval = 0.27%, 0.95%) increase in AD/ADRD ED visits. For PM2.5, a positive association with AD/ADRD ED visits was found only in New York (0.64%, 95% confidence interval = 0.26%, 1.01% per 6.3 µg/m3). Associations with warm-season ozone levels were null. Conclusions Our results suggest AD/ADRD patients are vulnerable to short-term health effects of ambient air pollution and strategies to lower exposure may reduce morbidity.
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Hasegawa K, Tsukahara T, Nomiyama T. Short-term associations of ambient air pollution with hospital admissions for ischemic stroke in 97 Japanese cities. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:78821-78831. [PMID: 35701697 DOI: 10.1007/s11356-022-21206-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
The short-term association between ambient air pollution and hospital admissions for ischemic stroke is not fully understood. We examined the association between four regularly measured major ambient air pollutants, i.e., sulfur dioxide (SO2), nitrogen dioxide (NO2), photochemical oxidants (Ox), and particulate matter with aerodynamic diameters ≤ 2.5 μm (PM2.5), and hospital admissions for ischemic stroke by analyzing 3 years of nationwide claims data from 97 cities in Japan. We first estimated city-specific results by using generalized additive models with a quasi-Poisson regression, and we obtained the national average by combining city-specific results with the use of random-effect models. We identified a total of 335,248 hospital admissions for ischemic stroke during the 3-year period. Our analysis results demonstrated that interquartile range increases in the following four ambient air pollutants were significantly associated with hospital admissions for ischemic stroke on the same day: SO2 (1.05 ppb), 1.05% (95% CI: 0.59-1.50%); NO2 (6.40 ppb), 1.10% (95% CI: 0.61-1.59%); Ox (18.32 ppb), 1.43% (95% CI: 0.81-2.06%); and PM2.5 (7.86 μg/m3), 0.90% (95% CI: 0.35-1.45%). When the data were stratified by the hospital admittees' medication use, we observed stronger associations with SO2, NO2, and PM2.5 among the patients who were taking antihypertensive drugs and weaker associations with SO2, NO2, and Ox among those taking antiplatelet drugs. Short-term exposure to ambient air pollution was associated with increased hospital admissions for ischemic stroke, and medication use and season may modify the association.
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Affiliation(s)
- Kohei Hasegawa
- Department of Preventive Medicine and Public Health, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Teruomi Tsukahara
- Department of Preventive Medicine and Public Health, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
- Department of Occupational Medicine, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tetsuo Nomiyama
- Department of Preventive Medicine and Public Health, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
- Department of Occupational Medicine, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Ma Y, Shen J, Zhang Y, Wang H, Li H, Cheng Y, Guo Y. Short-term effect of ambient ozone pollution on respiratory diseases in western China. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2022; 44:4129-4140. [PMID: 35001229 DOI: 10.1007/s10653-021-01174-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
Ambient air pollution has been regarded as an important cause of the morbidity and mortality of respiratory diseases. In the current work, a total of 469,490 respiratory emergency room (ER) visits in Lanzhou, China from Jan 1, 2013 to Dec 31, 2016 were collected. A generalized additive model (GAM) was used to investigate the association between O3 and respiratory ER visits for the different gender and age subgroups. The results showed that: (a) with per inter-quartile range (IQR) (31 µg/m3) increase in O3, the greatest relative risk (RR) of respiratory ER visits for the total was 1.014 (95% CI 1.008-1.020) at lag 4 days. Females and 16-to-45-year-olds were relatively more sensitive to O3; (b) the significant lag effects were found in single-day lag models, with the highest RR values for different groups were observed at lag 3-lag 5 days. The multi-day cumulative lag effects were stronger for the total; (c) in the multiple-pollutant models, the effects of O3 were generally increased when introducing other pollutants (PM10, PM2.5, SO2 and NO2) for adjustment. This study demonstrated that short-term exposure to O3 increased the RR of respiratory ER visits in Lanzhou, China.
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Affiliation(s)
- Yuxia Ma
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China.
| | - Jiahui Shen
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Yifan Zhang
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Hang Wang
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Heping Li
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Yifan Cheng
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Yongtao Guo
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
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Lin YC, Shih HS, Lai CY. Long-term nonlinear relationship between PM 2.5 and ten leading causes of death. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2022; 44:3967-3990. [PMID: 34773532 DOI: 10.1007/s10653-021-01136-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
Air pollution has become a major concern worldwide. Many epidemiological studies have proved relationships between fine particulate matter (PM2.5) and various diseases, but most studies only use short-term and models for specific groups to derive relationships with acute diseases. This makes it difficult to understand long-term exposure, nonlinear relationships, and spatial-temporal health risks regarding chronic diseases. Therefore, this study proposed to analyze and map PM2.5 exceedance probability from long-term spatial-temporal monitoring data using radial basis function estimation. We then constructed and compared multiple linear regression and generalized additive models to investigate linear and nonlinear relationships between long-term average PM2.5 concentration, PM2.5 potential probability for exceeding the standard, and standardized mortality for the top ten causes of death in all towns and villages in Taiwan nationally from 2010 to 2017. Linear models indicate that increasing PM2.5 concentration increased malignant neoplasm, pneumonia, and chronic lower respiratory disease mortalities; chronic liver diseases; and cirrhosis; whereas heart diseases and esophagus cancer mortality decreased. For the nonlinear model results, it can be found that there were also significant nonlinear relationships between PM2.5 concentration and malignant mortalities for neoplasm, heart disease, diabetes; and trachea, bronchus, lung, liver, intrahepatic bile duct, and esophagus cancer. Thus, long-term exposure to PM2.5 may be a significant risk factor for multiple acute and chronic diseases. Results from this study can be directly applied worldwide to provide air quality and health management references for governments, and important information on long-term health risks for local residents in the study area.
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Affiliation(s)
- Yuan-Chien Lin
- Department of Civil Engineering, National Central University, No. 300, Zhongda Rd., Zhongli District, Taoyuan, 32001, Taiwan.
| | - Hua-San Shih
- Department of Civil Engineering, National Central University, No. 300, Zhongda Rd., Zhongli District, Taoyuan, 32001, Taiwan
| | - Chun-Yeh Lai
- Department of Civil Engineering, National Central University, No. 300, Zhongda Rd., Zhongli District, Taoyuan, 32001, Taiwan
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Ho AFW, Hu Z, Woo TZC, Tan KBK, Lim JH, Woo M, Liu N, Morgan GG, Ong MEH, Aik J. Ambient Air Quality and Emergency Hospital Admissions in Singapore: A Time-Series Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13336. [PMID: 36293917 PMCID: PMC9603816 DOI: 10.3390/ijerph192013336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
Air pollution exposure may increase the demand for emergency healthcare services, particularly in South-East Asia, where the burden of air-pollution-related health impacts is high. This article aims to investigate the association between air quality and emergency hospital admissions in Singapore. Quasi-Poisson regression was applied with a distributed lag non-linear model (DLNM) to assess the short-term associations between air quality variations and all-cause, emergency admissions from a major hospital in Singapore, between 2009 and 2017. Higher concentrations of SO2, PM2.5, PM10, NO2, and CO were positively associated with an increased risk of (i) all-cause, (ii) cardiovascular-related, and (iii) respiratory-related emergency admissions over 7 days. O3 concentration increases were associated with a non-linear decrease in emergency admissions. Females experienced a higher risk of emergency admissions associated with PM2.5, PM10, and CO exposure, and a lower risk of admissions with NO2 exposure, compared to males. The older adults (≥65 years) experienced a higher risk of emergency admissions associated with SO2 and O3 exposure compared to the non-elderly group. We found significant positive associations between respiratory disease- and cardiovascular disease-related emergency hospital admissions and ambient SO2, PM2.5, PM10, NO2, and CO concentrations. Age and gender were identified as effect modifiers of all-cause admissions.
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Affiliation(s)
- Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore 168753, Singapore
- Pre-Hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Zhongxun Hu
- Duke-NUS Medical School, Singapore 169857, Singapore
| | | | - Kenneth Boon Kiat Tan
- Department of Emergency Medicine, Singapore General Hospital, Singapore 168753, Singapore
| | - Jia Hao Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore 168753, Singapore
| | - Maye Woo
- Environmental Quality Monitoring Department, Environmental Monitoring and Modelling Division, National Environment Agency, Singapore 228231, Singapore
| | - Nan Liu
- Duke-NUS Medical School, Singapore 169857, Singapore
| | - Geoffrey G. Morgan
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore 168753, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Joel Aik
- Pre-Hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore 169857, Singapore
- Environmental Epidemiology and Toxicology Division, National Environment Agency, Singapore 228231, Singapore
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Cui M, Zhan C, Wu W, Guo D, Song Y. Acute Gaseous Air Pollution Exposure and Hospitalizations for Acute Ischemic Stroke: A Time-Series Analysis in Tianjin, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013344. [PMID: 36293925 PMCID: PMC9603069 DOI: 10.3390/ijerph192013344] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 05/13/2023]
Abstract
BACKGROUND Stroke has always been an important problem troubling human health. Short-term exposure to air pollutants is associated with increased hospital admissions. The rise of pollutants such as O3 has caused a huge social and economic burden. This study aims to explore the relationship between short-term exposure to ambient gaseous pollutants and daily hospitalizations for ischemic stroke, utilizing a four-year time-series study in Tianjin. METHODS Collecting the data of gaseous pollutants (NO2, SO2, CO, O3), meteorological data (including daily average temperature and relative humidity) and the number of hospitalizations due to ischemic stroke in Tianjin Medical University General Hospital from 2013 to 2016. Poisson regression generalized additive model with single-day and multi-day moving average lag structure was used to estimate adverse effects of gaseous pollutants on daily hospitalizations. Subgroup analysis was performed to detect modification effect by gender and age. RESULTS In total, there were 9081 ischemic stroke hospitalizations. After controlling for the meteorological factors in the same period, no significant findings were found with the increase of NO2, SO2, CO and O3 concentrations at most of the time in the single-pollutant model. Similarly, in the stratified analysis, no associations between gaseous pollutants and ischemic stroke were observed in this study. CONCLUSIONS Short-term exposure to NO2, SO2, CO and O3 was not distinctly associated with daily hospitalizations for ischemic stroke in Tianjin. Multicenter studies in the future are warranted to explore the associations between gaseous pollution exposure and ischemic stroke.
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Affiliation(s)
- Mingrui Cui
- General Medicine Department, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Changqing Zhan
- Department of Neurology, Wuhu No.2 People’s Hospital, Wuhu 241001, China
| | - Wenjuan Wu
- General Medicine Department, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Dandan Guo
- General Medicine Department, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yijun Song
- General Medicine Department, Tianjin Medical University General Hospital, Tianjin 300052, China
- Correspondence: ; Tel.: +86-13012270022
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Posadas-Sánchez R, Vargas-Alarcón G, Cardenas A, Texcalac-Sangrador JL, Osorio-Yáñez C, Sanchez-Guerra M. Long-Term Exposure to Ozone and Fine Particulate Matter and Risk of Premature Coronary Artery Disease: Results from Genetics of Atherosclerotic Disease Mexican Study. BIOLOGY 2022; 11:biology11081122. [PMID: 35892978 PMCID: PMC9332787 DOI: 10.3390/biology11081122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 11/26/2022]
Abstract
(1) Background: Epidemiological studies have identified associations between fine particulate matter (PM2.5) and ozone exposure with cardiovascular disease; however, studies linking ambient air pollution and premature coronary artery disease (pCAD) in Latin America are non-existing. (2) Methods: Our study was a case−control analysis nested in the Genetics of Atherosclerotic Disease (GEA) Mexican study. We included 1615 participants (869 controls and 746 patients with pCAD), recruited at the Instituto Nacional de Cardiología Ignacio Chávez from June 2008 to January 2013. We defined pCAD as history of myocardial infarction, angioplasty, revascularization surgery or coronary stenosis > 50% diagnosed before age 55 in men and age 65 in women. Controls were healthy individuals without personal or family history of pCAD and with coronary artery calcification equal to zero. Hourly measurements of ozone and PM2.5 from the Atmospheric Monitoring System in Mexico City (SIMAT in Spanish; Sistema de Monitero Atmosférico de la Ciudad de México) were used to calculate annual exposure to ozone and PM2.5 in the study participants. (3) Results: Each ppb increase in ozone at 1-year, 2-year, 3-year and 5-year averages was significantly associated with increased odds (OR = 1.10; 95% CI: 1.03−1.18; OR = 1.17; 95% CI: 1.05−1.30; OR = 1.18; 95% CI: 1.05−1.33, and OR = 1.13; 95% CI: 1.04−1.23, respectively) of pCAD. We observed higher risk of pCAD for each 5 µg/m3 increase only for the 5-year average of PM2.5 exposure (OR = 2.75; 95% CI: 1.47−5.16), compared to controls. (4) Conclusions: Ozone exposure at different time points and PM2.5 exposure at 5 years were associated with increased odds of pCAD. Our results highlight the importance of reducing long-term exposure to ambient air pollution levels to reduce the burden of cardiovascular disease in Mexico City and other metropolitan areas.
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Affiliation(s)
| | - Gilberto Vargas-Alarcón
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (R.P.-S.); (G.V.-A.)
| | - Andres Cardenas
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720, USA;
| | | | - Citlalli Osorio-Yáñez
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico City 04510, Mexico
- Laboratorio de Fisiología Cardiovascular y Trasplante Renal, Unidad de Investigación en Medicina Traslacional, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México and Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
- Correspondence: (C.O.-Y.); (M.S.-G.); Tel.: +52-55-5573-2911 (ext. 27319) (C.O.-Y.); +52-55-5520-9900 (ext. 129) (M.S.-G.)
| | - Marco Sanchez-Guerra
- Instituto Nacional de Perinatología, Mexico City 11000, Mexico
- Correspondence: (C.O.-Y.); (M.S.-G.); Tel.: +52-55-5573-2911 (ext. 27319) (C.O.-Y.); +52-55-5520-9900 (ext. 129) (M.S.-G.)
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Sîrbu CA, Stefan I, Dumitru R, Mitrica M, Manole AM, Vasile TM, Stefani C, Ranetti AE. Air Pollution and Its Devastating Effects on the Central Nervous System. Healthcare (Basel) 2022; 10:1170. [PMID: 35885697 PMCID: PMC9324939 DOI: 10.3390/healthcare10071170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Air pollution is a real public health problem, it being one of the five most common causes of mortality in developing countries. However, pollution studies have focused on the cardiovascular and pulmonary systems in recent decades. Recently, researchers have moved towards a new direction, tracing a direct link between pollution and stroke. Stroke has many known risk factors such as smoking, a sedentary lifestyle, and hypertension. Pollution is universally widespread, already a matter of public interest, so that, although intuitive, it is difficult to connect the two. The particles found in the air that we breathe, regardless of their origin, can attack the body in different ways, causing inflammation, and triggering a true cascade of phenomena that end up attacking the central nervous system and other organs. This article tries to explain the series of phenomena that determine the harmful effect of particles present in the air, with an increased focus on the central nervous system and especially on strokes. A deeper understanding of these phenomena helps in guiding future studies and finding viable solutions to protect people at risk.
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Affiliation(s)
- Carmen Adella Sîrbu
- Department of Neurology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010242 Bucharest, Romania; (C.A.S.); (R.D.)
| | - Ion Stefan
- Department of Infectious Diseases, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010242 Bucharest, Romania
- Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 031593 Bucharest, Romania
| | - Rodica Dumitru
- Department of Neurology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010242 Bucharest, Romania; (C.A.S.); (R.D.)
| | - Marian Mitrica
- Clinical Neurosciences Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania;
| | - Aida Mihaela Manole
- Department of Neurology, Clinical Ambulatory, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010242 Bucharest, Romania;
| | - Titus Mihai Vasile
- Clinical Neurosciences Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania;
| | - Constantin Stefani
- Department of Family Medicine and Clinical Base, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010242 Bucharest, Romania;
- Department No. 5, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Aurelian Emil Ranetti
- Department No. 2, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania;
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Cheng B, Zhou J, Ma Y, Zhang Y, Wang H, Chen Y, Shen J, Feng F. Association between atmospheric particulate matter and emergency room visits for cerebrovascular disease in Beijing, China. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2022; 20:293-303. [PMID: 35669822 PMCID: PMC9163215 DOI: 10.1007/s40201-021-00776-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 12/25/2021] [Indexed: 06/15/2023]
Abstract
PURPOSE The association between atmospheric particulate matter and emergency room visits for cerebrovascular disease were evaluated in Beijing. METHODS A generalized additive model was used to evaluate the associations between particulate matter and cerebrovascular disease, based on the daily data of meteorological elements, PM concentrations, and emergency room (ER) visits for cerebrovascular disease in Beijing from 2009 to 2012. Long-term trends and the effects of holidays, the day of the week, and confounding factors were controlled to determine the lag effect at 0-6 days. Single- and double-pollutant models were employed for different age and sex groups. RESULTS The effect of PM2.5 concentration on the number of daily ER visits for cerebrovascular disease was much stronger than that of PM10 concentration. PM2.5 and PM10 had maximum RR values of 1.096 and 1.054 at lag 6 for patients aged 61-75 years. For each inter-quartile range (IQR) increase in PM10 concentration, the maximum RR values for the total, males, females, aged 15-60 years, aged 61-75 years, and aged > 75 years were 1.024, 1.044, 1.043, 1.038, 1.054, and 1.032, respectively. For each IQR increase in PM2.5 concentration, the maximum RR values for the total, males, females, aged 15-60 years, aged 61-75 years, and aged > 75 years were 1.038, 1.064, 1.076, 1.054, 1.096, and 1.049, respectively. The RR values of the double-pollutant models were lower than those of the single-pollutant models. CONCLUSION This study showed that the effects of PM pollution on cerebrovascular disease were different among different gender and age groups, and aged 61-75 years were mostly sensitive to particulate matters. The effects of PM2.5 on cerebrovascular disease were stronger than those of PM10. Our results can provide scientific evidence for the local government to take effective measures to improve air quality and the health of residents. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40201-021-00776-w.
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Affiliation(s)
- Bowen Cheng
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000 China
| | - Jianding Zhou
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000 China
- Quanzhou Meteorological Bureau, Quanzhou, 362000 China
| | - Yuxia Ma
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000 China
| | - Yifan Zhang
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000 China
| | - Hang Wang
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000 China
| | - Yan Chen
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000 China
| | - Jiahui Shen
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000 China
| | - Fengliu Feng
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000 China
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Liao SH, Chiu CS, Jang LH, Hu SY, How CK, Hsieh VCR, Hsieh MS. Long-Term Exposures to Air Pollutants and Risk of Peripheral Arterial Occlusive Disease: A Nationwide Cohort Study in Taiwan. Front Cardiovasc Med 2022; 9:796423. [PMID: 35669470 PMCID: PMC9163433 DOI: 10.3389/fcvm.2022.796423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 04/15/2022] [Indexed: 11/25/2022] Open
Abstract
Air pollution is one of the most alarming environmental issues which causes multiple health hazards. An association between air pollution and cardiovascular diseases has been established through many prior studies. In this study, we aimed to evaluate the risk of long-term exposure to air pollution (PM2.5, CO, and NO2) and its association with the risk of developing peripheral arterial occlusive disease (PAOD). PAOD is a condition involving impairment of perfusion of blood in the distal parts of the aorta due to narrowing of the arteries (arterial stenosis) and has been reported as a risk factor for developing cardiovascular diseases. Furthermore, the risk of PAOD increases with age, and hence is a serious public health issue and a cause for concern, especially for an aging society such as Taiwan. Two national-scale databases from Taiwan, the national health insurance database (NHIRD) and the Taiwan air quality-monitoring database (TAQMD), were linked to conduct this cohort study between 2003 and 2013. Cox proportional hazards regression with time-dependent modeling was used to evaluate the hazard ratio (HR) for PAOD with respect to daily exposure to air pollutants. The concentrations of each of the pollutants of interest (PM2.5, NO2, and CO) were categorized into four categories according to the daily average concentration of air pollutants for every quarter of the year, Q1 to Q4 (Q4 = highest). The cumulative incidence of PAOD was examined by Kaplan–Meier analysis with two-tailed log-rank test. A total of 1,598 PAOD cases were identified during the 10-year follow-up period, along with 98,540 non-PAOD controls. In the multivariate analysis, after adjusting for age, gender, urbanization level, residential area, baseline comorbidities, and medications, the adjusted HRs were PM2.5 = 1.14 (95% CI 1.13–1.16), NO2 = 1.03 (95% CI 1.02–1.04), and CO = 2.35 (95% CI 1.95–2.84). Kaplan–Meier analysis showed that CO (P < 0.0001) and PM2.5 (P < 0.0001) concentrations were strongly and positively associated with the cumulative incidence of PAOD during the follow-up period. Findings from this study established that prolonged exposure to air pollutants CO and PM2.5 are significant factors that, among other well-known causes, may also play a potential role in PAOD pathogenesis.
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Affiliation(s)
- Shu-Hui Liao
- Department of Pathology and Laboratory, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
| | - Chien-Shan Chiu
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Li-Ho Jang
- Department of Critical Care, Saint Paul's Hospital, Taoyuan, Taiwan
| | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chorng-Kuang How
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Vivian Chia-Rong Hsieh
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Ming-Shun Hsieh
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
- *Correspondence: Ming-Shun Hsieh
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Elser H, Chen KT, Arteaga D, Reimer R, Picciotto S, Costello S, Eisen EA. Metalworking Fluid Exposure and Stroke Mortality Among US Autoworkers. Am J Epidemiol 2022; 191:1040-1049. [PMID: 35029630 PMCID: PMC9393063 DOI: 10.1093/aje/kwac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/26/2021] [Accepted: 01/05/2022] [Indexed: 01/16/2023] Open
Abstract
Although air pollution is an important risk factor for stroke, few studies have considered the impact of workplace exposure to particulate matter (PM). We examined implications of exposure to PM composed of metalworking fluids (MWFs) for stroke mortality in the United Autoworkers-General Motors cohort. Cox proportional hazards models with age as the timescale were used to estimate the association of cumulative straight, soluble, and synthetic MWF exposure with stroke mortality, controlling for sex, race, plant, calendar year, and hire year. Among 38,553 autoworkers followed during 1941-1995, we identified 114 ischemic stroke deaths and 113 hemorrhagic stroke deaths. Overall stroke mortality risk was increased among workers in the middle exposure category for straight MWF (hazard ratio (HR) = 1.31, 95% confidence interval (CI): 0.87, 1.98) and workers in the highest exposure category for synthetic MWF (HR = 1.94, 95% CI: 1.13, 3.16) compared with workers who had no direct exposure. Ischemic stroke mortality risk was increased among workers in the highest exposure categories for straight MWF (HR = 1.45, 95% CI: 0.83, 2.52) and synthetic MWF (HR = 2.39, 95% CI: 1.39, 4.50). We observed no clear relationship between MWF exposure and hemorrhagic stroke mortality. Our results support a potentially important role for occupational PM exposures in stroke mortality and indicate the need for further studies of PM exposure and stroke in varied occupational settings.
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Affiliation(s)
- Holly Elser
- Correspondence to Dr. Holly Elser, Department of Neurology, 3 Gates, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (e-mail: )
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Weng L, Li N, Feng T, Zhu R, Zheng ZJ. Short-Term Association of Air Pollutant Levels and Hospital Admissions for Stroke and Effect Modification by Apparent Temperature: Evidence From Shanghai, China. Front Public Health 2021; 9:716153. [PMID: 34646803 PMCID: PMC8503471 DOI: 10.3389/fpubh.2021.716153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/23/2021] [Indexed: 11/19/2022] Open
Abstract
The epidemiological evidence on relationships between air pollution, temperature, and stroke remains inconclusive. Limited evidence is available for the effect modification by apparent temperature, an indicator reflecting reactions to the thermal environment, on short-term associations between air pollution and hospital admissions for stroke. We used a generalized additive model with Poisson regression to estimate the relative risk (RR) of stroke admissions in Shanghai, China, between 2014 and 2016 associated with air pollutants, with subgroup analyses by age, sex, apparent temperature, and season. During the study period, changes in the daily number of stroke admissions per 10 μg/m3 increase in nitrogen dioxide (at lags 0, 1, 0–1, and 0–2) ranged from 1.05 (95% CI: 0.82%, 2.88%) to 2.24% (95% CI: 0.84%, 3.65%). For each 10 μg/m3 increase in sulfur dioxide concentrations at lags 1, 2, 0–1, and 0–2, the RR of daily stroke admissions increased by 3.34 (95% CI: 0.955%, 5.79%), 0.32 (95% CI: −1.97%, 2.67%), 3.33 (95% CI: 0.38%, 6.37%), and 2.86% (95% CI: −0.45%, 6.28%), respectively. The associations of same-day exposure to nitrogen dioxide with stroke admissions remained significant after adjustment for ozone levels. These associations were not modified by sex, age, apparent temperature, or season. More research is warranted to determine whether apparent temperature modifies the associations between air pollution and stroke admissions.
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Affiliation(s)
- Lvkan Weng
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Chest Hospital, Shanghai, China
| | - Na Li
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Tienan Feng
- Clinic Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongjia Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University, Shanghai, China.,Clinic Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
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Yan Y, Chen X, Guo Y, Wu C, Zhao Y, Yang N, Dai J, Gong J, Xiang H. Ambient air pollution and cerebrovascular disease mortality: an ecological time-series study based on 7-year death records in central China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:27299-27307. [PMID: 33511535 DOI: 10.1007/s11356-021-12474-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
Most studies of short-term exposure to ambient air pollution and cerebrovascular diseases focused on specific stroke-related outcomes, and results were inconsistent due to data unavailability and limited sample size. It is unclear yet how ambient air pollution contributes to the total cardiovascular mortality in central China. Daily deaths from cerebrovascular diseases were obtained from the Disease Surveillance Point System (DSPs) of Wuhan Center for Disease Control and Prevention during the period from 2013 to 2019. Air pollution data were obtained from Wuhan Ecology and Environment Institute from 10 national air quality monitoring stations, including average daily PM2.5, PM10, SO2, NO2, and O3. Average daily temperature and relative humidity were obtained from Wuhan Meteorological Bureau. We performed a Poisson regression in generalized additive models (GAM) to examine the association between ambient air pollution and cerebrovascular disease mortality. We observed a total of 84,811 deaths from cerebrovascular diseases from 1 January 2013 to 31 December 2019 in Wuhan. Short-term exposure to PM2.5, PM10, SO2, and NO2 was positively associated with daily deaths from cerebrovascular diseases, and no significant association was found for O3. The largest effect on cerebrovascular disease mortality was found at lag0 for PM2.5 (ERR: 0.927, 95% CI: 0.749-1.105 per 10 μg/m3) and lag1 for PM10 (ERR: 0.627, 95% CI: 0.493-0.761 per 10 μg/m3), SO2 (ERR: 2.518, 95% CI: 1.914, 3.122 per 10 μg/m3), and NO2 (ERR: 1.090, 95% CI: 0.822-1.358 per 10 μg/m3). The trends across lags were statistically significant. The stratified analysis demonstrated that females were more susceptible to SO2 and NO2, while elder individuals aged above 65 years old, compared with younger people, suffered more from air pollution, especially from SO2. Short-term exposure to PM2.5, PM10, SO2, and NO2 were significantly associated with a higher risk of cerebrovascular disease mortality, and elder females seemed to suffer more from air pollution. Further research is required to reveal the underlying mechanisms.
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Affiliation(s)
- Yaqiong Yan
- Wuhan Centers for Disease Control and Prevention, No.288 Machang Road, Wuhan, China
| | - Xi Chen
- Wuhan Centers for Disease Control and Prevention, No.288 Machang Road, Wuhan, China
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Yan Guo
- Wuhan Centers for Disease Control and Prevention, No.288 Machang Road, Wuhan, China
| | - Chuangxin Wu
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Yuanyuan Zhao
- Wuhan Centers for Disease Control and Prevention, No.288 Machang Road, Wuhan, China
| | - Niannian Yang
- Wuhan Centers for Disease Control and Prevention, No.288 Machang Road, Wuhan, China
| | - Juan Dai
- Wuhan Centers for Disease Control and Prevention, No.288 Machang Road, Wuhan, China
| | - Jie Gong
- Wuhan Centers for Disease Control and Prevention, No.288 Machang Road, Wuhan, China.
| | - Hao Xiang
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China.
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Balram D, Lian KY, Sebastian N. A novel soft sensor based warning system for hazardous ground-level ozone using advanced damped least squares neural network. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2020; 205:111168. [PMID: 32846299 DOI: 10.1016/j.ecoenv.2020.111168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
Estimation of hazardous air pollutants in the urban environment for maintaining public safety is a significant concern to mankind. In this paper, we have developed an efficient air quality warning system based on a low-cost and robust ground-level ozone soft sensor. The soft sensor was developed based on a novel technique of damped least squares neural network (DLSNN) with greedy backward elimination (GBE) for the estimation of hazardous ground-level ozone. Only three meteorological factors were used as input variables in the estimation of ground-level ozone and we have used weighted k-nearest neighbors (WkNN) classifier with fast response for development of air quality warning system. We have chosen the urban areas of Taiwan for this study and have analyzed seasonal variations in the ground-level ozone concentration of various cities in Taiwan as part of this work. Moreover, descriptive statistics and linear dependence of ozone concentration based on Spearman correlation coefficient, Kendall's tau coefficient, and Pearson coefficient are calculated. The proposed DLSNN/GBE method exhibited excellent performance resulting in very low mean square error (MSE), mean absolute error (MAE), and high coefficient of determination (R2) compared to other traditional approaches in ozone concentration estimation. We have achieved a good fit in the determination of ozone concentration from meteorological features of atmosphere. Moreover, the excellent performance of proposed urban air quality warning system was evident from the good F1-score value of 0.952 achieved by the WkNN classifier.
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Affiliation(s)
- Deepak Balram
- Department of Electrical Engineering, National Taipei University of Technology, No. 1, Section 3, Zhongxiao East Road, Taipei, 106, Taiwan, ROC
| | - Kuang-Yow Lian
- Department of Electrical Engineering, National Taipei University of Technology, No. 1, Section 3, Zhongxiao East Road, Taipei, 106, Taiwan, ROC.
| | - Neethu Sebastian
- Institute of Organic and Polymeric Materials, National Taipei University of Technology, No. 1, Section 3, Zhongxiao East Road, Taipei, 106, Taiwan, ROC
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Air Pollution and Emergency Hospital Admissions—Evidences from Lisbon Metropolitan Area, Portugal. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10227997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The relevance of air pollution in the public health agenda has recently been reinforced—it is known that exposure to it has negative effects in the health of individuals, especially in big cities and metropolitan areas. In this article we observed the evolution of air pollutants (CO, NO, NO2, O3, PM10) emissions and we confront them with health vulnerabilities related to respiratory and circulatory diseases (all circulatory diseases, cardiac diseases, cerebrovascular disease, ischemic heart disease, all respiratory diseases, chronic lower respiratory diseases, acute upper respiratory infections). The study is supported in two databases, one of air pollutants and the other of emergency hospital admissions, in the 2005–2015 period, applied to the Lisbon Metropolitan Area. The analysis was conducted through Ordinary Least Squares (OLS) regression, while also using semi-elasticity to quantify associations. Results showed positive associations between air pollutants and admissions, tendentially higher in respiratory diseases, with CO and O3 having the highest number of associations, and the senior age group being the most impacted. We concluded that O3 is a good predictor for the under-15 age group and PM10 for the over-64 age group; also, there seems to exist a distinction between the urban city core and its suburban areas in air pollution and its relation to emergency hospital admissions.
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Association Between Fine Particulate Matter and Fatal Hemorrhagic Stroke Incidence. J Occup Environ Med 2020; 62:916-921. [DOI: 10.1097/jom.0000000000001973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang Y, Liu Y, Yan H. Effect of long-term particulate matter exposure on Parkinson's risk. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2020; 42:2265-2275. [PMID: 31894453 DOI: 10.1007/s10653-019-00484-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/24/2019] [Indexed: 06/10/2023]
Abstract
Environmental pollution is a critical predisposing factor underlying neurodegenerative diseases, but the association between particulate matter (PM) exposure and Parkinson's disease (PD) remains unclear. This study aimed to evaluate the association between long-term PM2.5/PM10 exposure and PD risk. We searched the PubMed, Ovid Medline, EMBASE, Cochrane Library, and Web of Science citation databases to select studies about the relationship between long-term PM exposure and PD risk. The association was assessed using meta-analysis, and subgroup analysis was carried out on the basis of the types of PM (PM2.5 and PM10). Among the 611 articles identified from the databases, we selected six articles, including three cohort studies and three case-control studies, which collectively involved 10,077,029 participants. With every 10 μg/m3 increment, the relative risks (RRs) and 95% confidence intervals (CIs) were 1.03 (0.98, 1.07), 1.21 (0.95, 1.54), and 1.01 (0.97, 1.05) for the total PM, PM2.5, and PM10, respectively. In the current study, no statistically substantial association was observed between long-term PM2.5/PM10 exposure and PD incidence. However, further large-scale prospective studies are needed to determine the association.
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Affiliation(s)
- Yiqi Wang
- Department of Health Toxicology, MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong-Road, Wuhan, 430030, People's Republic of China
| | - Ying Liu
- Department of Health Toxicology, MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong-Road, Wuhan, 430030, People's Republic of China
| | - Hong Yan
- Department of Health Toxicology, MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong-Road, Wuhan, 430030, People's Republic of China.
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22
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Do Ambient Ozone or Other Pollutants Modify Effects of Controlled Ozone Exposure on Pulmonary Function? Ann Am Thorac Soc 2020; 17:563-572. [DOI: 10.1513/annalsats.201908-597oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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23
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Sun S, Stewart JD, Eliot MN, Yanosky JD, Liao D, Tinker LF, Eaton CB, Whitsel EA, Wellenius GA. Short-term exposure to air pollution and incidence of stroke in the Women's Health Initiative. ENVIRONMENT INTERNATIONAL 2019; 132:105065. [PMID: 31382185 PMCID: PMC6754774 DOI: 10.1016/j.envint.2019.105065] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/26/2019] [Accepted: 07/28/2019] [Indexed: 05/07/2023]
Abstract
BACKGROUND Evidence of the association between daily variation in air pollution and risk of stroke is inconsistent, potentially due to the heterogeneity in stroke etiology. OBJECTIVES To estimate the associations between daily variation in ambient air pollution and risk of stroke and its subtypes among participants of the Women's Health Initiative, a large prospective cohort study in the United States. METHODS We used national-scale, log-normal ordinary kriging models to estimate daily concentrations of fine particulate matter (PM2.5), respirable particulate matter (PM10), nitrogen dioxide (NO2), nitrogen oxides (NOx), sulphur dioxide, and ozone at participant addresses. Stroke was adjudicated by trained neurologists and classified as ischemic or hemorrhagic. Ischemic strokes were further classified according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. We used a time-stratified case-crossover approach to estimate the odds ratio (OR) of the risk of stroke associated with an interquartile range (IQR) increase in concentrations of each air pollutant. We performed stratified analysis to examine whether associations varied across subgroups defined by age at stroke onset, US census region, smoking status, body mass index, and prior history of diabetes mellitus, hypertension, heart or circulation problems, or arterial fibrillation at enrollment. RESULTS Among 5417 confirmed strokes between 1993 and 2012, 4300 (79.4%) were classified as ischemic and 924 (17.1%) as hemorrhagic. No association was observed between day-to-day variation in any pollutant and risk of total stroke, ischemic stroke, or specific etiologies of ischemic stroke. We observed a positive association between risk of hemorrhagic stroke and NO2 and NOx in the 3 days prior to stroke with OR of 1.24 (95% CI: 1.01, 1.52) and 1.18 (95% CI: 1.03, 1.34) per IQR increase, respectively. The observed associations with hemorrhagic stroke were more pronounced among non-obese participants. CONCLUSIONS In this large cohort of post-menopausal US women, daily NO2 and NOx were associated with higher risk of hemorrhagic stroke, but ambient levels of four other air pollutants were not associated with higher risk of total stroke, ischemic stroke, or ischemic stroke subtypes.
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Affiliation(s)
- Shengzhi Sun
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA.
| | - James D Stewart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Melissa N Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA
| | - Jeff D Yanosky
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Duanping Liao
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Charles B Eaton
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA
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24
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Balmes JR, Arjomandi M, Bromberg PA, Costantini MG, Dagincourt N, Hazucha MJ, Hollenbeck-Pringle D, Rich DQ, Stark P, Frampton MW. Ozone effects on blood biomarkers of systemic inflammation, oxidative stress, endothelial function, and thrombosis: The Multicenter Ozone Study in oldEr Subjects (MOSES). PLoS One 2019; 14:e0222601. [PMID: 31553765 PMCID: PMC6760801 DOI: 10.1371/journal.pone.0222601] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/02/2019] [Indexed: 02/01/2023] Open
Abstract
The evidence that exposure to ozone air pollution causes acute cardiovascular effects is mixed. We postulated that exposure to ambient levels of ozone would increase blood markers of systemic inflammation, prothrombotic state, oxidative stress, and vascular dysfunction in healthy older subjects, and that absence of the glutathione S-transferase Mu 1 (GSTM1) gene would confer increased susceptibility. This double-blind, randomized, crossover study of 87 healthy volunteers 55-70 years of age was conducted at three sites using a common protocol. Subjects were exposed for 3 h in random order to 0 parts per billion (ppb) (filtered air), 70 ppb, and 120 ppb ozone, alternating 15 min of moderate exercise and rest. Blood was obtained the day before, approximately 4 h after, and approximately 22 h after each exposure. Linear mixed effect and logistic regression models evaluated the impact of exposure to ozone on pre-specified primary and secondary outcomes. The definition of statistical significance was p<0.01. There were no effects of ozone on the three primary markers of systemic inflammation and a prothrombotic state: C-reactive protein, monocyte-platelet conjugates, and microparticle-associated tissue factor activity. However, among the secondary endpoints, endothelin-1, a potent vasoconstrictor, increased from pre- to post-exposure with ozone concentration (120 vs 0 ppb: 0.07 pg/mL, 95% confidence interval [CI] 0.01, 0.14; 70 vs 0 ppb: -0.03 pg/mL, CI -0.09, 0.04; p = 0.008). Nitrotyrosine, a marker of oxidative and nitrosative stress, decreased with increasing ozone concentrations, with marginal significance (120 vs 0 ppb: -41.5, CI -70.1, -12.8; 70 vs 0 ppb: -14.2, CI -42.7, 14.2; p = 0.017). GSTM1 status did not modify the effect of ozone exposure on any of the outcomes. These findings from healthy older adults fail to identify any mechanistic basis for the epidemiologically described cardiovascular effects of exposure to ozone. The findings, however, may not be applicable to adults with cardiovascular disease.
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Affiliation(s)
- John R. Balmes
- Department of Medicine, University of California at San Francisco, San Francisco, CA, United States of America
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, United States of America
| | - Mehrdad Arjomandi
- Department of Medicine, University of California at San Francisco, San Francisco, CA, United States of America
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States of America
| | - Philip A. Bromberg
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC, United States of America
| | | | | | - Milan J. Hazucha
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC, United States of America
| | | | - David Q. Rich
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Paul Stark
- New England Research Institute, Watertown, MA, United States of America
| | - Mark W. Frampton
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
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25
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Wang C, Feng L, Chen K. The impact of ambient particulate matter on hospital outpatient visits for respiratory and circulatory system disease in an urban Chinese population. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 666:672-679. [PMID: 30812001 DOI: 10.1016/j.scitotenv.2019.02.256] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/26/2019] [Accepted: 02/16/2019] [Indexed: 05/27/2023]
Abstract
There are limited evidence on the association between short-term exposure to ambient particulate matter (PM) and overall hospital outpatient visits for respiratory system disease (RESD) and cardio-cerebrovascular system disease (CCD) in high-polluted countries like China. Though previous epidemiological studies of RESD and CCD generally applied a linear relationship of the acute PM effects, it is unclear whether this linear exposure-response relationship holds in high pollution area. In this study, a time-series study during 2013 through 2016 was conducted to investigate 245,442 and 430,486 hospital visits for RESD and CCD respectively from Nanjing city, China. A combination of logistic generalized additive model (GAM) was used to evaluate the exposure-response associations. The results disclosed that a 10 μg/m3 increase in PM2.5 and PM10 concentration on the current day of exposure (lag 0) was associated with 0.36% (95% CI: -0.02%-0.73%) and 0.33% (0.07%-0.60%) increase in RESD; and 0.42% (0.00%-0.85%) and 0.37% (0.08%-0.67%) increase in CCD. The exposure-response association was approximately linear within 0-150 μg/m3 of PM concentration and non-linear across the full range of exposures. The effects of PM on RESD and CCD were sensitive to additional adjustment for co-pollutants, indicating the health effects of air pollution mixture in Nanjing city. There was no evidence of potential effect modification of RESD and CCD by season (cold and warm), age (5-64, 65-74, ≧75 years) and sex (male and female) groups. Though not statistically significant, the estimated risks in warm season were higher than those in cold season, suggesting potential synergistic effects of ambient PM pollution and temperature on triggering RESD and CCD.
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Affiliation(s)
- Ce Wang
- School of Energy and Environment, Southeast University, Nanjing, 210096, PR China; State Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Southeast University, Nanjing, 210096, PR China.
| | - Lan Feng
- National-Provincial Joint Engineering Research Center of Electromechanical Product Packaging, College of Civil Engineering, Nanjing Forestry University, Nanjing, 210037, PR China.
| | - Kai Chen
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
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26
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Tian Y, Liu H, Xiang X, Zhao Z, Juan J, Li M, Song J, Cao Y, Wu Y, Wang X, Chen L, Wei C, Gao P, Hu Y. Ambient Coarse Particulate Matter and Hospital Admissions for Ischemic Stroke. Stroke 2019; 50:813-819. [DOI: 10.1161/strokeaha.118.022687] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background and Purpose—
Evidence on the effects of coarse particulate matter (PM
10–2.5
) on ischemic stroke is limited and inconsistent. We evaluated the acute effects of PM
10–2.5
exposure on hospital admissions for ischemic stroke in China.
Methods—
We conducted a national time-series analysis of associations between daily PM
10–2.5
concentrations and daily hospital admissions for ischemic stroke in China between January 2014 and December 2016. Hospital admissions for ischemic stroke were identified from the database of Urban Employee Basic Medical Insurance, which contains data from 0.28 billion beneficiaries. We applied a city-specific Poisson regression to examine the associations of PM
10–2.5
and daily ischemic stroke admissions. We combined the city-specific effect estimates with a random effects meta-analysis, and further evaluated the exposure-response relationship curve and potential effect modifiers.
Results—
We identified >2 million hospital admissions for ischemic stroke in 172 Chinese cities. A 10 μg/m
3
increase in PM
10–2.5
concentrations (lag day 0) was associated with a 0.91% (95% CI, 0.73–1.10) increase in hospital admissions for ischemic stroke. The association remained significant after adjusting for PM
2.5
(percentage change, 0.96%; 95% CI, 0.75–1.18). The exposure-response relationship was approximately linear, with a moderate response at lower levels (<200 μg/m
3
) and a steeper response at higher levels. The association was stronger in cities with lower PM
10–2.5
concentrations, higher temperatures, or higher relative humidity.
Conclusions—
This nationwide study provides robust evidence of the short-term association between exposure to PM
10–2.5
and increased hospital admissions for ischemic stroke and supports the hypothesis that the association differs by city characteristics.
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Affiliation(s)
- Yaohua Tian
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Hui Liu
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
- Medical Informatics Center (H.L.), Peking University, Beijing, China
| | - Xiao Xiang
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Zuolin Zhao
- Beijing HealthCom Data Technology Co, Ltd, Beijing, China (Z.Z., L.C., C.W.)
| | - Juan Juan
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Man Li
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Jing Song
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Yaying Cao
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Yao Wu
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Xiaowen Wang
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Libo Chen
- Beijing HealthCom Data Technology Co, Ltd, Beijing, China (Z.Z., L.C., C.W.)
| | - Chen Wei
- Beijing HealthCom Data Technology Co, Ltd, Beijing, China (Z.Z., L.C., C.W.)
| | - Pei Gao
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Yonghua Hu
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
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27
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Fisher JA, Puett RC, Laden F, Wellenius GA, Sapkota A, Liao D, Yanosky JD, Carter-Pokras O, He X, Hart JE. Case-crossover analysis of short-term particulate matter exposures and stroke in the health professionals follow-up study. ENVIRONMENT INTERNATIONAL 2019; 124:153-160. [PMID: 30641259 PMCID: PMC6692897 DOI: 10.1016/j.envint.2018.12.044] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/16/2018] [Accepted: 12/19/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND Stroke is a leading cause of morbidity and mortality in the United States. Associations between short-term exposures to particulate matter (PM) air pollution and stroke are inconsistent. Many prior studies have used administrative and hospitalization databases where misclassification of the type and timing of the stroke event may be problematic. METHODS In this case-crossover study, we used a nationwide kriging model to examine short-term ambient exposure to PM10 and PM2.5 and risk of ischemic and hemorrhagic stroke among men enrolled in the Health Professionals Follow-up Study. Conditional logistic regression models were used to obtain estimates of odds ratios (OR) and 95% confidence intervals (CI) associated with an interquartile range (IQR) increase in PM2.5 or PM10. Lag periods up to 3 days prior to the stroke event were considered in addition to a 4-day average. Stratified models were used to examine effect modification by patient characteristics. RESULTS Of the 727 strokes that occurred between 1999 and 2010, 539 were ischemic and 122 were hemorrhagic. We observed positive statistically significant associations between PM10 and ischemic stroke (ORlag0-3 = 1.26; 95% CI: 1.03-1.55 per IQR increase [14.46 μg/m3]), and associations were elevated for nonsmokers, aspirin nonusers, and those without a history of high cholesterol. However, we observed no evidence of a positive association between short-term exposure to PM and hemorrhagic stroke or between PM2.5 and ischemic stroke in this cohort. CONCLUSIONS Our study provides evidence that ambient PM10 may be associated with higher risk of ischemic stroke and highlights that ischemic and hemorrhagic strokes are heterogeneous outcomes that should be treated as such in analyses related to air pollution.
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Affiliation(s)
- Jared A Fisher
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA; Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA.
| | - Robin C Puett
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Francine Laden
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Amir Sapkota
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Duanping Liao
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jeff D Yanosky
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Olivia Carter-Pokras
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Xin He
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Jaime E Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Tian Y, Liu H, Zhao Z, Xiang X, Li M, Juan J, Song J, Cao Y, Wang X, Chen L, Wei C, Hu Y, Gao P. Association between ambient air pollution and daily hospital admissions for ischemic stroke: A nationwide time-series analysis. PLoS Med 2018; 15:e1002668. [PMID: 30286080 PMCID: PMC6171821 DOI: 10.1371/journal.pmed.1002668] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 09/07/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Evidence of the short-term effects of ambient air pollution on the risk of ischemic stroke in low- and middle-income countries is limited and inconsistent. We aimed to examine the associations between air pollution and daily hospital admissions for ischemic stroke in China. METHODS AND FINDINGS We identified hospital admissions for ischemic stroke in 2014-2016 from the national database covering up to 0.28 billion people who received Urban Employee Basic Medical Insurance (UEBMI) in China. We examined the associations between air pollution and daily ischemic stroke admission using a two-stage method. Poisson time-series regression models were firstly fitted to estimate the effects of air pollution in each city. Random-effects meta-analyses were then conducted to combine the estimates. Meta-regression models were applied to explore potential effect modifiers. More than 2 million hospital admissions for ischemic stroke were identified in 172 cities in China. In single-pollutant models, increases of 10 μg/m3 in particulate matter with aerodynamic diameter <2.5 μm (PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3) and 1 mg/m3 in carbon monoxide (CO) concentrations were associated with 0.34% (95% confidence interval [CI], 0.20%-0.48%), 1.37% (1.05%-1.70%), 1.82% (1.45%-2.19%), 0.01% (-0.14%-0.16%), and 3.24% (2.05%-4.43%) increases in hospital admissions for ischemic stroke on the same day, respectively. SO2 and NO2 associations remained significant in two-pollutant models, but not PM2.5 and CO associations. The effect estimates were greater in cities with lower air pollutant levels and higher air temperatures, as well as in elderly subgroups. The main limitation of the present study was the unavailability of data on individual exposure to ambient air pollution. CONCLUSIONS As the first national study in China to systematically examine the associations between short-term exposure to ambient air pollution and ischemic stroke, our findings indicate that transient increase in air pollution levels may increase the risk of ischemic stroke, which may have significant public health implications for the reduction of ischemic stroke burden in China.
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Affiliation(s)
- Yaohua Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Hui Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Medical Informatics Center, Peking University, Beijing, China
| | - Zuolin Zhao
- Beijing HealthCom Data Technology Co. Ltd, Beijing, China
| | - Xiao Xiang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Man Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Juan Juan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jing Song
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yaying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Xiaowen Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Libo Chen
- Beijing HealthCom Data Technology Co. Ltd, Beijing, China
| | - Chen Wei
- Beijing HealthCom Data Technology Co. Ltd, Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- * E-mail: (YH); (PG)
| | - Pei Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- * E-mail: (YH); (PG)
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29
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Rich DQ, Balmes JR, Frampton MW, Zareba W, Stark P, Arjomandi M, Hazucha MJ, Costantini MG, Ganz P, Hollenbeck-Pringle D, Dagincourt N, Bromberg PA. Cardiovascular function and ozone exposure: The Multicenter Ozone Study in oldEr Subjects (MOSES). ENVIRONMENT INTERNATIONAL 2018; 119:193-202. [PMID: 29980042 DOI: 10.1016/j.envint.2018.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/08/2018] [Accepted: 06/12/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND To date, there have been relatively few studies of acute cardiovascular responses to controlled ozone inhalation, although a number of observational studies have reported significant positive associations between both ambient ozone levels and acute cardiovascular events and long-term ozone exposure and cardiovascular mortality. OBJECTIVES We hypothesized that short-term controlled exposure to low levels of ozone in filtered air would induce autonomic imbalance, repolarization abnormalities, arrhythmia, and vascular dysfunction. METHODS This randomized crossover study of 87 healthy volunteers 55-70 years of age was conducted at three sites using a common protocol, from June 2012 to April 2015. Subjects were exposed for 3 h in random order to 0 ppb (filtered air), 70 ppb ozone, and 120 ppb ozone, alternating 15 min of moderate exercise with 15 min of rest. A suite of cardiovascular endpoints was measured the day before, the day of, and up to 22 h after each exposure. Mixed effect linear and logit models evaluated the impact of exposure to ozone on pre-specified primary and secondary outcomes. Site and time were included in the models. RESULTS We found no significant effects of ozone exposure on any of the primary or secondary measures of autonomic function, repolarization, ST segment change, arrhythmia, or vascular function (systolic blood pressure and flow-mediated dilation). CONCLUSIONS In this multicenter study of older healthy women and men, there was no convincing evidence for acute effects of 3-h, relatively low-level ozone exposures on cardiovascular function. However, we cannot exclude the possibility of effects with higher ozone concentrations, more prolonged exposure, or in subjects with underlying cardiovascular disease. Further, we cannot exclude the possibility that exposure to ambient ozone and other pollutants in the days before the experimental exposures obscured or blunted cardiovascular biomarker response to the controlled ozone exposures.
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Affiliation(s)
- David Q Rich
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States of America; Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States of America; Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States of America.
| | - John R Balmes
- Department of Medicine, University of California at San Francisco, San Francisco, CA, United States of America; Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, United States of America
| | - Mark W Frampton
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States of America; Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Wojciech Zareba
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Paul Stark
- New England Research Institute, Watertown, MA, United States of America
| | - Mehrdad Arjomandi
- Department of Medicine, University of California at San Francisco, San Francisco, CA, United States of America; San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States of America
| | - Milan J Hazucha
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America; Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC, United States of America
| | | | - Peter Ganz
- Department of Medicine, University of California at San Francisco, San Francisco, CA, United States of America
| | | | | | - Philip A Bromberg
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America; Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC, United States of America
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Knezovic M, Pintaric S, Jelavic MM, Kes VB, Nesek V, Bogovic S, Cvetkovic B, Pintaric H. The role of weather conditions and normal level of air pollution in appearance of stroke in the region of Southeast Europe. Acta Neurol Belg 2018; 118:267-275. [PMID: 29478214 DOI: 10.1007/s13760-018-0885-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Abstract
We investigated correlation between the normal level of air pollution, weather conditions and stroke occurrence in the region of Southeast Europe with a humid continental climate. This retrospective study included 1963 patients, 1712 (87.2%) with ischemic (IS) and 251 (12.8%) with hemorrhagic stroke (HS) admitted to emergency department. The number of patients, values of weather condition (meteorological parameters) [air temperature (°C), atmospheric pressure (kPa), relative humidity (%)] and concentrations of air pollutants [particulate matter (PM10), nitrogen dioxide (NO2), ozone (O3)], were recorded and evaluated for each season (spring, summer, autumn, winter) during 2 years (July 2008-June 2010). The highest rate of IS was observed during spring (28.9%) (p = 0.0002) and HS in winter (33.9%) (p = 0.0006). We have found negative Spearman's correlations (after Bonferroni adjustment for the multiple correlations) of the number of males with values of relative humidity (%) (day 0, rho = - 0.15), the total number of strokes (day 2, rho = - 0.12), females (day 2, rho = - 0.12) and IS (day 2, rho = - 0.13) with concentrations of PM10 (µg/m3), as well as negative correlations of the number of females (day 2, rho = - 0.12) and IS (day 2, rho = - 0.12) with concentrations of NO2 (µg/m3) (for all p < 0.002). In winter, the number of HS (day 0, rho = 0.25, p = 0.001) positively correlated with concentrations of O3 (µg/m3). The appearance of stroke has seasonal variations, with the highest rates during spring and winter. Positive correlation between the number of HS and values of O3 requires an additional reduction of the legally permitted pollutants concentrations.
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31
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Mazidi M, Speakman JR. Impact of Obesity and Ozone on the Association Between Particulate Air Pollution and Cardiovascular Disease and Stroke Mortality Among US Adults. J Am Heart Assoc 2018; 7:JAHA.117.008006. [PMID: 29848499 PMCID: PMC6015356 DOI: 10.1161/jaha.117.008006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Cardiovascular diseases (CVDs) and stroke are the highest and third highest causes of death, respectively, in the whole United States. It is well established that both long‐ and short‐term exposure to particulate air pollution (particulate matter with diameters <2.5 μm [PM2.5]) increases the risks of both CVD and stroke mortality. Methods and Results We combined county‐level data for CVD and stroke mortality, and prevalence of hypertension and obesity, with spatial patterns of PM2.5 and ozone in a cross‐sectional ecological study. We found significant positive associations between both CVD (β=15.4, P<0.001) and stroke (β=2.7, P<0.001) mortality with PM2.5. Ozone had significant link with just CVD (β=1372.1, P<0.001). Once poverty, ethnicity, and education were taken into account, there were still significant positive associations between PM2.5 and both CVD (β=1.2, P<0.001) and stroke (β=1.1, P<0.001) mortality. Moreover, the association between CVD and ozone remained after adjustment for these factors (β=21.8, P<0.001). PM2.5 and ozone were independent risk factors. The impact of PM2.5 on CVD and stroke mortality was strongly dependent on the prevalence of obesity. Hypertension partially mediated the associations of PM2.5 and mortality from CVD and stroke. Conclusions There was a spatial association between PM2.5 exposure and the leading causes of death and disability in United States. The effect of PM2.5 was considerably greater in areas where obesity is more prevalent. Hypertension is a possible mediator of the association of PM2.5 and both CVD and stroke.
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Affiliation(s)
- Mohsen Mazidi
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Chaoyang Beijing, China.,University of the Chinese Academy of Sciences, Beijing, China
| | - John R Speakman
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Chaoyang Beijing, China .,Institute of Biological and Environmental Science, University of Aberdeen, Scotland, United Kingdom
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32
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Does the Short-Term Effect of Air Pollution Influence the Incidence of Spontaneous Intracerebral Hemorrhage in Different Patient Groups? Big Data Analysis in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121547. [PMID: 29232865 PMCID: PMC5750965 DOI: 10.3390/ijerph14121547] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 01/18/2023]
Abstract
Spontaneous intracerebral hemorrhage (sICH) has a high mortality rate. Research has demonstrated that the occurrence of sICH is related to air pollution. This study used big data analysis to explore the impact of air pollution on the risk of sICH in patients of differing age and geographic location. 39,053 cases were included in this study; 14,041 in the Taipei region (Taipei City and New Taipei City), 5537 in Taoyuan City, 7654 in Taichung City, 4739 in Tainan City, and 7082 in Kaohsiung City. The results of correlation analysis indicated that there were two pollutants groups, the CO and NO2 group and the PM2.5 and PM10 group. Furthermore, variations in the correlations of sICH with air pollutants were identified in different age groups. The co-factors of the influence of air pollutants in the different age groups were explored using regression analysis. This study integrated Taiwan National Health Insurance data and air pollution data to explore the risk factors of sICH using big data analytics. We found that PM2.5 and PM10 are very important risk factors for sICH, and age is an important modulating factor that allows air pollutants to influence the incidence of sICH.
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Liu H, Tian Y, Xu Y, Zhang J. Ambient Particulate Matter Concentrations and Hospitalization for Stroke in 26 Chinese Cities. Stroke 2017; 48:2052-2059. [PMID: 28663508 DOI: 10.1161/strokeaha.116.016482] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 05/17/2017] [Accepted: 06/06/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Hui Liu
- From the Medical Informatics Center (H.L.) and Department of Epidemiology and Biostatistics, School of Public Health (Y.T.), Peking University, Beijing, China; and Department of Neurology, Peking University People’s Hospital, Beijing, China (Y.X., J.Z.)
| | - Yaohua Tian
- From the Medical Informatics Center (H.L.) and Department of Epidemiology and Biostatistics, School of Public Health (Y.T.), Peking University, Beijing, China; and Department of Neurology, Peking University People’s Hospital, Beijing, China (Y.X., J.Z.)
| | - Yan Xu
- From the Medical Informatics Center (H.L.) and Department of Epidemiology and Biostatistics, School of Public Health (Y.T.), Peking University, Beijing, China; and Department of Neurology, Peking University People’s Hospital, Beijing, China (Y.X., J.Z.)
| | - Jun Zhang
- From the Medical Informatics Center (H.L.) and Department of Epidemiology and Biostatistics, School of Public Health (Y.T.), Peking University, Beijing, China; and Department of Neurology, Peking University People’s Hospital, Beijing, China (Y.X., J.Z.)
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Li X, Zhang Q, Zhang Y, Zhang L, Wang Y, Zhang Q, Li M, Zheng Y, Geng G, Wallington TJ, Han W, Shen W, He K. Attribution of PM 2.5 exposure in Beijing-Tianjin-Hebei region to emissions: implication to control strategies. Sci Bull (Beijing) 2017; 62:957-964. [PMID: 36659467 DOI: 10.1016/j.scib.2017.06.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 06/07/2017] [Accepted: 06/09/2017] [Indexed: 01/21/2023]
Abstract
The Beijing-Tianjin-Hebei (BTH) region is one of the most heavily polluted regions in China, with both high PM2.5 concentrations and a high population density. A quantitative source-receptor relationship can provide valuable insights that can inform effective emission control strategies. Both source apportionment (SA) and source sensitivity (SS) can provide such information from different perspectives. In this study, both methods are applied in northern China to identify the most significant emission categories and source regions for PM2.5 exposure in BTH in 2013. Despite their differences, both models show similar distribution patterns for population and simulated PM2.5 concentrations, resulting in overall high PM2.5 exposure values (approximately 110μg/m3) and particularly high exposure values during the winter (approximately 200μg/m3). Both methods show that local emissions play a dominant role (70%), with some contribution from surrounding provinces (e.g., Shandong) via regional transport. The two methods also agree on the priority of local emission controls: both identify industrial, residential, and agricultural emissions as the top three categories that should be controlled locally. In addition, the effect of controlling agricultural ammonia emissions is approximately doubled when the co-benefits of reducing nitrate are considered. The synthesis of SA and SS for addressing specific categories of emissions provides a quantitative basis for the development of emission control strategies and policies for controlling PM2.5 in China.
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Affiliation(s)
- Xin Li
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing 100084, China; Department of Marine, Earth, and Atmospheric Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - Qiang Zhang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing 100084, China; Collaborative Innovation Center for Regional Environmental Quality, Beijing 100084, China.
| | - Yang Zhang
- Department of Marine, Earth, and Atmospheric Sciences, North Carolina State University, Raleigh, NC 27695, USA; Collaborative Innovation Center for Regional Environmental Quality, Beijing 100084, China
| | - Lin Zhang
- Laboratory for Climate and Ocean-Atmosphere Sciences, Department of Atmospheric and Oceanic Sciences, School of Physics, Peking University, Beijing 100871, China
| | - Yuxuan Wang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing 100084, China; Department of Marine Sciences, Texas A&M University at Galveston, Galveston, TX, USA; Department of Atmospheric Sciences, Texas A&M University, College Station, TX, USA
| | - Qianqian Zhang
- National Satellite Meteorological Center, China Meteorological Administration, Beijing 100081, China
| | - Meng Li
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing 100084, China
| | - Yixuan Zheng
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing 100084, China
| | - Guannan Geng
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing 100084, China
| | - Timothy J Wallington
- Research and Advanced Engineering, Ford Motor Company, Village Road, Dearborn MI 48121, USA
| | - Weijian Han
- Research and Advanced Engineering, Ford Motor Company, Village Road, Dearborn MI 48121, USA
| | - Wei Shen
- Asia Pacific Research, Ford Motor Company, Beijing 100022, China
| | - Kebin He
- Collaborative Innovation Center for Regional Environmental Quality, Beijing 100084, China; State Key Joint Laboratory of Environment Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing 100084, China
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Tian Y, Xiang X, Wu Y, Cao Y, Song J, Sun K, Liu H, Hu Y. Fine Particulate Air Pollution and First Hospital Admissions for Ischemic Stroke in Beijing, China. Sci Rep 2017; 7:3897. [PMID: 28634403 PMCID: PMC5478610 DOI: 10.1038/s41598-017-04312-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/15/2017] [Indexed: 12/26/2022] Open
Abstract
The primary objective of this study was to assess the association between short-term changes in ambient fine particulate matter (PM2.5) and first hospital admissions for ischemic stroke. We identified 63,956 first hospital admissions for ischemic stroke from the Beijing Medical Claim Data for Employees from January 1, 2010, through June 30, 2012. A generalized additive Poisson model was applied to explore the association between PM2.5 and admissions for ischemic stroke. We also explore the effect modification of risk by age and gender. The exposure-response relationship between PM2.5 and admissions for ischemic stroke was approximately linear, with a relatively stable response at lower concentrations (<100 μg/m3) and a steeper response at higher concentrations. A 10 μg/m3 increase in the same-day PM2.5 concentration was associated with 0.31% (95% CI, 0.17-0.45%, P < 1.57 × 10-5) increase in the daily admissions for ischemic stroke. The association was also statistically significant at lag 1, 2, 3, 0-2 and 0-4 days. Subgroup analyses showed that the association was not different between patients ≥65 years and <65 years old or between males and females. In conclusion, short-term exposure to PM2.5 was positively associated with first hospital admissions for ischemic stroke in Beijing, China.
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Affiliation(s)
- Yaohua Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38 Xueyuan Road, 100191, Beijing, China
| | - Xiao Xiang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38 Xueyuan Road, 100191, Beijing, China
| | - Yiqun Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38 Xueyuan Road, 100191, Beijing, China
| | - Yaying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38 Xueyuan Road, 100191, Beijing, China
| | - Jing Song
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38 Xueyuan Road, 100191, Beijing, China
| | - Kexin Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38 Xueyuan Road, 100191, Beijing, China
| | - Hui Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38 Xueyuan Road, 100191, Beijing, China
- Medical Informatics Center, Peking University, No. 38 Xueyuan Road, 100191, Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38 Xueyuan Road, 100191, Beijing, China.
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Lee GW, Bae MJ, Yang JY, Son JW, Cho JL, Lee SG, Jang BM, Lee HW, Lim JS, Shin DC, Lim YW. Decreased blood pressure associated with in-vehicle exposure to carbon monoxide in Korean volunteers. Environ Health Prev Med 2017; 22:34. [PMID: 29165122 PMCID: PMC5664420 DOI: 10.1186/s12199-017-0622-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/09/2017] [Indexed: 02/08/2023] Open
Abstract
Background Carbon monoxide (CO) is one of the primary components of emissions from light-duty vehicles, and reportedly comprises 77% of all pollutants emitted in terms of concentration. Exposure to CO aggravates cardiovascular disease and causes other health disorders. The study was aimed to assess the negative effects by injecting different amounts of CO concentration directly to human volunteers boarding in the car. Methods Human volunteers were exposed to CO concentrations of 0, 33.2, and 72.4 ppm, respectively during the first test and 0, 30.3, and 48.8 ppm respectively during the second test while seated in the car. The volunteers were exposed to each concentration for approximately 45 min. After exposure, blood pressure measurement, blood collection (carboxyhemoglobin [COHb] analysis), medical interview, echocardiography test, and cognitive reaction test were performed. Result In patients who were exposed to a mean concentration of CO for 72.4 ± 1.4 ppm during the first exposure test and 48.8 ± 3.7 ppm during the second exposure test, the COHb level exceeded 2%. Moreover, the diastolic blood pressure was decreased while increasing in CO concentration after exposure. The medical interview findings showed that the degree of fatigue was increased and the degree of concentration was reduced when the exposed concentration of CO was increased. Conclusion Although the study had a limited sample size, we found that even a low concentration of CO flowing into a car could have a negative influence on human health, such as change of blood pressure and degree of fatigue.
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Affiliation(s)
- Geon-Woo Lee
- Department of Public Health, Graduate School, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, Korea.,The Institute for Environmental Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Korea
| | - Mun-Joo Bae
- Graduate School of Public Health, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, Korea
| | - Ji-Yeon Yang
- The Institute for Environmental Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Korea
| | - Jung-Woo Son
- Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Korea
| | - Jae-Lim Cho
- Department of Occupational and Environmental Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Sang-Gyu Lee
- The Institute for Environmental Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Korea
| | - Bo-Mi Jang
- The Institute for Environmental Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Korea
| | - Hyun-Woo Lee
- Korea Automobile Testing & Research Institute, 200 Samjon-ro, Songsan-myun, Hwaseong-si, Gyeonggi-do, Korea
| | - Jong-Soon Lim
- Korea Automobile Testing & Research Institute, 200 Samjon-ro, Songsan-myun, Hwaseong-si, Gyeonggi-do, Korea
| | - Dong-Chun Shin
- The Institute for Environmental Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Korea
| | - Young-Wook Lim
- The Institute for Environmental Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Korea.
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Yang HC, Chang SH, Lu R, Liou DM. The effect of particulate matter size on cardiovascular health in Taipei Basin, Taiwan. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 137:261-268. [PMID: 28110730 DOI: 10.1016/j.cmpb.2016.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/15/2016] [Accepted: 08/19/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Although the overall effect of particulate matter (PM) on cardiovascular disease (CVD) has been previously documented, the effect of different PM sizes (PM10, PM2.5-10 and PM2.5) has not been well studied. This study estimates the effect of different PM sizes on the incidence of CVD in Taipei, Taiwan. METHODS We collected outpatients with CVD from 2006 to 2010 and data on the concentrations of air pollutants such as PM10, PM2.5-10, PM2.5, sulfur dioxide, carbon monoxide, nitrogen dioxide, and ozone. A Distributed Lag Non-linear Model (DLNM) was used to explore the effect of different PM sizes on CVD risk. RESULTS In high air pollution events, PM2.5 was significantly associated with elevated risk (4.9%) [95% confidence interval (CI): 1.010-1.089] for CVD with increasing interquartile range (IQR) in single air pollutant model. PM2.5-10 and PM10 did not show a significant positive association with CVD in this study. After adjusting for other air pollutants such as SO2, CO, NO2, and O3, the estimated effect of PM2.5 only decreased 0.2%. Moreover, patients under 40 years old did not show a significant association between PM2.5 and CVD. CONCLUSION This study demonstrates that only PM2.5 is significantly positively correlated with the number of daily outpatient visits for CVD during high air pollution events.
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Affiliation(s)
- Hsuan-Chia Yang
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan; International Center for Health Information Technology (ICHIT), Taipei Medical University, Taiwan
| | - Shu-Hao Chang
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Richard Lu
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taiwan; Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Der-Ming Liou
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan; Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan; Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.
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38
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Alterations in the airborne bacterial community during Asian dust events occurring between February and March 2015 in South Korea. Sci Rep 2016; 6:37271. [PMID: 27849049 PMCID: PMC5110963 DOI: 10.1038/srep37271] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 10/27/2016] [Indexed: 11/14/2022] Open
Abstract
During Asian dust events, a relatively high concentration of particulate matter is transported by wind from arid and semi-arid regions, such as the Gobi and Taklamakan deserts, to nearby countries, including China, Korea, and Japan. The dust particles contain various microorganisms, which can affect human health as well as the environmental microbe population. In the current study, we investigated the characteristics of the airborne bacterial community during Asian dust events between February and March 2015 in South Korea. Bacterial diversity indexes such as operational taxonomic units, Chao1 and Inverse Simpson index were increased, along with total 16S rRNA gene copy number during Asian dust events. The bacterial community structure during Asian dust events was clearly distinguishable from that during non-Asian dust days. The genera Bacillus and Modestobacter were increased 3.9- and 2.7-fold, respectively, while Escherichia-Shigella was decreased by 89.8%. A non-metric multidimensional scaling plot with metadata analysis revealed association of particulate matter concentration, but not temperature, humidity or wind speed, with bacterial community structure, suggesting that the newly transported dust particles contain various microorganisms that influence the airborne bacterial environment.
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Matsuo R, Michikawa T, Ueda K, Ago T, Nitta H, Kitazono T, Kamouchi M. Short-Term Exposure to Fine Particulate Matter and Risk of Ischemic Stroke. Stroke 2016; 47:3032-3034. [PMID: 27811333 DOI: 10.1161/strokeaha.116.015303] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 08/31/2016] [Accepted: 09/27/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE There is a strong association between ambient concentrations of particulate matter (PM) and cardiovascular disease. However, it remains unclear whether acute exposure to fine PM (PM2.5) triggers ischemic stroke events and whether the timing of exposure is associated with stroke risk. We, therefore, examined the association between ambient PM2.5 and occurrence of ischemic stroke. METHODS We analyzed data for 6885 ischemic stroke patients from a multicenter hospital-based stroke registry in Japan who were previously independent and hospitalized within 24 hours of stroke onset. Time of symptom onset was confirmed, and the association between PM (suspended PM and PM2.5) and occurrence of ischemic stroke was analyzed by time-stratified case-crossover analysis. RESULTS Ambient PM2.5 and suspended PM at lag days 0 to 1 were associated with subsequent occurrence of ischemic stroke (ambient temperature-adjusted odds ratio [95% confidence interval] per 10 μg/m3: suspended PM, 1.02 [1.00-1.05]; PM2.5, 1.03 [1.00-1.06]). In contrast, ambient suspended PM and PM2.5 at lag days 2 to 3 or 4 to 6 showed no significant association with stroke occurrence. The association between PM2.5 at lag days 0 to 1 and ischemic stroke was maintained after adjusting for other air pollutants (nitrogen dioxide, photochemical oxidants, or sulfur dioxide) or influenza epidemics and was evident in the cold season. CONCLUSIONS These findings suggest that short-term exposure to PM2.5 within 1 day before onset is associated with the subsequent occurrence of ischemic stroke.
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Affiliation(s)
- Ryu Matsuo
- From the Department of Health Care Administration and Management (R.M., M.K.), Department of Medicine and Clinical Science (R.M., T.A., T.K.), and Center for Cohort Studies (T.K., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Environmental Epidemiology Section, Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan (T.M., K.U., H.N.); and Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Japan (K.U.)
| | - Takehiro Michikawa
- From the Department of Health Care Administration and Management (R.M., M.K.), Department of Medicine and Clinical Science (R.M., T.A., T.K.), and Center for Cohort Studies (T.K., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Environmental Epidemiology Section, Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan (T.M., K.U., H.N.); and Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Japan (K.U.)
| | - Kayo Ueda
- From the Department of Health Care Administration and Management (R.M., M.K.), Department of Medicine and Clinical Science (R.M., T.A., T.K.), and Center for Cohort Studies (T.K., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Environmental Epidemiology Section, Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan (T.M., K.U., H.N.); and Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Japan (K.U.)
| | - Tetsuro Ago
- From the Department of Health Care Administration and Management (R.M., M.K.), Department of Medicine and Clinical Science (R.M., T.A., T.K.), and Center for Cohort Studies (T.K., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Environmental Epidemiology Section, Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan (T.M., K.U., H.N.); and Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Japan (K.U.)
| | - Hiroshi Nitta
- From the Department of Health Care Administration and Management (R.M., M.K.), Department of Medicine and Clinical Science (R.M., T.A., T.K.), and Center for Cohort Studies (T.K., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Environmental Epidemiology Section, Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan (T.M., K.U., H.N.); and Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Japan (K.U.)
| | - Takanari Kitazono
- From the Department of Health Care Administration and Management (R.M., M.K.), Department of Medicine and Clinical Science (R.M., T.A., T.K.), and Center for Cohort Studies (T.K., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Environmental Epidemiology Section, Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan (T.M., K.U., H.N.); and Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Japan (K.U.)
| | - Masahiro Kamouchi
- From the Department of Health Care Administration and Management (R.M., M.K.), Department of Medicine and Clinical Science (R.M., T.A., T.K.), and Center for Cohort Studies (T.K., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Environmental Epidemiology Section, Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan (T.M., K.U., H.N.); and Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Japan (K.U.).
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Han MH, Yi HJ, Kim YS, Ko Y, Kim YS. Association between Diurnal Variation of Ozone Concentration and Stroke Occurrence: 24-Hour Time Series Study. PLoS One 2016; 11:e0152433. [PMID: 27015421 PMCID: PMC4807846 DOI: 10.1371/journal.pone.0152433] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 03/14/2016] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Increasing ozone concentrations have been known to damage human health and ecosystems. Although ozone tends to display diurnal variation, most studies have reported only on the association between daily ozone concentrations and ischemic stroke occurrence on the same day, or with a 1-day lag. We investigated the effect of the diurnal variation of ozone on ischemic stroke occurrence during the same day. Methods We included a consecutive series of 1,734 patients from January 1, 2008, to December 31, 2014, at a single tertiary hospital in Seoul, South Korea. We evaluated differences between temperature and pollutants at the time of stroke onset for each time interval and averaged those parameters across the 7-year study period. Results During the interval from 13:00 to 16:59, we found a positive association between ischemic stroke occurrence and ozone concentration relative to other time periods. Upper median ozone levels from 13:00 to 16:59 were positively correlated with ischemic stroke (odds ratio, 1.550; 95% confidence intervals, 1.220 to 1.970; P = <0.001) when compared with lower median levels. Conclusions The results show diurnal patterns of ischemic stroke occurrence based on upper and lower median ozone levels for a 24-hour period, which extends understanding of the association between stroke occurrence and environmental influences.
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Affiliation(s)
- Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471–701, Gyonggi-do, Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, 222–1, Wangsimni-ro, Seongdong-gu, Seoul, Korea
- * E-mail:
| | - Young-Seo Kim
- Department of Neurology, Hanyang University Medical Center, 222–1, Wangsimni-ro, Seongdong-gu, Seoul, Korea
| | - Yong Ko
- Department of Neurosurgery, Hanyang University Medical Center, 222–1, Wangsimni-ro, Seongdong-gu, Seoul, Korea
| | - Young-Soo Kim
- Department of Neurosurgery, Hanyang University Medical Center, 222–1, Wangsimni-ro, Seongdong-gu, Seoul, Korea
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Tian L, Qiu H, Pun VC, Ho KF, Chan CS, Yu IT. Carbon monoxide and stroke: A time series study of ambient air pollution and emergency hospitalizations. Int J Cardiol 2015; 201:4-9. [DOI: 10.1016/j.ijcard.2015.07.099] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/06/2015] [Accepted: 07/29/2015] [Indexed: 12/16/2022]
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Männistö T, Mendola P, Grantz KL, Leishear K, Sundaram R, Sherman S, Ying Q, Liu D. Acute and recent air pollution exposure and cardiovascular events at labour and delivery. Heart 2015; 101:1491-8. [PMID: 26105036 PMCID: PMC5575746 DOI: 10.1136/heartjnl-2014-307366] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 05/26/2015] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To study the relationship between acute air pollution exposure and cardiovascular events during labour/delivery. METHODS The Consortium on Safe Labor (2002-2008), an observational US cohort with 223,502 singleton deliveries provided electronic medical records. Air pollution exposure was estimated by modified Community Multiscale Air Quality models. Cardiovascular events (cardiac failure/arrest, stroke, myocardial infarcts and other events) were recorded in the hospital discharge records for 687 pregnancies (0.3%). Logistic regression with generalised estimating equations estimated the relationship between cardiovascular events and daily air pollutant levels for delivery day and the 7 days preceding delivery. RESULTS Increased odds of cardiovascular events were observed for each IQR increase in exposure to nitric oxides at 5 and 6 days prior to delivery (OR=1.17, 99% CI 1.04 to 1.30 and OR=1.15, 1.03 to 1.28, respectively). High exposure to toxic air pollution species such as ethylbenzene (OR=1.50, 1.08 to 2.09), m-xylene (OR=1.54, 1.11 to 2.13), o-xylene (OR=1.51, 1.09 to 2.09), p-xylene (OR=1.43, 1.03 to 1.99) and toluene (OR=1.42, 1.02 to 1.97) at 5 days prior to delivery were also associated with cardiovascular events. Decreased odds of events were observed with exposure to ozone. CONCLUSIONS Air pollution in the days prior to delivery, especially nitrogen oxides and some toxic air pollution species, was associated with increased risk of cardiovascular events during the labour/delivery admission.
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Affiliation(s)
- Tuija Männistö
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland, USA
- Northern Finland Laboratory Centre NordLab, Oulu, Finland
- Department of Clinical Chemistry, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Oulu, Finland
| | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland, USA
| | - Katherine Laughon Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland, USA
| | - Kira Leishear
- Glotech Inc., Rockville, Maryland, USA
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland, USA
| | | | - Qi Ying
- Zachry Department of Civil Engineering, Texas A&M University, College Station, Texas, USA
| | - Danping Liu
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland, USA
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Korek MJ, Bellander TD, Lind T, Bottai M, Eneroth KM, Caracciolo B, de Faire UH, Fratiglioni L, Hilding A, Leander K, Magnusson PKE, Pedersen NL, Östenson CG, Pershagen G, Penell JC. Traffic-related air pollution exposure and incidence of stroke in four cohorts from Stockholm. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2015; 25:517-23. [PMID: 25827311 PMCID: PMC4648059 DOI: 10.1038/jes.2015.22] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 02/23/2015] [Accepted: 02/23/2015] [Indexed: 05/19/2023]
Abstract
We investigated the risk of stroke related to long-term ambient air pollution exposure, in particular the role of various exposure time windows, using four cohorts from Stockholm County, Sweden. In total, 22,587 individuals were recruited from 1992 to 2004 and followed until 2011. Yearly air pollution levels resulting from local road traffic emissions were assessed at participant residences using dispersion models for particulate matter (PM10) and nitrogen oxides (NOX). Cohort-specific hazard ratios were estimated for time-weighted air pollution exposure during different time windows and the incidence of stroke, adjusted for common risk factors, and then meta-analysed. Overall, 868 subjects suffered a non-fatal or fatal stroke during 238,731 person-years of follow-up. An increment of 20 μg/m(3) in estimated annual mean of road-traffic related NOX exposure at recruitment was associated with a hazard ratio of 1.16 (95% CI 0.83-1.61), with evidence of heterogeneity between the cohorts. For PM10, an increment of 10 μg/m(3) corresponded to a hazard ratio of 1.14 (95% CI 0.68-1.90). Time-window analyses did not reveal any clear induction-latency pattern. In conclusion, we found suggestive evidence of an association between long-term exposure to NOX and PM10 from local traffic and stroke at comparatively low levels of air pollution.
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Affiliation(s)
- Michal J Korek
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Karolinska Institutet, Institute of Environmental Medicine, Nobels väg 13 Box 210, Stockholm, SE-171 77, Sweden. Tel.: +46 8 524 87457. Fax: +46 8 304571. E-mail:
| | - Tom D Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Tomas Lind
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Barbara Caracciolo
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Ulf H de Faire
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Laura Fratiglioni
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
- Division of Clinical Geriatrics, Karolinska University Hospital, Stockholm, Sweden
| | - Agneta Hilding
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistcs, Karolinska Institutet, Stockholm, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistcs, Karolinska Institutet, Stockholm, Sweden
| | - Claes-Göran Östenson
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johanna C Penell
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Shah ASV, Lee KK, McAllister DA, Hunter A, Nair H, Whiteley W, Langrish JP, Newby DE, Mills NL. Short term exposure to air pollution and stroke: systematic review and meta-analysis. BMJ 2015; 350:h1295. [PMID: 25810496 PMCID: PMC4373601 DOI: 10.1136/bmj.h1295] [Citation(s) in RCA: 469] [Impact Index Per Article: 52.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To review the evidence for the short term association between air pollution and stroke. DESIGN Systematic review and meta-analysis of observational studies DATA SOURCES Medline, Embase, Global Health, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science searched to January 2014 with no language restrictions. ELIGIBILITY CRITERIA Studies investigating the short term associations (up to lag of seven days) between daily increases in gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide, ozone) and particulate matter (<2.5 µm or <10 µm diameter (PM2.5 and PM10)), and admission to hospital for stroke or mortality. MAIN OUTCOME MEASURES Admission to hospital and mortality from stroke. RESULTS From 2748 articles, 238 were reviewed in depth with 103 satisfying our inclusion criteria and 94 contributing to our meta-estimates. This provided a total of 6.2 million events across 28 countries. Admission to hospital for stroke or mortality from stroke was associated with an increase in concentrations of carbon monoxide (relative risk 1.015 per 1 ppm, 95% confidence interval 1.004 to 1.026), sulphur dioxide (1.019 per 10 ppb, 1.011 to 1.027), and nitrogen dioxide (1.014 per 10 ppb, 1.009 to 1.019). Increases in PM2.5 and PM10 concentration were also associated with admission and mortality (1.011 per 10 μg/m(3) (1.011 to 1.012) and 1.003 per 10 µg/m(3) (1.002 to 1.004), respectively). The weakest association was seen with ozone (1.001 per 10 ppb, 1.000 to 1.002). Strongest associations were observed on the day of exposure with more persistent effects observed for PM(2·5). CONCLUSION Gaseous and particulate air pollutants have a marked and close temporal association with admissions to hospital for stroke or mortality from stroke. Public and environmental health policies to reduce air pollution could reduce the burden of stroke. SYSTEMATIC REVIEW REGISTRATION PROSPERO-CRD42014009225.
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Affiliation(s)
- Anoop S V Shah
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Kuan Ken Lee
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - David A McAllister
- Centre of Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Amanda Hunter
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Harish Nair
- Centre of Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - William Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jeremy P Langrish
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - David E Newby
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Nicholas L Mills
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
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Guo L, Li B, Miao JJ, Yun Y, Li GK, Sang N. Seasonal Variation in Air Particulate Matter (PM10) Exposure-Induced Ischemia-Like Injuries in the Rat Brain. Chem Res Toxicol 2014; 28:431-9. [DOI: 10.1021/tx500392n] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Lin Guo
- College of Environment and
Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, P. R. China
| | - Ben Li
- College of Environment and
Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, P. R. China
| | - Juan-juan Miao
- College of Environment and
Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, P. R. China
| | - Yang Yun
- College of Environment and
Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, P. R. China
| | - Guang-ke Li
- College of Environment and
Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, P. R. China
| | - Nan Sang
- College of Environment and
Resource, Research Center of Environment and Health, Shanxi University, Taiyuan, Shanxi 030006, P. R. China
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Shin HH, Fann N, Burnett RT, Cohen A, Hubbell BJ. Outdoor fine particles and nonfatal strokes: systematic review and meta-analysis. Epidemiology 2014; 25:835-42. [PMID: 25188557 PMCID: PMC4222795 DOI: 10.1097/ede.0000000000000162] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 05/02/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Epidemiologic studies find that long- and short-term exposure to fine particles (PM2.5) is associated with adverse cardiovascular outcomes, including ischemic and hemorrhagic strokes. However, few systematic reviews or meta-analyses have synthesized these results. METHODS We reviewed epidemiologic studies that estimated the risks of nonfatal strokes attributable to ambient PM2.5. To pool risks among studies we used a random-effects model and 2 Bayesian approaches. The first Bayesian approach assumes a normal prior that allows risks to be zero, positive or negative. The second assumes a gamma prior, where risks can only be positive. This second approach is proposed when the number of studies pooled is small, and there is toxicological or clinical literature to support a causal relation. RESULTS We identified 20 studies suitable for quantitative meta-analysis. Evidence for publication bias is limited. The frequentist meta-analysis produced pooled risk ratios of 1.06 (95% confidence interval = 1.00-1.13) and 1.007 (1.003-1.010) for long- and short-term effects, respectively. The Bayesian meta-analysis found a posterior mean risk ratio of 1.08 (95% posterior interval = 0.96-1.26) and 1.008 (1.003-1.013) from a normal prior, and of 1.05 (1.02-1.10) and 1.008 (1.004-1.013) from a gamma prior, for long- and short-term effects, respectively, per 10 μg/m PM2.5. CONCLUSIONS Sufficient evidence exists to develop a concentration-response relation for short- and long-term exposures to PM2.5 and stroke incidence. Long-term exposures to PM2.5 result in a higher risk ratio than short-term exposures, regardless of the pooling method. The evidence for short-term PM2.5-related ischemic stroke is especially strong.
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Affiliation(s)
- Hwashin H. Shin
- From the Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada; Department of Mathematics and Statistics, Queen’s University, Kingston, ON, Canada; Health and Environmental Impacts Division, Office of Air Quality Planning and Standards, U.S. Environmental Protection Agency, NC; and Health Effects Institute, Boston, MA
| | - Neal Fann
- From the Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada; Department of Mathematics and Statistics, Queen’s University, Kingston, ON, Canada; Health and Environmental Impacts Division, Office of Air Quality Planning and Standards, U.S. Environmental Protection Agency, NC; and Health Effects Institute, Boston, MA
| | - Richard T. Burnett
- From the Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada; Department of Mathematics and Statistics, Queen’s University, Kingston, ON, Canada; Health and Environmental Impacts Division, Office of Air Quality Planning and Standards, U.S. Environmental Protection Agency, NC; and Health Effects Institute, Boston, MA
| | - Aaron Cohen
- From the Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada; Department of Mathematics and Statistics, Queen’s University, Kingston, ON, Canada; Health and Environmental Impacts Division, Office of Air Quality Planning and Standards, U.S. Environmental Protection Agency, NC; and Health Effects Institute, Boston, MA
| | - Bryan J. Hubbell
- From the Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada; Department of Mathematics and Statistics, Queen’s University, Kingston, ON, Canada; Health and Environmental Impacts Division, Office of Air Quality Planning and Standards, U.S. Environmental Protection Agency, NC; and Health Effects Institute, Boston, MA
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Affiliation(s)
- Petter L Ljungman
- From the Department of Medicine Cardiovascular Epidemiology Research Unit, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (P.L.L., M.A.M.); and Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.)
| | - Murray A Mittleman
- From the Department of Medicine Cardiovascular Epidemiology Research Unit, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (P.L.L., M.A.M.); and Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.).
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Talbott EO, Rager JR, Benson S, Brink LA, Bilonick RA, Wu C. A case-crossover analysis of the impact of PM(2.5) on cardiovascular disease hospitalizations for selected CDC tracking states. ENVIRONMENTAL RESEARCH 2014; 134:455-65. [PMID: 25277761 DOI: 10.1016/j.envres.2014.06.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 05/23/2014] [Accepted: 06/19/2014] [Indexed: 05/21/2023]
Abstract
BACKGROUND Information is currently being collected by the CDC Environmental Public Health Tracking (EPHT) network on hospitalizations due to Acute Myocardial Infarction (AMI) and there is interest by CDC in exploring the relationship between fine particulate matter (PM2.5) and other cardiovascular (CVD) outcomes in the context of the EPHT program. The goal of this study was to assess the short term effects of daily PM(2.5) air pollution levels on hospitalizations for CVD for seven states within the CDC EPHT network (Florida, Massachusetts, New Hampshire, New Jersey, New Mexico, New York, and Washington). METHODS Hospitalization data was obtained for 2001-2008 admissions for circulatory disease (primary discharge diagnosis of ICD-9 codes 390-459) from data stewards in those states and included admission date, age, gender, and zip code of residence. We used CMAQ-derived predicted daily PM2.5 data as estimated by EPA at the centroid of each Census Bureau Zip Code Tabulation Area (ZCTA) and linked to zip code of patient residence. A time-stratified case-crossover study design with conditional logistic regression was used to evaluate the short-term association of PM2.5 on risk of non-elective hospitalizations for CVD. Specifically, we considered all circulatory disease, ischemic heart disease, acute myocardial infarction, heart failure, cardiac arrhythmia, cerebrovascular disease and peripheral vascular disease endpoints. RESULTS Data were obtained on over 7,500,000 hospitalizations for this time period. Mean annual PM2.5 exposure levels were lowest for New Mexico and Washington (6.5 μg/m3 PM2.5 and 8.4 μg/m3 PM2.5). New Jersey, New York and Massachusetts exhibited the highest annual averages for PM2.5, (12.8 μg/m3, 11.1 μg/m3 and 10.8 μg/m3), respectively. The Northeast states (Massachusetts, New Jersey, New Hampshire and New York) exhibited significant effects of PM2.5 during the cooler months across most disease categories after adjustment for ozone and maximum apparent temperature. Ischemic heart disease risk per 10 μg/m3 increase in PM2.5 varied from 1.02 to 1.05 for the cooler months. The largest lag effect was noted on lag days 0 and 1. New Mexico and Washington exhibited no cool or warm month significant effects. Although Florida showed no cooler month effects, significant increases were noted in odds ratios for the warm weather months for all outcomes except peripheral vascular disease. This study is one of the first large scale applications of linkage of hospitalization data by state with national US EPA statistically modeled air pollution data. The results demonstrate that state-wide, there are multiple cardiovascular outcomes in addition to AMI which may be impacted by particulate air pollution.
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Affiliation(s)
- Evelyn O Talbott
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA 15261, United States
| | - Judith R Rager
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA 15261, United States
| | - Stacey Benson
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA 15261, United States
| | - Lu Ann Brink
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA 15261, United States
| | - Richard A Bilonick
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA 15261, United States
| | - Candace Wu
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA 15261, United States
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Wang Y, Eliot MN, Wellenius GA. Short-term changes in ambient particulate matter and risk of stroke: a systematic review and meta-analysis. J Am Heart Assoc 2014; 3:jah3630. [PMID: 25103204 PMCID: PMC4310387 DOI: 10.1161/jaha.114.000983] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Stroke is a leading cause of death and long‐term disability in the United States. There is a well‐documented association between ambient particulate matter air pollution (PM) and cardiovascular disease morbidity and mortality. Given the pathophysiologic mechanisms of these effects, short‐term elevations in PM may also increase the risk of ischemic and/or hemorrhagic stroke morbidity and mortality, but the evidence has not been systematically reviewed. Methods and Results We provide a comprehensive review of all observational human studies (January 1966 to January 2014) on the association between short‐term changes in ambient PM levels and cerebrovascular events. We also performed meta‐analyses to evaluate the evidence for an association between each PM size fraction (PM2.5, PM10, PM2.5‐10) and each outcome (total cerebrovascular disease, ischemic stroke/transient ischemic attack, hemorrhagic stroke) separately for mortality and hospital admission. We used a random‐effects model to estimate the summary percent change in relative risk of the outcome per 10‐μg/m3 increase in PM. Conclusions We found that PM2.5 and PM10 are associated with a 1.4% (95% CI 0.9% to 1.9%) and 0.5% (95% CI 0.3% to 0.7%) higher total cerebrovascular disease mortality, respectively, with evidence of inconsistent, nonsignificant associations for hospital admission for total cerebrovascular disease or ischemic or hemorrhagic stroke. Current limited evidence does not suggest an association between PM2.5‐10 and cerebrovascular mortality or morbidity. We discuss the potential sources of variability in results across studies, highlight some observations, and identify gaps in literature and make recommendations for future studies.
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Affiliation(s)
- Yi Wang
- Department of Epidemiology, Brown University School of Public Health, Providence, RI (Y.W., M.N.E., G.A.W.) Department of Environmental Health Sciences, Indiana University Fairbanks School of Public Health, Indianapolis, IN (Y.W.)
| | - Melissa N Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI (Y.W., M.N.E., G.A.W.)
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI (Y.W., M.N.E., G.A.W.)
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Sørensen M, Lühdorf P, Ketzel M, Andersen ZJ, Tjønneland A, Overvad K, Raaschou-Nielsen O. Combined effects of road traffic noise and ambient air pollution in relation to risk for stroke? ENVIRONMENTAL RESEARCH 2014; 133:49-55. [PMID: 24906068 DOI: 10.1016/j.envres.2014.05.011] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/05/2014] [Accepted: 05/07/2014] [Indexed: 05/06/2023]
Abstract
Exposure to road traffic noise and air pollution have both been associated with risk for stroke. The few studies including both exposures show inconsistent results. We aimed to investigate potential mutual confounding and combined effects between road traffic noise and air pollution in association with risk for stroke. In a population-based cohort of 57,053 people aged 50-64 years at enrollment, we identified 1999 incident stroke cases in national registries, followed by validation through medical records. Mean follow-up time was 11.2 years. Present and historical residential addresses from 1987 to 2009 were identified in national registers and road traffic noise and air pollution were modeled for all addresses. Analyses were done using Cox regression. A higher mean annual exposure at time of diagnosis of 10 µg/m(3) nitrogen dioxide (NO2) and 10 dB road traffic noise at the residential address was associated with ischemic stroke with incidence rate ratios (IRR) of 1.11 (95% CI: 1.03, 1.20) and 1.16 (95% CI: 1.07, 1.24), respectively, in single exposure models. In two-exposure models road traffic noise (IRR: 1.15) and not NO2 (IRR: 1.02) was associated with ischemic stroke. The strongest association was found for combination of high noise and high NO2 (IRR=1.28; 95% CI=1.09-1.52). Fatal stroke was positively associated with air pollution and not with traffic noise. In conclusion, in mutually adjusted models road traffic noise and not air pollution was associated ischemic stroke, while only air pollution affected risk for fatal strokes. There were indications of combined effects.
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Affiliation(s)
- Mette Sørensen
- Diet, Genes and Environment, Danish Cancer Society Research Centre, Strandboulevarden 49, 2100 Copenhagen, Denmark.
| | - Pernille Lühdorf
- Department of Neurology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Zorana J Andersen
- Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Centre, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Raaschou-Nielsen
- Diet, Genes and Environment, Danish Cancer Society Research Centre, Strandboulevarden 49, 2100 Copenhagen, Denmark
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