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Yang L, Wang M, Xuan C, Yu C, Zhu Y, Luo H, Meng X, Shi S, Wang Y, Chu H, Chen R, Yan J. Long-term exposure to particulate matter pollution and incidence of ischemic and hemorrhagic stroke: A prospective cohort study in Eastern China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 358:124446. [PMID: 38945192 DOI: 10.1016/j.envpol.2024.124446] [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: 03/11/2024] [Revised: 06/18/2024] [Accepted: 06/24/2024] [Indexed: 07/02/2024]
Abstract
Although epidemiological studies have demonstrated significant associations of long-term exposure to particulate matter (PM) air pollution with stroke, evidence on the long-term effects of PM exposure on cause-specific stroke incidence is scarce and inconsistent. We incorporated 33,282 and 33,868 individuals aged 35-75 years without a history of ischemic or hemorrhagic stroke at the baseline in 2014, who were followed up till 2021. Residential exposures to particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5) and particulate matter with an aerodynamic diameter less than 10 μm (PM10) for each participant were predicted using a satellite-based model with a spatial resolution of 1 × 1 km. We employed time-varying Cox proportional hazards models to assess the long-term effect of PM pollution on incident stroke. We identified 926 cases of ischemic stroke and 211 of hemorrhagic stroke. Long-term PM exposure was significantly associated with increased incidence of both ischemic and hemorrhagic stroke, with almost 2 times higher risk on hemorrhagic stroke. Specifically, a 10 μg/m³ increase in 3-year average concentrations of PM2.5 was linked to a hazard ratio (HR) of 1.35 (95% confidence interval (CI): 1.18-1.54) for incident ischemic stroke and 1.79 (95% CI: 1.36-2.34) for incident hemorrhagic stroke. The HR related to PM10, though smaller, remained statistically significant, with a HR of 1.25 for ischemic stroke and a HR of 1.51 for hemorrhagic stroke. The excess risks are larger among rural residents and individuals with lower educational attainment. The present cohort study contributed to the mounting evidence on the increased risk of incident stroke associated with long-term PM exposures. Our results further provide valuable evidence on the heightened sensitivity of hemorrhagic stroke to air pollution exposures compared with ischemic stroke.
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Affiliation(s)
- Li Yang
- Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Menghao Wang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Cheng Xuan
- Chronic Disease Control Department, Zhuji Second People's Hospital, Zhuji, Zhejiang, China
| | - Caiyan Yu
- Chronic Disease Control Department, Zhuji Second People's Hospital, Zhuji, Zhejiang, China
| | - Yixiang Zhu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Huihuan Luo
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Xia Meng
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Su Shi
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yali Wang
- Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Hongjie Chu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Jing Yan
- Zhejiang Hospital, Hangzhou, Zhejiang, China.
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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 PMCID: PMC11274972 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; (G.K.); (L.B.)
| | - 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; (G.K.); (L.B.)
| | - Paweł Zagożdżon
- Department of Hygiene and Epidemiology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
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White AR. The firestorm within: A narrative review of extreme heat and wildfire smoke effects on brain health. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 922:171239. [PMID: 38417511 DOI: 10.1016/j.scitotenv.2024.171239] [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: 11/20/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/01/2024]
Abstract
Climate change is generating increased heatwaves and wildfires across much of the world. With these escalating environmental changes comes greater impacts on human health leading to increased numbers of people suffering from heat- and wildfire smoke-associated respiratory and cardiovascular impairment. One area of health impact of climate change that has received far less attention is the effects of extreme heat and wildfire smoke exposure on human brain health. As elevated temperatures, and wildfire-associated smoke, are increasingly experienced simultaneously over summer periods, understanding this combined impact is critical to management of human health especially in the elderly, and people with dementia, and other neurological disorders. Both extreme heat and wildfire smoke air pollution (especially particulate matter, PM) induce neuroinflammatory and cerebrovascular effects, oxidative stress, and cognitive impairment, however the combined effect of these impacts are not well understood. In this narrative review, a comprehensive examination of extreme heat and wildfire smoke impact on human brain health is presented, with a focus on how these factors contribute to cognitive impairment, and dementia, one of the leading health issues today. Also discussed is the potential impact of combined heat and wildfire smoke on brain health, and where future efforts should be applied to help advance knowledge in this rapidly growing and critical field of health research.
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Affiliation(s)
- Anthony R White
- Mental Health and Neuroscience Program, QIMR Berghofer Medical Research Institute, Herston, Queensland 4006, Australia; A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Neulaniementie 2, 70211 Kuopio, Finland; School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, QLD, Australia.
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Wu Y, Shen P, Yang Z, Yu L, Xu L, Zhu Z, Li T, Luo D, Lin H, Shui L, Tang M, Jin M, Chen K, Wang J. Outdoor Light at Night, Air Pollution, and Risk of Cerebrovascular Disease: A Cohort Study in China. Stroke 2024; 55:990-998. [PMID: 38527152 DOI: 10.1161/strokeaha.123.044904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 01/22/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND We sought to explore the associations of outdoor light at night (LAN) and air pollution with the risk of cerebrovascular disease (CeVD). METHODS We included a total of 28 302 participants enrolled in Ningbo, China from 2015 to 2018. Outdoor LAN and air pollution were assessed by Satellite-derived images and land-use regression models. CeVD cases were confirmed by medical records and death certificates and further subdivided into ischemic and hemorrhagic stroke. Cox proportional hazard models were used to estimate hazard ratios and 95% CIs. RESULTS A total of 1278 CeVD cases (including 777 ischemic and 133 hemorrhagic stroke cases) were identified during 127 877 person-years of follow-up. In the single-exposure models, the hazard ratios for CeVD were 1.17 (95% CI, 1.06-1.29) for outdoor LAN, 1.25 (1.12-1.39) for particulate matter with an aerodynamic diameter ≤2.5 µm, 1.14 (1.06-1.22) for particulate matter with aerodynamic diameter ≤10 μm, and 1.21 (1.06-1.38) for NO2 in every interquartile range increase. The results were similar for ischemic stroke, whereas no association was observed for hemorrhagic stroke. In the multiple-exposure models, the associations of outdoor LAN and PM with CeVD persisted but not for ischemic stroke. Furthermore, no interaction was observed between outdoor LAN and air pollution. CONCLUSIONS Levels of exposure to outdoor LAN and air pollution were positively associated with the risk of CeVD. Furthermore, the detrimental effects of outdoor LAN and air pollution might be mutually independent.
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Affiliation(s)
- Yonghao Wu
- Department of Public Health, and Department of Endocrinology of the Children's Hospital (Y.W., Z.Y., L.Y., L.X., T.L., J.W.), Zhejiang University School of Medicine, Hangzhou, China
| | - Peng Shen
- Department of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China (P.S., H.L.)
| | - Zongming Yang
- Department of Public Health, and Department of Endocrinology of the Children's Hospital (Y.W., Z.Y., L.Y., L.X., T.L., J.W.), Zhejiang University School of Medicine, Hangzhou, China
| | - Luhua Yu
- Department of Public Health, and Department of Endocrinology of the Children's Hospital (Y.W., Z.Y., L.Y., L.X., T.L., J.W.), Zhejiang University School of Medicine, Hangzhou, China
| | - Lisha Xu
- Department of Public Health, and Department of Endocrinology of the Children's Hospital (Y.W., Z.Y., L.Y., L.X., T.L., J.W.), Zhejiang University School of Medicine, Hangzhou, China
| | - Zhanghang Zhu
- Department of Public Health, Second Affiliated Hospital (Z.Z., M.J., K.C.), Zhejiang University School of Medicine, Hangzhou, China
| | - Tiezheng Li
- Department of Public Health, and Department of Endocrinology of the Children's Hospital (Y.W., Z.Y., L.Y., L.X., T.L., J.W.), Zhejiang University School of Medicine, Hangzhou, China
| | - Dan Luo
- Department of Public Health, Hangzhou Medical College, China (D.L.)
| | - Hongbo Lin
- Department of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China (P.S., H.L.)
| | - Liming Shui
- Yinzhou District Health Bureau of Ningbo, China (L.S.)
| | - Mengling Tang
- Department of Public Health, Fourth Affiliated Hospital (M.T.), Zhejiang University School of Medicine, Hangzhou, China
| | - Mingjuan Jin
- Department of Public Health, Second Affiliated Hospital (Z.Z., M.J., K.C.), Zhejiang University School of Medicine, Hangzhou, China
| | - Kun Chen
- Department of Public Health, Second Affiliated Hospital (Z.Z., M.J., K.C.), Zhejiang University School of Medicine, Hangzhou, China
| | - Jianbing Wang
- Department of Public Health, and Department of Endocrinology of the Children's Hospital (Y.W., Z.Y., L.Y., L.X., T.L., J.W.), Zhejiang University School of Medicine, Hangzhou, China
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Lamorie-Foote K, Ge B, Shkirkova K, Liu Q, Mack W. Effect of Air Pollution Particulate Matter on Ischemic and Hemorrhagic Stroke: A Scoping Review. Cureus 2023; 15:e46694. [PMID: 37942398 PMCID: PMC10629995 DOI: 10.7759/cureus.46694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
Air pollution particulate matter (PM) exposure has been established as a risk factor for stroke. However, few studies have investigated the effects of PM exposure on stroke subtypes (ischemic and hemorrhagic stroke). Ischemic (IS) and hemorrhagic strokes (HS) involve distinctive pathophysiological pathways and may be differentially influenced by PM exposure. This review aims to characterize the effects of PM exposure on ischemic and hemorrhagic strokes. It also identifies subpopulations that may be uniquely vulnerable to PM toxicity. Pubmed was queried from 2000 to 2023 to identify clinical and epidemiological studies examining the association between PM exposure and stroke subtypes (ischemic and hemorrhagic stroke). Inclusion criteria were: 1) articles written in English 2) clinical and epidemiological studies 3) studies with a clear definition of stroke, IS, HS, and air pollution 4) studies reporting the effects of PM and 5) studies that included distinct analyses per stroke subtype. Two independent reviewers screened the literature for applicable studies. A total of 50 articles were included in this review. Overall, PM exposure increases ischemic stroke risk in both lightly and heavily polluted countries. The association between PM exposure and hemorrhagic stroke is variable and may be influenced by a country's ambient air pollution levels. A stronger association between PM exposure and stroke is demonstrated in older individuals and those with pre-existing diabetes. There is no clear effect of sex or hypertension on PM-associated stroke risk. Current literature suggests PM exposure increases ischemic stroke risk, with an unclear effect on hemorrhagic stroke risk. Older patients and those with pre-existing diabetes may be the most vulnerable to PM toxicity. Future investigations are needed to characterize the influence of sex and hypertension on PM-associated stroke risk.
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Affiliation(s)
| | - Brandon Ge
- Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, USA
| | - Kristina Shkirkova
- Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, USA
| | - Qinghai Liu
- Neurological Surgery, University of Southern California, Los Angeles, USA
| | - William Mack
- Neurological Surgery, University of Southern California, Los Angeles, USA
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Hasegawa K, Tsukahara T, Nomiyama T. Short-term associations of low-level fine particulate matter (PM 2.5) with cardiorespiratory hospitalizations in 139 Japanese cities. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 258:114961. [PMID: 37137261 DOI: 10.1016/j.ecoenv.2023.114961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/09/2023] [Accepted: 04/24/2023] [Indexed: 05/05/2023]
Abstract
There have been few studies in non-western countries on the relationship between low levels of daily fine particulate matter (PM2.5) exposure and morbidity or mortality, and the impact of PM2.5 concentrations below 15 μg/m3, which is the latest World Health Organization Air Quality Guideline (WHO AQG) value for the 24-h mean, is not yet clear. We assessed the associations between low-level PM2.5 exposure and cardiorespiratory admissions in Japan. We collected the daily hospital admission count data, air pollutant data, and meteorological condition data recorded from April 2016 to March 2019 in 139 Japanese cities. City-specific estimates were obtained from conditional logistic regression models in a time-stratified case-crossover design and pooled by random-effect models. We estimated that every 10-μg/m3 increase in the concurrent-day PM2.5 concentration was related to a 0.52% increase in cardiovascular admissions (95% CI: 0.13-0.92%) and a 1.74% increase in respiratory admissions (95% CI: 1.41-2.07%). These values were nearly the same when the datasets were filtered to contain only daily PM2.5 concentrations <15 μg/m3. The exposure-response curves showed approximately sublinear-to-linear curves with no indication of thresholds. These associations with cardiovascular diseases weakened after adjusting for nitrogen dioxide or sulfur dioxide, but associations with respiratory diseases were almost unchanged when additionally adjusted for other pollutants. This study demonstrated that associations between daily PM2.5 and daily cardiorespiratory hospitalizations might persist at low concentrations, including those below the latest WHO AQG value. Our findings suggest that the updated guideline value may still be insufficient from the perspective of public health.
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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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7
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Święczkowski M, Dobrzycki S, Kuźma Ł. Multi-City Analysis of the Acute Effect of Polish Smog on Cause-Specific Mortality (EP-PARTICLES Study). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085566. [PMID: 37107848 PMCID: PMC10139136 DOI: 10.3390/ijerph20085566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 05/11/2023]
Abstract
Polish smog is a specific type of air pollution present in Eastern Poland, which may cause particularly adverse cardiovascular effects. It is characterized primarily by high concentrations of particulate matter (PM) and different favorable conditions of formation. Our study aimed to assess whether PM and nitrogen dioxide (NO2) have a short-term impact on mortality due to acute coronary syndrome (ACS) and ischemic stroke (IS). The study covered the years 2016-2020, a total of 6 million person-years from five main cities in Eastern Poland. To evaluate the association between air pollution and cause-specific mortality, a case-crossover study design with conditional logistic regression was used at days with LAG from 0 to 2. We recorded 87,990 all-cause deaths, including 9688 and 3776 deaths due to ACS and IS, respectively. A 10 μg/m3 increase in air pollutants was associated with an increase in mortality due to ACS (PM2.5 OR = 1.029, 95%CI 1.011-1.047, p = 0.002; PM10 OR = 1.015, 95%CI 1-1.029, p = 0.049) on LAG 0. On LAG 1 we recorded an increase in both IS (PM2.5 OR = 1.03, 95%CI 1.001-1.058, p = 0.04) and ACS (PM2.5 OR = 1.028, 95%CI 1.01-1.047, p = 0.003; PM10 OR = 1.026, 95%CI 1.011-1.041, p = 0.001; NO2 OR = 1.036, 95%CI 1.003-1.07, p = 0.04). There was a strong association between air pollution and cause-specific mortality in women (ACS: PM2.5 OR = 1.032, 95%CI 1.006-1.058, p = 0.01; PM10 OR = 1.028, 95%CI 1.008-1.05, p = 0.01) and elderly (ACS: PM2.5 OR = 1.03, 95%CI 1.01-1.05, p = 0.003; PM10 OR = 1.027, 95% CI 1.011-1.043, p < 0.001 and IS: PM2.5 OR = 1.037, 95%CI 1.007-1.069, p = 0.01; PM10 OR = 1.025, 95%CI 1.001-1.05, p = 0.04). The negative influence of PMs was observed on mortality due to ACS and IS. NO2 was associated with only ACS-related mortality. The most vulnerable subgroups were women and the elderly.
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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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9
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Choi Y, Byun G, Lee JT. Temporal Heterogeneity of Short-Term Effects of Particulate Matter on Stroke Outpatients in Seven Major Cities of the Republic of Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12316. [PMID: 36231621 PMCID: PMC9566257 DOI: 10.3390/ijerph191912316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
Although particulate matter (PM) is a major risk factor for stroke, its effects on hospital outpatients admitted for stroke have not been documented in Korea. In addition, recent studies have reported that the effects of PM10 on circulatory mortality changed over time. We aimed to estimate the effects of PM10 on stroke and their temporal heterogeneity in seven major cities of Korea during the period 2002-2015. The study period was divided into five years of moving time windows, and city-specific PM10 effects on ischemic and hemorrhagic stroke outpatients were calculated. We pooled the estimates using meta-analysis and plotted them into a sequence to identify their temporal trends. A 10 µg/m3 increase of PM10 was significantly associated with increments in hospital outpatients admitted for ischemic stroke (0.24%, 95% CI: 0.04%, 0.44%), but not for hemorrhagic stroke (0.33%, 95% CI: -0.06%, 0.73%). Effect estimates for strokes increased during the period 2003-2013 but decreased after. For the first time, we have estimated the effects of PM10 on hospital outpatients admitted for stroke in Korea. The observed temporal trend in PM10 effects was similar to patterns of circulatory mortality, suggesting that the temporal heterogeneity in PM10 effects might be due to systematic causes rather than random fluctuations.
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Affiliation(s)
- Yongsoo Choi
- School of Health Policy and Management, College of Health Science, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02481, Korea
| | - Garam Byun
- Interdisciplinary Program in Precision Public Health, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02481, Korea
| | - Jong-Tae Lee
- School of Health Policy and Management, College of Health Science, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02481, Korea
- Interdisciplinary Program in Precision Public Health, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02481, Korea
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10
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Li W, Lin G, Xiao Z, Zhang Y, Li B, Zhou Y, Ma Y, Chai E. A review of respirable fine particulate matter (PM2.5)-induced brain damage. Front Mol Neurosci 2022; 15:967174. [PMID: 36157076 PMCID: PMC9491465 DOI: 10.3389/fnmol.2022.967174] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
Respirable fine particulate matter (PM2.5) has been one of the most widely publicized indicators of pollution in recent years. Epidemiological studies have established a strong association between PM2.5, lung disease, and cardiovascular disease. Recent studies have shown that PM2.5 is also strongly associated with brain damage, mainly cerebrovascular damage (stroke) and neurological damage to the brain (changes in cognitive function, dementia, psychiatric disorders, etc.). PM2.5 can pass through the lung–gas–blood barrier and the “gut–microbial–brain” axis to cause systemic oxidative stress and inflammation, or directly enter brain tissue via the olfactory nerve, eventually damaging the cerebral blood vessels and brain nerves. It is worth mentioning that there is a time window for PM2.5-induced brain damage to repair itself. However, the exact pathophysiological mechanisms of brain injury and brain repair are not yet fully understood. This article collects and discusses the mechanisms of PM2.5-induced brain injury and self-repair after injury, which may provide new ideas for the prevention and treatment of cerebrovascular and cerebral neurological diseases.
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Affiliation(s)
- Wei Li
- The First Clinical Medical College of Gansu University of Chinese Medical, Lan Zhou, China
- Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lan Zhou, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lan Zhou, China
| | - Guohui Lin
- Day Treatment Center II of Gansu Provincial Maternity and Child-Care Hospital, Lan Zhou, China
| | - Zaixing Xiao
- Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lan Zhou, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lan Zhou, China
| | - Yichuan Zhang
- Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lan Zhou, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lan Zhou, China
| | - Bin Li
- Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lan Zhou, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lan Zhou, China
| | - Yu Zhou
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lan Zhou, China
- The First School of Clinical Medicine of Lanzhou University, Lan Zhou, China
| | - Yong Ma
- Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lan Zhou, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lan Zhou, China
| | - Erqing Chai
- Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lan Zhou, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lan Zhou, China
- *Correspondence: Erqing Chai
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11
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Short-Term Effects of Low-Level Ambient Air NO 2 on the Risk of Incident Stroke in Enshi City, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116683. [PMID: 35682266 PMCID: PMC9180296 DOI: 10.3390/ijerph19116683] [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: 04/12/2022] [Revised: 05/19/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022]
Abstract
Previous studies found that exposure to ambient nitrogen dioxide (NO2) was associated with an increased risk of incident stroke, but few studies have been conducted for relatively low NO2 pollution areas. In this study, the short-term effects of NO2 on the risk of incident stroke in a relatively low-pollution area, Enshi city of Hubei Province, China, were investigated through time-series analysis. Daily air-pollution data, meteorological data, and stroke incidence data of residents in Enshi city from 1 January 2015 to 31 December 2018 were collected. A time-series analysis using a generalised additive model (GAM) based on Poisson distribution was applied to explore the short-term effects of low-level NO2 exposure on the risk of incident stroke and stroke subtypes, as well as possible age, sex, and seasonal differences behind the effects. In the GAM model, potential confounding factors, such as public holidays, day of the week, long-term trends, and meteorological factors (temperature and relative humidity), were controlled. A total of 9122 stroke incident cases were included during the study period. We found that NO2 had statistically significant effects on the incidence of stroke and ischemic stroke, estimated by excess risk (ER) of 0.37% (95% CI: 0.04–0.70%) and 0.58% (95% CI: 0.18–0.98%), respectively. For the cumulative lag effects, the NO2 still had a statistically significant effect on incident ischemic stroke, estimated by ER of 0.61% (95% CI: 0.01–1.21%). The two-pollutant model showed that the effects of NO2 on incident total stroke were still statistically significant after adjusting for other air pollutants (PM2.5, PM10, SO2, CO, and O3). In addition, the effects of NO2 exposure on incident stroke were statistically significant in elderly (ER = 0.75%; 95% CI: 0.11–1.40%), males (ER = 0.47%; 95% CI: 0.05–0.89%) and cold season (ER = 0.83%; 95% CI: 0.15–1.51%) subgroups. Our study showed that, as commonly observed in high-pollution areas, short-term exposure to low-level NO2 was associated with an increased risk of incident stroke, including ischemic stroke. Males and elderly people were more vulnerable to the effects of NO2, and the adverse effects might be promoted in the cold season.
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12
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Xu R, Wang Q, Wei J, Lu W, Wang R, Liu T, Wang Y, Fan Z, Li Y, Xu L, Shi C, Li G, Chen G, Zhang L, Zhou Y, Liu Y, Sun H. Association of short-term exposure to ambient air pollution with mortality from ischemic and hemorrhagic stroke. Eur J Neurol 2022; 29:1994-2005. [PMID: 35363940 DOI: 10.1111/ene.15343] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Short-term exposure to ambient air pollution has been linked to increased risk of stroke mortality, but its adverse effects on mortality from specific types of stroke including ischemic stroke and hemorrhagic stroke remain poorly understood. METHODS Using the China National Mortality Surveillance System, we conducted a time-stratified case-crossover study among 412,567 stroke deaths in Jiangsu province, China during 2015-2019. Residential daily PM2.5 , PM10 , SO2 , NO2 , CO and O3 exposure concentration was extracted from the ChinaHighAirPollutants dataset for each subject. Conditional logistic regression models were performed to conduct exposure-response analysis. RESULTS Each 10 μg/m3 increase of PM2.5 , PM10 , SO2 , NO2 , CO and O3 was respectively associated with a 1.44%, 0.93%, 5.55%, 2.90%, 0.148%, and 0.54% increase in odds of mortality from ischemic stroke, which was significantly stronger than that from hemorrhagic stroke (percent change in odds: 0.74%, 0.51%, 3.11%, 1.15%, 0.090%, and 0.10%). The excess fraction of ischemic stroke mortality associated with PM2.5 , PM10 , SO2 , NO2 , CO, and O3 exposure was 6.90%, 6.48%, 8.21%, 8.61%, 9.67%, and 4.76%, respectively, which was also significantly higher than that of hemorrhagic stroke mortality (excess fraction: 3.49%, 3.48%, 4.69%, 3.48%, 5.86%, and 0.88%). These differences in adverse effects generally remained across sex, age, and season. CONCLUSIONS Short-term exposure to ambient air pollution was significantly associated with increased risk of both ischemic and hemorrhagic stroke mortality and posed considerable excess mortality. Our results suggest that air pollution exposure may lead to substantially greater adverse effects on mortality from ischemic stroke than that from hemorrhagic stroke.
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Affiliation(s)
- Ruijun Xu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qingqing Wang
- Department of Environment and Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, USA
| | - Wenfeng Lu
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.,Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Rui Wang
- Luohu District Chronic Disease Hospital, Shenzhen, Guangdong, China
| | - Tingting Liu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yaqi Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhaoyu Fan
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yingxin Li
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Luxi Xu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chunxiang Shi
- Meteorological Data Laboratory, National Meteorological Information Center, Beijing, China
| | - Guo Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Gongbo Chen
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lan Zhang
- Institute of Chronic Noncommunicable Disease Control and Prevention, Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei, China
| | - Yun Zhou
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.,Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuewei Liu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hong Sun
- Department of Environment and Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
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13
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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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Ho AFW, Lim MJR, Zheng H, Leow AST, Tan BYQ, Pek PP, Raju Y, Seow WJ, Yeo TT, Sharma VK, Aik J, Ong MEH. Association of ambient air pollution with risk of hemorrhagic stroke: A time-stratified case crossover analysis of the Singapore stroke registry. Int J Hyg Environ Health 2021; 240:113908. [PMID: 34974273 DOI: 10.1016/j.ijheh.2021.113908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/06/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Haemorrhagic stroke (HS) is a major cause of mortality and disability. Previous studies reported inconsistent associations between ambient air pollutants and HS risk. OBJECTIVE We evaluated the association between air pollutant exposure and the risk of HS in a cosmopolitan city in the tropics. METHODS We performed a nationwide, population-based, time-stratified case-crossover analysis on all HS cases reported to the Singapore Stroke Registry from 2009 to 2018 (n = 12,636). We estimated the risk of HS across tertiles of air pollutant concentrations in conditional Poisson models, adjusting for meteorological confounders. We stratified our analysis by age, atrial fibrillation and smoking status, and investigated the lagged effects of each pollutant on the risk of HS up to 5 days. RESULTS All 12,636 episodes of HS were included. The median (1st-to 3rd-quartile) daily pollutant levels from 22 remote stations deployed across the island were as follows: (PM2.5 = 15.9 (12.7-20.5), PM10 = 27.3 (22.7-33.4), O3 = 22.5 (17.3-29.8), NO2 = 23.3 (18.8-28.4), SO2 = 10.2 (5.6-14.4), CO = 0.5 (0.5-0.6). The median (1st-to 3rd-quartile) temperature (°C) was 27.9 (27.1-28.7), that of relative humidity (%) was 79.4 (75.6-83.2), and that of total rainfall (mm) was 0.0 (0.0-4.2). Higher levels of CO were significantly associated with an increased risk of HS (3rd tertile vs 1st tertile: Incidence Rate Ratio (IRR) = 1.06, 95% CI = 1.01-1.12). The increased risk of HS due to CO persisted for at least 5 days after exposure. Individuals under 65 years old and non-smokers had a higher risk of HS when exposed to CO. O3 was associated with increased risk of HS up to 5 days (3rd tertile vs 1st tertile: IRRday 1 = 1.07, 95% CI = 1.02-1.12; IRRday 5 = 1.07, 95% CI = 1.02-1.13). CONCLUSION Short-term exposure to ambient CO levels was associated with an increased risk of HS. A reduction in CO emissions may reduce the burden of HS in the population.
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Affiliation(s)
- Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Pre-hospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore.
| | - Mervyn Jun Rui Lim
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
| | - Huili Zheng
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | | | | | - Pin Pin Pek
- Pre-hospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Yogeswari Raju
- Environmental Quality Monitoring Department, Environmental Monitoring and Modelling Division, National Environment Agency, Singapore
| | - Wei-Jie Seow
- National Registry of Diseases Office, Health Promotion Board, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joel Aik
- Pre-hospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore; Environmental Epidemiology and Toxicology Division, National Environment Agency, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Pre-hospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Li B, Yang J, Dong H, Li M, Cai D, Yang Z, Zhang C, Wang H, Hu J, Bergmann S, Lin G, Wang B. PM 2.5 constituents and mortality from a spectrum of causes in Guangzhou, China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 222:112498. [PMID: 34265527 DOI: 10.1016/j.ecoenv.2021.112498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 06/13/2023]
Abstract
As the major constituents of PM2.5, carbonaceous constituents and inorganic ions have attracted emerging attentions on their health risks, particularly on cardiorespiratory diseases. However, evidences on the risks of PM2.5 constituents on other diseases (eg. nervous disease, genitourinary disease, neoplasms and endocrine disease) remain scarce. In our study, we firstly calculated residuals of PM2.5 constituents regressed on PM2.5 to remove the confounding effect of PM2.5. Then, generalized additive model (GAM) was used to assess impacts of residuals of PM2.5 constituents on mortality from 36 diseases (10 broad categories and 26 subcategories) during 2011-2015 in Guangzhou, China. Results of constituent-residual models showed that only EC, OC and NO3- were significantly associated with all-cause mortality, with per IQR change in corresponding constituent residuals related to percentage changes of 1.69% (95% CI: 0.42, 2.97), 1.94% (95% CI: 0.37, 3.54) and 2.59% (95% CI: 1.02, 4.18) at lag 03 days. All these pollutants were significantly associated with elevated mortality risk of cardiovascular disease, but only EC was significantly associated with respiratory mortality, and NO3- with endocrine disease and neoplasm. For more specific causes, the highest effect estimates of EC and NO3-were both observed on mortality from other form of heart disease, and OC on intentional self-harm, with estimates of 11.45% (95% CI: 2.74, 20.91), 12.59% (95% CI: 1.41, 25.02) and 18.01% (95% CI: 2.14, 36.36), respectively. Our findings highlighted that stricter emission control measures are still warranted to reduce air pollution level and protect the public health.
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Affiliation(s)
- Bixia Li
- Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China
| | - Jun Yang
- Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China; JNU-QUT Joint Laboratory for Air Quality Science and Management, Jinan University, Guangzhou 511443, China; Guangdong-Hongkong-Macau Joint Laboratory of Collaborative Innovation for Environmental Quality, Guangzhou 511443, China.
| | - Hang Dong
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, Guangdong, China
| | - Mengmeng Li
- Department of Cancer Prevention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Dongjie Cai
- Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China
| | - Zhou Yang
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Chunlin Zhang
- Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China; JNU-QUT Joint Laboratory for Air Quality Science and Management, Jinan University, Guangzhou 511443, China; Guangdong-Hongkong-Macau Joint Laboratory of Collaborative Innovation for Environmental Quality, Guangzhou 511443, China
| | - Hao Wang
- Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China; JNU-QUT Joint Laboratory for Air Quality Science and Management, Jinan University, Guangzhou 511443, China; Guangdong-Hongkong-Macau Joint Laboratory of Collaborative Innovation for Environmental Quality, Guangzhou 511443, China
| | - Jianlin Hu
- Jiangsu Key Laboratory of Atmospheric Environment Monitoring and Pollution Control, Jiangsu Engineering Technology Research Center of Environmental Cleaning Materials, Collaborative Innovation Center of Atmospheric Environment and Equipment Technology, School of Environmental Science and Engineering, Nanjing University of Information Science and Technology, 219 Ningliu Road, Nanjing 210044, China
| | - Stéphanie Bergmann
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Guozhen Lin
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, Guangdong, China.
| | - Boguang Wang
- Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China; JNU-QUT Joint Laboratory for Air Quality Science and Management, Jinan University, Guangzhou 511443, China; Guangdong-Hongkong-Macau Joint Laboratory of Collaborative Innovation for Environmental Quality, Guangzhou 511443, China.
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16
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Liu X, Li Z, Guo M, Zhang J, Tao L, Xu X, Deginet A, Lu F, Luo Y, Liu M, Liu M, Sun Y, Li H, Guo X. Acute effect of particulate matter pollution on hospital admissions for stroke among patients with type 2 diabetes in Beijing, China, from 2014 to 2018. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 217:112201. [PMID: 33838569 DOI: 10.1016/j.ecoenv.2021.112201] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The health effect of particulate matter pollution on stroke has been widely examined; however, the effect among patients with comorbid type 2 diabetes (T2D) in developing countries has remained largely unknown. METHODS A time-series study was conducted to investigate the short-term effect of fine particulate matter (PM2.5) and inhalable particulate matter (PM10) on hospital admissions for stroke among patients with T2D in Beijing, China, from 2014 to 2018. An over-dispersed Poisson generalized additive model was employed to adjust for important covariates, such as weather conditions and long-term and seasonal trends. RESULTS A total of 159,298 hospital admissions for stroke comorbid with T2D were reported. Approximately linear exposure-response curves were observed for PM2.5 and PM10 in relation to stroke admissions among T2D patients. A 10 μg/m3 increase in the four-day moving average of PM2.5 and PM10 was associated with 0.14% (95% confidence interval [CI]: 0.05-0.23%) and 0.14% (95% CI: 0.06-0.22%) incremental increases in stroke admissions among T2D patients, respectively. A 10 μg/m3 increase in PM2.5 in the two-day moving average corresponded to a 0.72% (95% CI: 0.02-1.42%) incremental increase in hemorrhagic stroke, and a 10 μg/m3 increase in PM10 in the four-day moving average corresponded to a 0.14% (95% CI: 0.06-0.22%) incremental increase in ischemic stroke. CONCLUSIONS High particulate matter might be a risk factor for stroke among patients with T2D. PM2.5 and PM10 have a linear exposure-response relationship with stroke among T2D patients. The study provided evidence of the risk of stroke due to particulate matter pollution among patients with comorbid T2D.
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Affiliation(s)
- Xiangtong Liu
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Zhiwei Li
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Moning Guo
- Beijing Municipal Health Commission Information Center, Beijing 100034, China.
| | - Jie Zhang
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Lixin Tao
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Xiaolin Xu
- School of Public Health, Zhejiang University, Hangzhou 310058, China; The University of Queensland, Brisbane, Australia.
| | - Aklilu Deginet
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Feng Lu
- Beijing Municipal Health Commission Information Center, Beijing 100034, China.
| | - Yanxia Luo
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Mengmeng Liu
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Mengyang Liu
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Yue Sun
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Haibin Li
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Xiuhua Guo
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
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17
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Wu Z, Li J, Huang J, Wang Y, Cao R, Yin P, Wang L, Zeng Q, Pan X, Zhou M, Li G. Ambient sulfur dioxide and years of life lost from stroke in China: a time-series analysis in 48 cities. CHEMOSPHERE 2021; 267:128857. [PMID: 33183785 DOI: 10.1016/j.chemosphere.2020.128857] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Sulfur dioxide (SO2) is a ubiquitous air pollutant and its concentration in China remains at a higher level in the world. However, evidence regarding short-term effect of SO2 on years of life lost (YLL) from stroke is scarce. We aim to estimate the short-term association between SO2 pollution and YLL for stroke and the related excess life years and economic loss. METHODS A national time-series study was conducted in 48 Chinese cities from 2013 to 2017. Generalized additive model coupled with random-effects model were used to explore the effects of SO2 on YLL from stroke. Stratified analyses were performed by demographical and geographical factors, and the effect modification of city-level factors was estimated. In addition, the related economic loss was calculated using the method of the value per statistical life year (VSLY). RESULTS Averaged daily mean SO2 concentration was 27.1 μg/m3 in 48 Chinese cities from 2013 to 2017. Per 10 μg/m3 increase in the concentration of SO2 (lag03) was associated with an increment of 0.70% (95% confidence interval: 0.27%,1.13%), 0.51% (-0.01%,1.04%), 0.71% (0.14%,1.28%) increase in YLL from total stroke, hemorrhagic and ischemic stroke, respectively. The effect of short-term ambient SO2 exposure on YLL from stroke was more pronounced in the less-educated population and those living in the south. The corresponding excess economic loss during the study period due to SO2-related YLL from stroke accounted for 0.08% (0.03%, 0.13%) of the GDP in China. CONCLUSIONS Our results provide evidence from China that short-term exposure to SO2 is positively associated with YLL from stroke and its major subtypes in certain subgroups of population. This study calls for greater awareness of the adverse health effect due to SO2 in China and other developing countries, as well as local-specific implementation of air pollution mitigation measures.
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Affiliation(s)
- Ziting Wu
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Jie Li
- Department of Occupational Health and Environmental Health, School of Public Health, Capital Medical University, Beijing, 100069, China; National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Jing Huang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Yuxin Wang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Ru Cao
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Qiang Zeng
- Department of Occupational Disease Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin, 300011, PR China
| | - Xiaochuan Pan
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China.
| | - Guoxing Li
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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18
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Association between exposure to ambient air pollution and hospital admission, incidence, and mortality of stroke: an updated systematic review and meta-analysis of more than 23 million participants. Environ Health Prev Med 2021; 26:15. [PMID: 33499804 PMCID: PMC7839211 DOI: 10.1186/s12199-021-00937-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/10/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Previous studies have suggested that exposure to air pollution may increase stroke risk, but the results remain inconsistent. Evidence of more recent studies is highly warranted, especially gas air pollutants. METHODS We searched PubMed, Embase, and Web of Science to identify studies till February 2020 and conducted a meta-analysis on the association between air pollution (PM2.5, particulate matter with aerodynamic diameter less than 2.5 μm; PM10, particulate matter with aerodynamic diameter less than 10 μm; NO2, nitrogen dioxide; SO2, sulfur dioxide; CO, carbon monoxide; O3, ozone) and stroke (hospital admission, incidence, and mortality). Fixed- or random-effects model was used to calculate pooled odds ratios (OR)/hazard ratio (HR) and their 95% confidence intervals (CI) for a 10 μg/m3 increase in air pollutant concentration. RESULTS A total of 68 studies conducted from more than 23 million participants were included in our meta-analysis. Meta-analyses showed significant associations of all six air pollutants and stroke hospital admission (e.g., PM2.5: OR = 1.008 (95% CI 1.005, 1.011); NO2: OR = 1.023 (95% CI 1.015, 1.030), per 10 μg/m3 increases in air pollutant concentration). Exposure to PM2.5, SO2, and NO2 was associated with increased risks of stroke incidence (PM2.5: HR = 1.048 (95% CI 1.020, 1.076); SO2: HR = 1.002 (95% CI 1.000, 1.003); NO2: HR = 1.002 (95% CI 1.000, 1.003), respectively). However, no significant differences were found in associations of PM10, CO, O3, and stroke incidence. Except for CO and O3, we found that higher level of air pollution (PM2.5, PM10, SO2, and NO2) exposure was associated with higher stroke mortality (e.g., PM10: OR = 1.006 (95% CI 1.003, 1.010), SO2: OR = 1.006 (95% CI 1.005, 1.008). CONCLUSIONS Exposure to air pollution was positively associated with an increased risk of stroke hospital admission (PM2.5, PM10, SO2, NO2, CO, and O3), incidence (PM2.5, SO2, and NO2), and mortality (PM2.5, PM10, SO2, and NO2). Our study would provide a more comprehensive evidence of air pollution and stroke, especially SO2 and NO2.
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Zeng S, Luo L, Chen F, Li Y, Chen M, He X. Association of outdoor air pollution with the medical expense of ischemic stroke: The case study of an industrial city in western China. Int J Health Plann Manage 2021; 36:715-728. [PMID: 33474742 DOI: 10.1002/hpm.3115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 11/05/2020] [Accepted: 12/28/2020] [Indexed: 11/11/2022] Open
Abstract
Ischemic stroke, the most frequent cause of severe disability, imposes a significant mental and economic burden on patients and their families. There is increasing evidence to indicate that air pollution contributes to the risk of ischemic stroke. This study aimed to examine the correlation between air pollution and the expense imposed by an ischemic stroke. Data were obtained from hospitals and environmental monitoring stations in an industry city, Longspring, in western China. We used a generalized additive model to estimate the associations between the two factors, measured during 2015-2017. Counter-intuitively, the medical expenses arising from ischemia were negatively associated with the level of air pollution. The corresponding ER for per interquartile range increase of PM2.5, PM10, SO2 , and NO2 in lag10 was -0.17% (95% confidence interval (95% CI -0.31%, -0.03%), -0.11% (95% CI -0.2%, -0.02%), -1.04% (95% CI -1.92%, -0.17%) and -0.44% (95% CI -0.66%, -0.22%), respectively (p < 0.05). Subgroups based on gender, age, and season were considered in the analysis. The results indicated that pollutants had significant effects on ischaemia's medical expenses, which were stronger for older people, patients who survived, and warm seasons. This study is the first step in optimizing medical resources, which are essential for policymaking and service planning.
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Affiliation(s)
- Siyu Zeng
- Business School, Sichuan University, Chengdu, China
| | - Li Luo
- Business School, Sichuan University, Chengdu, China
| | - Fang Chen
- Department of Neurosurgery, First People's Hospital of Longquan, Chengdu, China
| | - Yue Li
- Business School, Sichuan University, Chengdu, China
| | - Mei Chen
- Department of Record Room, First People's Hospital of Longquan, Chengdu, China
| | - Xiaozhou He
- Business School, Sichuan University, Chengdu, China
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20
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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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21
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Huang K, Liang F, Yang X, Liu F, Li J, Xiao Q, Chen J, Liu X, Cao J, Shen C, Yu L, Lu F, Wu X, Zhao L, Wu X, Li Y, Hu D, Huang J, Liu Y, Lu X, Gu D. Long term exposure to ambient fine particulate matter and incidence of stroke: prospective cohort study from the China-PAR project. BMJ 2019; 367:l6720. [PMID: 31888885 PMCID: PMC7190010 DOI: 10.1136/bmj.l6720] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To study the effect of long term exposure to ambient fine particulate matter of diameter ≤2.5 μm (PM2.5) on the incidence of total, ischemic, and hemorrhagic stroke among Chinese adults. DESIGN Population based prospective cohort study. SETTING Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project carried out in 15 provinces across China. PARTICIPANTS 117 575 Chinese men and women without stroke at baseline in the China-PAR project. MAIN OUTCOME MEASURES Incidence of total, ischemic, and hemorrhagic stroke. RESULTS The long term average PM2.5 level from 2000 to 2015 at participants' residential addresses was 64.9 μg/m3, ranging from 31.2 μg/m3 to 97.0 μg/m3. During 900 214 person years of follow-up, 3540 cases of incident stroke were identified, of which 63.0% (n=2230) were ischemic and 27.5% (n=973) were hemorrhagic. Compared with the first quarter of exposure to PM2.5 (<54.5 μg/m3), participants in the highest quarter (>78.2 μg/m3) had an increased risk of incident stroke (hazard ratio 1.53, 95% confidence interval 1.34 to 1.74), ischemic stroke (1.82, 1.55 to 2.14), and hemorrhagic stroke (1.50, 1.16 to 1.93). For each increase of 10 μg/m3 in PM2.5 concentration, the increased risks of incident stroke, ischemic stroke, and hemorrhagic stroke were 13% (1.13, 1.09 to 1.17), 20% (1.20, 1.15 to 1.25), and 12% (1.12, 1.05 to 1.20), respectively. Almost linear exposure-response relations between long term exposure to PM2.5 and incident stroke, overall and by its subtypes, were observed. CONCLUSIONS This study provides evidence from China that long term exposure to ambient PM2.5 at relatively high concentrations is positively associated with incident stroke and its major subtypes. These findings are meaningful for both environmental and health policy development related to air pollution and stroke prevention, not only in China, but also in other low and middle income countries.
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Affiliation(s)
- Keyong Huang
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, China
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, China
| | - Fengchao Liang
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, China
| | - Xueli Yang
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, China
| | - Fangchao Liu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, China
| | - Jianxin Li
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, China
| | - Qingyang Xiao
- School of Environment, Tsinghua University, Beijing, China
| | - Jichun Chen
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, China
| | - Xiaoqing Liu
- Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China
| | - Jie Cao
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, China
| | - Chong Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ling Yu
- Department of Cardiology, Fujian Provincial Hospital, Fuzhou, China
| | - Fanghong Lu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China
| | - Xianping Wu
- Center for Chronic and Noncommunicable Disease Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Liancheng Zhao
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, China
| | - Xigui Wu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, China
| | - Ying Li
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, China
| | - Dongsheng Hu
- Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China
| | - Jianfeng Huang
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, China
| | - Yang Liu
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Xiangfeng Lu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, China
| | - Dongfeng Gu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, China
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, China
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Qian Y, Yu H, Cai B, Fang B, Wang C. Association between incidence of fatal intracerebral hemorrhagic stroke and fine particulate air pollution. Environ Health Prev Med 2019; 24:38. [PMID: 31153356 PMCID: PMC6545210 DOI: 10.1186/s12199-019-0793-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/13/2019] [Indexed: 11/10/2022] Open
Abstract
Objective Few studies investigating associations between fine particulate air pollution and hemorrhagic stroke have considered subtypes. Additionally, less is known about the modification of such association by factors measured at the individual level. We aimed to investigate the risk of fatal intracerebral hemorrhage (ICH) incidence in case of PM2.5 (particles ≤ 2.5 μm in aerodynamic diameter) exposure. Methods Data on incidence of fatal ICH from 1 June 2012 to 31 May 2014 were extracted from the acute stroke mortality database in Shanghai Municipal Center for Disease Control and Prevention (SCDC). We used the time-stratified case-crossover approach to assess the association between daily concentrations of PM2.5 and fatal ICH incidence in Shanghai, China. Results A total of 5286 fatal ICH cases occurred during our study period. The averaged concentration of PM2.5 was 77.45 μg/m3. The incidence of fatal ICH was significantly associated with PM2.5 concentration. Substantial differences were observed among subjects with diabetes compared with those without; following the increase of PM2.5 in lag2, the OR (95% CI) for subjects with diabetes was 1.26 (1.09–1.46) versus 1.05 (0.98–1.12) for those without. We did not find evidence of effect modification by hypertension and cigarette smoking. Conclusions Fatal ICH incidence was associated with PM2.5 exposure. Our results also suggested that diabetes may increase the risk for ICH incidence in relation to PM2.5. Electronic supplementary material The online version of this article (10.1186/s12199-019-0793-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yifeng Qian
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Huiting Yu
- Department of Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Binxin Cai
- Songjiang District Center for Disease Control and Prevention, Shanghai, China
| | - Bo Fang
- Department of Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Chunfang Wang
- Department of Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
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23
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Luo L, Dai Y, Zhang F, Chen M, Chen F, Qing F. Time series analysis of ambient air pollution effects on dynamic stroke mortality. Int J Health Plann Manage 2019; 35:79-103. [PMID: 31149758 DOI: 10.1002/hpm.2821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 12/11/2022] Open
Abstract
This study aims to examine the correlations between air pollution and dynamic stroke mortality, which is defined as the daily real-time number of deaths from stroke. Death data were obtained from daily medical records of 7230 incidents from the Center for Disease Control and Prevention in the Longquanyi District of China from 2016 to 2017. Air pollution data were obtained from environmental monitoring stations in the Longquanyi District. Time series analysis using generalized additive Poisson regression models was applied, and single-pollutant and two-pollutant adjusted models were utilized. Furthermore, categories based on gender, age, and meteorological factors were considered in the analysis. The results indicated that PM2.5, PM10, O3 , and CO had significant effects on dynamic stroke mortality, which were stronger for older people and during the cold season. This study helps hospital managers, patients, and governments seeking to prevent and control the effects of air pollution on the risks of stroke.
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Affiliation(s)
- Li Luo
- Business School, Sichuan University, Chengdu, China
| | - Yuting Dai
- Business School, Sichuan University, Chengdu, China
| | - Fengyi Zhang
- Business School, Sichuan University, Chengdu, China
| | - Mei Chen
- The First People's Hospital of Longquanyi District, Chengdu, China
| | - Fang Chen
- The First People's Hospital of Longquanyi District, Chengdu, China
| | - Fang Qing
- Business School, Sichuan University, Chengdu, China
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24
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Wu T, Ma Y, Wu X, Bai M, Peng Y, Cai W, Wang Y, Zhao J, Zhang Z. Association between particulate matter air pollution and cardiovascular disease mortality in Lanzhou, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:15262-15272. [PMID: 30929170 DOI: 10.1007/s11356-019-04742-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/28/2019] [Indexed: 05/22/2023]
Abstract
Ambient particulate matter (PM) pollution has been linked to elevated mortality, especially from cardiovascular diseases. However, evidence on the effects of particulate matter pollution on cardiovascular mortality is still limited in Lanzhou, China. This research aimed to examine the associations of daily mean concentrations of ambient air pollutants (PM2.5, PMC, and PM10) and cardiovascular mortality due to overall and cause-specific diseases in Lanzhou. Data representing daily cardiovascular mortality rates, meteorological factors (daily average temperature, daily average humidity, and atmospheric pressure), and air pollutants (PM2.5, PM10, SO2, NO2) were collected from January 1, 2014, to December 31, 2017, in Lanzhou. A quasi-Poisson regression model combined with a distributed lag non-linear model (DLNM) was used to estimate the associations. Stratified analyses were also performed by different cause-specific diseases, including cerebrovascular disease (CD), ischemic heart disease (IHD), heart rhythm disturbances (HRD), and heart failure (HF). The results showed that elevated concentration of PM2.5, PMC, and PM10 had different effects on mortality of different cardiovascular diseases. Only cerebrovascular disease showed a significant positive association with elevated PM2.5. Positive associations were identified between PMC and daily mortality rates from total cardiovascular diseases, cerebrovascular diseases, and ischemic heart diseases. Besides, increased concentration of PM10 was correlated with increased death of cerebrovascular diseases and ischemic heart diseases. For cerebrovascular disease, each 10 μg/m3 increase in PM2.5 at lag4 was associated with increments of 1.22% (95% CI 0.11-2.35%). The largest significant effects for PMC on cardiovascular diseases and ischemic heart diseases were both observed at lag0, and a 10 μg/m3 increment in concentration of PMC was associated with 0.47% (95% CI 0.06-0.88%) and 0.85% (95% CI 0.18-1.52%) increases in cardiovascular mortality and ischemic heart diseases. In addition, it exhibited a lag effect on cerebrovascular mortality as well, which was most significant at lag6d, and an increase of 10 μg/m3 in PMC was associated with a 0.76% (95% CI 0.16-1.37%) increase in cerebrovascular mortality. The estimates of percentage change in daily mortality rates per 10 μg/m3 increase in PM10 were 0.52% (95% CI 0.05-1.02%) for cerebrovascular disease at lag6 and 0.53% (95% CI 0.01-1.05%) for ischemic heart disease at lag0, respectively. Our study suggests that elevated concentration of atmospheric PM (PM2.5, PMC, and PM10) in Lanzhou is associated with increased mortality of cardiovascular diseases and that the health effect of elevated concentration of PM2.5 is more significant than that of PMC and PM10.
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Affiliation(s)
- Tingting Wu
- The First Clinical Medical College of Lanzhou University, No. 1, Donggang West Road, Chengguan District, 730000, Lanzhou, China
- Gansu Key Laboratory of Cardiovascular Disease, No. 1, Donggang West Road, Chengguan District, 730000, Lanzhou, China
- Department of Ultrasound in Children, The Second Hospital of Lanzhou University, No. 82, Cuiying Gate, Chengguan District, 730030, Lanzhou, China
| | - Yuan Ma
- The First Clinical Medical College of Lanzhou University, No. 1, Donggang West Road, Chengguan District, 730000, Lanzhou, China
| | - Xuan Wu
- Disease Control and Prevention Center in Chengguan District, No. 121, Qingyang Road, Lanzhou, 730000, China
| | - Ming Bai
- Gansu Key Laboratory of Cardiovascular Disease, No. 1, Donggang West Road, Chengguan District, 730000, Lanzhou, China
- Heart Center, The First Hospital of Lanzhou University, No. 1, Donggang West Road, Chengguan District, Lanzhou, 730000, China
| | - Yu Peng
- Gansu Key Laboratory of Cardiovascular Disease, No. 1, Donggang West Road, Chengguan District, 730000, Lanzhou, China
- Heart Center, The First Hospital of Lanzhou University, No. 1, Donggang West Road, Chengguan District, Lanzhou, 730000, China
| | - Weiting Cai
- Gansu Key Laboratory of Cardiovascular Disease, No. 1, Donggang West Road, Chengguan District, 730000, Lanzhou, China
- Heart Center, The First Hospital of Lanzhou University, No. 1, Donggang West Road, Chengguan District, Lanzhou, 730000, China
| | - Yongxiang Wang
- Gansu Key Laboratory of Cardiovascular Disease, No. 1, Donggang West Road, Chengguan District, 730000, Lanzhou, China
| | - Jing Zhao
- Gansu Key Laboratory of Cardiovascular Disease, No. 1, Donggang West Road, Chengguan District, 730000, Lanzhou, China
| | - Zheng Zhang
- Gansu Key Laboratory of Cardiovascular Disease, No. 1, Donggang West Road, Chengguan District, 730000, Lanzhou, China.
- Heart Center, The First Hospital of Lanzhou University, No. 1, Donggang West Road, Chengguan District, Lanzhou, 730000, China.
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25
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Zhang R, Liu G, Jiang Y, Li G, Pan Y, Wang Y, Wei Z, Wang J, Wang Y. Acute Effects of Particulate Air Pollution on Ischemic Stroke and Hemorrhagic Stroke Mortality. Front Neurol 2018; 9:827. [PMID: 30333790 PMCID: PMC6176083 DOI: 10.3389/fneur.2018.00827] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/13/2018] [Indexed: 12/29/2022] Open
Abstract
Background and Purpose: A large body of literature reported the association of particulate matter (PM) with stroke in high-income countries. Few studies have examined the association between PM and stroke in middle- and low-income countries and considered the types of stroke. In this study, we examined the short-term effects of particulate matter <2.5 μm in diameter (PM2.5) and particulate matter <10 μm in diameter (PM10) on ischemic stroke mortality and hemorrhagic stroke mortality in Beijing, China. Methods: We used an ecological study design and quasi-Poisson generalized additive models to evaluate the association of PM2.5 and PM10 and cerebrovascular diseases mortality, as well as ischemic- and hemorrhagic stroke mortality. In the model, we controlled long-term and season trends, temperature, and relative humidity, the day of the week and air pollution. For cerebrovascular diseases mortality, we examined the effects stratified by sex and age with different lag days. Results: A total of 48,122 deaths for cerebrovascular disease (32,799 deaths for ischemic stroke and 13,051 deaths for hemorrhagic stroke) were included in the study. PM2.5 was associated with stroke mortality. The 10 μg/m3 increase of PM2.5 was associated with the increase of mortality, 0.27% (95% CI, 0.12–0.43%) for cerebrovascular diseases, 0.23% (95% CI, 0.04–0.42%) for ischemic stroke and 0.37% (95% CI, 0.07–0.67%) for hemorrhagic stroke -. The associations between PM10 and mortality were also detected for cerebrovascular diseases and ischemic stroke, but not in hemorrhagic stroke. The stratified analysis suggested age and gender did not modify the effects of PM on mortality significantly. Conclusions: Our study suggested that short-term exposure to ambient PM was associated with the risk of stroke mortality.
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Affiliation(s)
- Runhua Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Gang Li
- Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Zaihua Wei
- Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Jing Wang
- Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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26
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Wang X, Qian Z, Wang X, Hong H, Yang Y, Xu Y, Xu X, Yao Z, Zhang L, Rolling CA, Schootman M, Liu T, Xiao J, Li X, Zeng W, Ma W, Lin H. Estimating the acute effects of fine and coarse particle pollution on stroke mortality of in six Chinese subtropical cities. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 239:812-817. [PMID: 29751339 DOI: 10.1016/j.envpol.2018.04.102] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 06/08/2023]
Abstract
While increasing evidence suggested that PM2.5 is the most harmful fraction of the particle pollutants, the health effects of coarse particles (PM10-2.5) have been inconclusive, especially on cerebrovascular diseases, we thus evaluated the effects of PM10, PM2.5, and PM10-2.5 on stroke mortality in six Chinese subtropical cities using generalized additive models. We also conducted random-effects meta-analyses to estimate the overall effects across the six cities. We found that PM10, PM2.5, and PM10-2.5 were significantly associated with stroke mortality. Each 10 μg/m3 increase of PM10, PM2.5 and PM10-2.5 (lag03) was associated with an increase of 1.88% (95% CI: 1.37%, 2.39%), 3.07% (95% CI: 2.35%, 3.79%), and 5.72% (95% CI: 3.82%, 7.65%) in overall stroke mortality. Using the World Health Organization's guideline as reference concentration, we estimated that 3.21% (95% CI: 1.65%, 3.01%) of stroke mortality (corresponding to 1743 stroke mortalities, 95% CI: 896, 1633) were attributed to PM10, 5.57% (95% CI: 0.50%, 1.23%) stroke mortality (3019, 95% CI: 2286, 3777) were attributed to PM2.5, and 2.02% (95% CI: 1.85%, 3.08%) of stroke mortality (1097, 95% CI: 1005, 1673) could be attributed to PM10-2.5. Our analysis indicates that both PM2.5 and PM10-2.5 are important risk factors of stroke mortality and should be considered in the prevention and control of stroke in the study area.
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Affiliation(s)
- Xiaojie Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510220, China; Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Zhengmin Qian
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, 63104, USA
| | - Xiaojie Wang
- Panyu District of Guangzhou Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Hua Hong
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Yin Yang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yanjun Xu
- Institute of Chronic Non-Communicable Disease Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Xiaojun Xu
- Institute of Chronic Non-Communicable Disease Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Zhenjiang Yao
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510220, China
| | - Lingli Zhang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510220, China; Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Craig A Rolling
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, 63104, USA
| | - Mario Schootman
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, 63104, USA
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China.
| | - Hualiang Lin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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Lee S, Guth M. Associations between Temperature and Hospital Admissions for Subarachnoid Hemorrhage in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14040449. [PMID: 28430143 PMCID: PMC5409649 DOI: 10.3390/ijerph14040449] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/17/2017] [Accepted: 04/19/2017] [Indexed: 11/16/2022]
Abstract
The relationship between temperature and subarachnoid hemorrhage (SAH) is less studied than that between temperature and myocardial infarction or other cardiovascular diseases. This study investigated the association between daily temperature and risk of SAH by analyzing the hospital admission records of 111,316 SAH patients from 2004 to 2012 in Korea. A Poisson regression model was used to examine the association between temperature and daily SAH hospital admissions. To analyze data and identify vulnerable groups, we used the following subgroups: sex, age, insurance type, area (rural or urban), and different climate zones. We confirmed a markedly higher SAH risk only for people of low socioeconomic status in both hot and cold temperatures; the relative risk (RR) in the Medicaid group was significantly increased and ranged from 1.04 to 1.11 for cold temperatures and 1.10 to 1.11 for hot temperatures. For the National Health Insurance group, the RR was increased to 1.02 for the maximum temperature only. The increased risk for SAH was highest in the temperate zone. An increase above the heat threshold temperature and a decrease below the cold threshold temperature were correlated with an increased risk of SAH in susceptible populations and were associated with different lag effects and RRs.
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Affiliation(s)
- Suji Lee
- Institute of Health and Environment, Seoul National University, Gwanak-gu, Seoul 151-742, Korea.
| | - Matthias Guth
- School of Medicine, Technische Universität München, Arcisstraße 21, 80333 Munich, Germany.
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Sohn J, You SC, Cho J, Choi YJ, Joung B, Kim C. Susceptibility to ambient particulate matter on emergency care utilization for ischemic heart disease in Seoul, Korea. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2016; 23:19432-19439. [PMID: 27380182 DOI: 10.1007/s11356-016-7144-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 06/23/2016] [Indexed: 06/06/2023]
Abstract
Many epidemiological studies have reported associations between ambient particulate matter (PM) and cardiovascular diseases. However, the effects associated with PM that promote cardiovascular events among susceptible populations who may respond differently than the general population to the same ambient air pollutants remain unclear. We conducted a time-series study with generalized additive models to assess the association between ambient PM10 and emergency department (ED) visits for ischemic heart disease (IHD) in Seoul, Republic of Korea from 2005 to 2009. The ED data and previous medical records within the 5 years of each IHD event to examine the effect of PM10 in a susceptible population were obtained from Health Insurance Review and Assessment Service. Overall, the adjusted relative risks (RRs) of ED visits for IHD were not statistically significant for PM10, but significant positive RRs were found for groups with hypertension (1.018; 95 % confidence interval [CI] 1.002-1.035) and those who are ≥80 years of age (1.019; 1.002-1.037) for same-day exposure and with diabetes (1.019; 1.002-1.037) for single-lag models. Subgroup analyses revealed gender differences in ED visits for IHD in hypertensive patients and those who are ≥80 years of age; positive correlations were found only in males with the lag models. Our study suggests that ambient PM10 is significantly associated with ED visits for IHD, especially in males with hypertension, diabetes mellitus, or who are aged ≥80 years. Identification of populations susceptible to air pollution is of paramount importance to establishing recommendations or guidelines for high-risk individuals.
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Affiliation(s)
- Jungwoo Sohn
- Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Seng Chan You
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Jaelim Cho
- Department of Occupational and Environmental Medicine, Gachon University Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea
| | - Yoon Jung Choi
- Health Insurance Review & Assessment Service, 267 Hyoyeong-ro, Seocho-gu, Seoul, 137-706, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
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Han MH, Yi HJ, Ko Y, Kim YS, Lee YJ. Association between hemorrhagic stroke occurrence and meteorological factors and pollutants. BMC Neurol 2016; 16:59. [PMID: 27146603 PMCID: PMC4855484 DOI: 10.1186/s12883-016-0579-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 04/26/2016] [Indexed: 12/11/2022] Open
Abstract
Background The purpose of this study is to determine whether intracerebral hemorrhage and subarachnoid hemorrhage have different incidence patterns based on monthly variations in meteorological and air pollution parameters in the Seongdong district of Seoul, South Korea. Methods From January 1, 2004 to December 31, 2014, 1,477 consecutive hemorrhagic stroke events (>19 years old) were registered among residents of the Seongdong district, Seoul, South Korea. The authors calculated the relative risk of hemorrhagic stroke and its subtype incidence based on meteorological and air pollution factors. We also estimated relative risk with 95 % confidence intervals using a multivariate Poisson regression model to identify potential independent variables among meteorological factors and pollutants associated with either intracerebral hemorrhage or subarachnoid hemorrhage occurrence. Results We observed a negative correlation between intracerebral hemorrhage and mean temperature. In the multivariate Poisson model, particulate matter with an aerodynamic diameter < 10 μm showed positive correlations with intracerebral hemorrhage (relative risk, 1.09; 95 % confidence interval, 1.02 to 1.15; P = 0.012). In contrast, ozone correlated significantly with subarachnoid hemorrhage occurrence (relative risk, 1.32; 95 % confidence interval, 1.10 to 1.58; P = 0.003). Conclusions Our findings show the relationship between hemorrhagic stroke and meteorological parameters and pollutants under similar weather and environmental conditions in a small area. Among meteorological and pollutant variables, only higher particulate matter concentrations correlated independently with intracerebral hemorrhage occurrence, while only ozone was independently associated with subarachnoid hemorrhage occurrence. These findings suggest the possibility that there are pathogenic associations between hemorrhagic stroke and meteorological factors and pollutants.
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Affiliation(s)
- Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Medical Center, 222 Haengdang-ro, Seoul, 133-792, South Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, 222 Haengdang-ro, Seoul, 133-792, South Korea.
| | - Yong Ko
- Department of Neurosurgery, Hanyang University Medical Center, 222 Haengdang-ro, Seoul, 133-792, South Korea
| | - Young-Soo Kim
- Department of Neurosurgery, Hanyang University Medical Center, 222 Haengdang-ro, Seoul, 133-792, South Korea
| | - Young-Jun Lee
- Department of Radiology, Hanyang University Medical Center, Seoul, South Korea
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Lin H, Tao J, Du Y, Liu T, Qian Z, Tian L, Di Q, Zeng W, Xiao J, Guo L, Li X, Xu Y, Ma W. Differentiating the effects of characteristics of PM pollution on mortality from ischemic and hemorrhagic strokes. Int J Hyg Environ Health 2016; 219:204-11. [DOI: 10.1016/j.ijheh.2015.11.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 11/13/2015] [Accepted: 11/14/2015] [Indexed: 11/24/2022]
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Yorifuji T, Kashima S, Doi H. Associations of acute exposure to fine and coarse particulate matter and mortality among older people in Tokyo, Japan. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 542:354-9. [PMID: 26519595 DOI: 10.1016/j.scitotenv.2015.10.113] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/09/2015] [Accepted: 10/23/2015] [Indexed: 05/20/2023]
Abstract
Recent studies have reported adverse health effects of short-term exposure to coarse particles independent of particulate matter less than 2.5 μm in diameter (PM2.5), but evidence in Asian countries is limited. We therefore evaluated associations between short-term exposure to particulate matter (PM) and mortality among older people in Tokyo, Japan. We used a time-stratified, case-crossover design. Study participants included 664,509 older people (≥65 years old) in the 23 urbanized wards of the Tokyo Metropolitan Government, who died between January 2002 and December 2013. We obtained PM2.5 and suspended particulate matter (SPM; PM<7 μm in diameter) from one general monitoring station. We calculated PM7-2.5 by subtracting PM2.5 from SPM to account for coarse particles. We then used conditional logistic regression to estimate odds ratios (ORs) and 95 confidence intervals (CIs). Same-day PM2.5 and PM7-2.5 were independently associated with all-cause and cause-specific mortality related to cardiovascular and respiratory diseases; for example, both pollutants were positively associated with increased risk of all-cause mortality even after simultaneous adjustment for each pollutant: OR of 1.006 (95% CI: 1.003, 1.009) for PM2.5 and 1.016 (95% CI: 1.011, 1.022) for PM7-2.5. Even below concentrations stipulated by the Japanese air quality guidelines for PM2.5 and SPM (PM7), we observed adverse health effects. This study provides further evidence that acute exposure to PM2.5 and coarse particles is associated with increased risk of mortality among older people. Rigorous evaluation of air quality guidelines for daily average PM2.5 and larger particles should be continued.
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Affiliation(s)
- Takashi Yorifuji
- Department of Human Ecology, Graduate School of Environmental and Life Science, Okayama University, 3-1-1 Tsushima-naka, Kita-ku, Okayama 700-8530, Japan.
| | - Saori Kashima
- Department of Public Health and Health Policy, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Hiroyuki Doi
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
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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: 479] [Impact Index Per Article: 53.2] [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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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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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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Yang WS, Wang X, Deng Q, Fan WY, Wang WY. An evidence-based appraisal of global association between air pollution and risk of stroke. Int J Cardiol 2014; 175:307-13. [PMID: 24866079 DOI: 10.1016/j.ijcard.2014.05.044] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/11/2014] [Accepted: 05/12/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the transient effects of air pollutants on stroke morbidity and mortality using the meta-analytic approach. METHODS Three databases were searched for case-crossover and time series studies assessing associations between daily increases in particles with diameter<2.5 μm (PM2.5) and diameter<10 μm (PM10), sulfur dioxide (SO2), carbon monoxide (CO), nitrogen dioxide (NO2), ozone, and risks of stroke hospitalizations and mortality. Risk estimates were combined using random-effects model. RESULTS A total of 34 studies were included in the meta-analysis. Stroke hospitalizations or mortality increased 1.20% (95%CI: 0.22-2.18) per 10 μg/m3 increase in PM2.5, 0.58% (95%CI: 0.31-0.86) per 10 μg/m3 increase in PM10, 1.53% (95%CI: 0.66-2.41) per 10 parts per billion (ppb) increase in SO2, 2.96% (95%CI: 0.70-5.27) per 1 ppm increase in CO, and 2.24% (95%CI: 1.16-3.33) per 10ppb increase in NO2. These positive associations were the strongest on the same day of exposure, and appeared to be more apparent for ischemic stroke (for all 4 gaseous pollutants) and among Asian countries (for all 6 pollutants). In addition, an elevated risk (2.45% per 10 ppb; 95%CI: 0.35-4.60) of ischemic stroke associated with ozone was found, but not for hemorrhagic stroke. CONCLUSION Our study indicates that air pollution may transiently increase the risk of stroke hospitalizations and stroke mortality. Although with a weak association, these findings if validated may be of both clinical and public health importance given the great global burden of stroke and air pollution.
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Affiliation(s)
- Wan-Shui Yang
- Department of Social Science and Public Health, School of Basic Medical Science, Jiujiang University, Jiujiang, China; Jiangxi Province Key Laboratory of Systems Biomedicine, Jiujiang University, Jiujiang, China.
| | - Xin Wang
- Department of Social Science and Public Health, School of Basic Medical Science, Jiujiang University, Jiujiang, China; Jiangxi Province Key Laboratory of Systems Biomedicine, Jiujiang University, Jiujiang, China
| | - Qin Deng
- Department of Social Science and Public Health, School of Basic Medical Science, Jiujiang University, Jiujiang, China; Jiangxi Province Key Laboratory of Systems Biomedicine, Jiujiang University, Jiujiang, China
| | - Wen-Yan Fan
- Department of Social Science and Public Health, School of Basic Medical Science, Jiujiang University, Jiujiang, China; Jiangxi Province Key Laboratory of Systems Biomedicine, Jiujiang University, Jiujiang, China
| | - Wei-Ye Wang
- Department of Social Science and Public Health, School of Basic Medical Science, Jiujiang University, Jiujiang, China; Jiangxi Province Key Laboratory of Systems Biomedicine, Jiujiang University, Jiujiang, China
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Yorifuji T, Suzuki E, Kashima S. Cardiovascular Emergency Hospital Visits and Hourly Changes in Air Pollution. Stroke 2014; 45:1264-8. [DOI: 10.1161/strokeaha.114.005227] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Takashi Yorifuji
- From the Department of Human Ecology, Graduate School of Environmental and Life Science (T.Y.), and Department of Epidemiology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences (E.S.), Okayama University, Okayama, Japan; and Department of Public Health and Health Policy, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan (S.K.)
| | - Etsuji Suzuki
- From the Department of Human Ecology, Graduate School of Environmental and Life Science (T.Y.), and Department of Epidemiology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences (E.S.), Okayama University, Okayama, Japan; and Department of Public Health and Health Policy, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan (S.K.)
| | - Saori Kashima
- From the Department of Human Ecology, Graduate School of Environmental and Life Science (T.Y.), and Department of Epidemiology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences (E.S.), Okayama University, Okayama, Japan; and Department of Public Health and Health Policy, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan (S.K.)
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Associations of particulate matter with stroke mortality: a multicity study in Japan. J Occup Environ Med 2014; 55:768-71. [PMID: 23787566 DOI: 10.1097/jom.0b013e3182973092] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evidence linking short-term exposure to outdoor air pollution with hemorrhagic stroke is inconclusive. METHODS We evaluated the effects of suspended particulate matter (SPM) on cardiovascular disease mortality, focusing on types of stroke, from March 2005 to December 2010, in five selected prefectures in western Japan. A multicity time-series analysis was used, and Asian dust was adjusted in the models. RESULTS Even after adjusting for Asian dust, the same-day SPM was positively associated with several types of stroke mortality. Following a 10-μg/m increase in SPM, rate ratios were 1.014 (90% confidence interval [CI]: 1.002 to 1.026) for stroke, 1.030 (90% CI: 1.004 to 1.056) for intracerebral hemorrhage, and 1.016 (90% CI: 1.003 to 1.030) for ischemic stroke mortality. CONCLUSIONS Short-term exposure to outdoor air pollution may increase the risks of hemorrhagic stroke as well as ischemic stroke mortality.
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Chen SY, Lin YL, Chang WT, Lee CT, Chan CC. Increasing emergency room visits for stroke by elevated levels of fine particulate constituents. THE SCIENCE OF THE TOTAL ENVIRONMENT 2014; 473-474:446-450. [PMID: 24388822 DOI: 10.1016/j.scitotenv.2013.12.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 12/08/2013] [Accepted: 12/09/2013] [Indexed: 06/03/2023]
Abstract
The associations between fine particulate matter (PM2.5) and stroke remain inconsistent. We conducted a time-series study to evaluate emergency room (ER) visits for ischemic and hemorrhagic strokes in relation to PM2.5 and its constituents. Generalized additive models were used to model the counts of daily ER visits for ischemic and hemorrhagic strokes among patients admitted to the National Taiwan University Hospital from 1 January 2004 to 31 August 2008. Exposure variables included PM2.5 and the four constituents, nitrate, sulfate, organic carbon (OC), and elemental carbon (EC). 12,982 ischemic stroke and 3362 hemorrhagic stroke cases were identified during the study period. For hemorrhagic stroke, the strongest relative risks (RRs) of ER visits were 1.19 [95% confidence interval (CI), 1.07-1.32] and 1.08 (95% CI, 1.02-1.15) for an interquartile range (IQR) increase in 3-day average nitrate and EC. For ischemic stroke, increased RRs of ER visits of 1.21 (95% CI, 1.07-1.36) and 1.18 (95% CI, 1.06-1.31) were observed in the warm season for an IQR increase in 3-day average of OC and EC, respectively. PM2.5 and OC were associated with increased RRs of ER visits for ischemic stroke among patients aged 65 years or older and female patients. In conclusion, PM2.5 constituents, rather than PM2.5 mass, are more closely related to ER visits for hemorrhagic stroke. Both PM2.5 mass and its chemical constituents are associated with ER visits for ischemic stroke in the warm season, among patients older than 65 years, and female patients.
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Affiliation(s)
- Szu-Ying Chen
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan; Division of Surgical Intensive Care, Department of Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Lun Lin
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chung-Te Lee
- Graduate Institute of Environmental Engineering, National Central University, Taoyuan, Taiwan
| | - Chang-Chuan Chan
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Impact of particulate matter exposition on the risk of ischemic stroke: epidemiologic evidence and putative mechanisms. J Cereb Blood Flow Metab 2014; 34:215-20. [PMID: 24301290 PMCID: PMC3915219 DOI: 10.1038/jcbfm.2013.212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 10/22/2013] [Accepted: 11/05/2013] [Indexed: 11/08/2022]
Abstract
Ambient particulate matter (PM) pollution is estimated to be responsible for 3.2 million deaths annually worldwide. Although many studies have demonstrated PM as a serious risk factor for cardiovascular diseases, less is known on its association with cerebrovascular events. Over the last decade, however, an increasing number of studies have provided data showing a relationship between PM exposure and ischemic stroke (IS). In this article, we will report on existing epidemiologic findings for an association between PM exposure and IS based on a systemic literature search. Thus, despite inconsistencies in the results, currently available data suggest that PM exposure is a risk factor for IS, especially in patients with preexisting illnesses. With regards to the mechanisms leading to PM-dependent vascular damage, in particular proinflammatory, prooxidative, as well as proatherogenic pathways have been suggested to be involved. Notably, to date there is only one study published, which demonstrates the influence of PM exposure on cerebrovascular function. We will discuss reasonable approaches for future neurovascular research in this field.
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Teng THK, Williams TA, Bremner A, Tohira H, Franklin P, Tonkin A, Jacobs I, Finn J. A systematic review of air pollution and incidence of out-of-hospital cardiac arrest. J Epidemiol Community Health 2013; 68:37-43. [DOI: 10.1136/jech-2013-203116] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Leiva G MA, Santibañez DA, Ibarra E S, Matus C P, Seguel R. A five-year study of particulate matter (PM2.5) and cerebrovascular diseases. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2013; 181:1-6. [PMID: 23796845 DOI: 10.1016/j.envpol.2013.05.057] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/17/2013] [Accepted: 05/21/2013] [Indexed: 05/21/2023]
Abstract
Cerebrovascular accidents, or strokes, are the second leading cause of mortality and the leading cause of morbidity in both Chile and the rest of the world. However, the relationship between particulate matter pollution and strokes is not well characterized. The association between fine particle concentration and stroke admissions was studied. Data on hospital admissions due to cerebrovascular accidents were collected from the Ministry of Health. Air quality and meteorological data were taken from the Air Quality database of the Santiago Metropolitan Area. Santiago reported 33,624 stroke admissions between January 1, 2002 and December 30, 2006. PM2.5 concentration was markedly seasonal, increasing during the winter. This study found an association between PM2.5 exposure and hospital admissions for stroke; for every PM2.5 concentration increase of 10 μg m(-3), the risk of emergency hospital admissions for cerebrovascular causes increased by 1.29% (95% CI 0.552%-2.03%).
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Affiliation(s)
- Manuel A Leiva G
- Centro de Ciencias Ambientales and Departamento de Química, Facultad de Ciencias, Universidad de Chile, Casilla 653, Santiago, Chile.
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Rinsky JL, Hoppin JA, Blair A, He K, Beane Freeman LE, Chen H. Agricultural exposures and stroke mortality in the Agricultural Health Study. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2013; 76:798-814. [PMID: 24028665 PMCID: PMC3773612 DOI: 10.1080/15287394.2013.819308] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Exposures associated with common agricultural activities may increase risk of stroke. The authors evaluated associations between self-reported agricultural activities including pesticide use and handling of crops and stroke mortality among 51,603 male pesticide applicators enrolled in the Agricultural Health Study (AHS). Vital status was obtained through 2008. Stroke mortality was defined by underlying or contributing cause of death (ICD-9 430-438, ICD-10 I60-I69). Information regarding lifetime pesticide use, working with crops or animals, engagement in other agricultural activities, and potential confounders was self-reported at enrollment. Cox proportional hazards models, with age as the time scale, were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) adjusted for state of residence, smoking status, and alcohol consumption. Median follow-up time was 13 yr, during which 308 stroke deaths occurred. No measure of overall or specific pesticide use was positively associated with mortality due to stroke. Stroke mortality was inversely associated with handling hay, grain, or silage at least once each year as reported at enrollment (HR: 0.75; 95% CI: 0.58, 0.98). There was no evidence of an association between pesticide use and stroke mortality. The inverse association between handling of hays and grains and stroke mortality may be due to (1) those engaging in such activities being healthier than those who did not or (2) exposure to some biological agent present in hays and grains. Further investigation of incident stroke, rather than stroke mortality, as well as stroke subtypes, is needed to determine the full role of agricultural exposures and stroke.
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Affiliation(s)
- Jessica L. Rinsky
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health. Chapel Hill, NC
| | - Jane A. Hoppin
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services. Research Triangle Park, NC
| | - Aaron Blair
- Occupational and Environmental Epidemiology Branch, National Cancer Institute, National Institutes of Health, Department of Health and Human Services. Bethesda, MD
| | - Ka He
- Departments of Nutrition and Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC and Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington. Bloomington, IN
| | - Laura E. Beane Freeman
- Occupational and Environmental Epidemiology Branch, National Cancer Institute, National Institutes of Health, Department of Health and Human Services. Bethesda, MD
| | - Honglei Chen
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services. Research Triangle Park, NC
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Villeneuve PJ, Johnson JYM, Pasichnyk D, Lowes J, Kirkland S, Rowe BH. Short-term effects of ambient air pollution on stroke: who is most vulnerable? THE SCIENCE OF THE TOTAL ENVIRONMENT 2012; 430:193-201. [PMID: 22647242 DOI: 10.1016/j.scitotenv.2012.05.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 04/17/2012] [Accepted: 05/01/2012] [Indexed: 05/23/2023]
Abstract
Several studies have demonstrated positive associations between day-to-day increases in air pollution and stroke. These findings have been inconsistent, and the influence of patient characteristics has been largely ignored. In this study, we investigated the short-term effects of air pollution on stroke using a time-stratified case-crossover design. Data for hospital visits for stroke were extracted from 5927 medical charts of patients who presented to emergency departments between 2003 and 2009 in Edmonton, Canada. Daily concentrations of five air pollutants (NO(2), PM (2.5), CO, O(3), and SO(2)) were obtained from fixed-site monitors. Relative humidity and temperature were obtained from a metrological station operating at the city's airport. Chart data included: disease history, medication use, and smoking status. Conditional logistic regression was used to estimate the odds ratio (OR) of stroke in relation to an increase in the interquartile range for each pollutant. Positive associations were observed between ischemic stroke and air pollution during the 'warm' season (April through September). Specifically, the OR for an increase in 9.4 ppb in the 3-day average of NO(2) was 1.50 (95% CI: 1.12, 2.01). There were no statistically significant associations with any of the other pollutants after adjusting for NO(2) concentrations. Associations with ischemic stroke were stronger for those with a history of stroke (OR=2.31; 95% CI: 1.39, 3.83), heart disease (OR=1.99; 95% CI: 1.20, 3.28), and taking medication for diabetes (OR=2.03; 95% CI: 1.14, 3.59). Temperature was inversely associated with ischemic stroke during the 'warm' season, but no associations were evident with the other stroke subtypes. Air pollution was not associated with hemorrhagic stroke or transient ischemic attacks. The findings suggest that specific patient characteristics modify associations between air pollution and ischemic stroke.
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Affiliation(s)
- Paul J Villeneuve
- Population Studies Division, Health Canada, Ottawa, Ontario, Canada.
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44
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Hori A, Hashizume M, Tsuda Y, Tsukahara T, Nomiyama T. Effects of weather variability and air pollutants on emergency admissions for cardiovascular and cerebrovascular diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2012; 22:416-430. [PMID: 22384943 DOI: 10.1080/09603123.2011.650155] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We examined the effect of ambient temperature, air pressure and air pollutants on daily emergency admissions by identifying the cause of admission for each type of stroke and cardiovascular disease using generalized linear Poisson regression models allowing for overdispersion, and controlling for seasonal and inter-annual variations, days of the week and public holidays, levels of influenza and respiratory syncytial viruses. Every 1°C decrease in mean temperature was associated with an increase in the daily number of emergency admissions by 7.83% (95% CI 2.06-13.25) for acute coronary syndrome (ACS) and heart failure, by 35.57% (95% CI 15.59-59.02) for intracerebral haemorrhage (ICH) and by 11.71% (95% CI 4.1-19.89) for cerebral infarction. An increase of emergency admissions due to ICH (3.25% (95% CI 0.94-5.51)), heart failure (3.56% (95% CI 1.09-5.96)) was observed at every 1 hPa decrease in air pressure from the previous days. We found stronger detrimental effect of cold on stroke than cardiovascular disease.
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Affiliation(s)
- Aya Hori
- Department of Preventive Medicine and Public Health , Shinshu University School of Medicine, Matsumoto, Japan.
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Genc S, Zadeoglulari Z, Fuss SH, Genc K. The adverse effects of air pollution on the nervous system. J Toxicol 2012; 2012:782462. [PMID: 22523490 PMCID: PMC3317189 DOI: 10.1155/2012/782462] [Citation(s) in RCA: 355] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 11/15/2011] [Indexed: 12/20/2022] Open
Abstract
Exposure to ambient air pollution is a serious and common public health concern associated with growing morbidity and mortality worldwide. In the last decades, the adverse effects of air pollution on the pulmonary and cardiovascular systems have been well established in a series of major epidemiological and observational studies. In the recent past, air pollution has also been associated with diseases of the central nervous system (CNS), including stroke, Alzheimer's disease, Parkinson's disease, and neurodevelopmental disorders. It has been demonstrated that various components of air pollution, such as nanosized particles, can easily translocate to the CNS where they can activate innate immune responses. Furthermore, systemic inflammation arising from the pulmonary or cardiovascular system can affect CNS health. Despite intense studies on the health effects of ambient air pollution, the underlying molecular mechanisms of susceptibility and disease remain largely elusive. However, emerging evidence suggests that air pollution-induced neuroinflammation, oxidative stress, microglial activation, cerebrovascular dysfunction, and alterations in the blood-brain barrier contribute to CNS pathology. A better understanding of the mediators and mechanisms will enable the development of new strategies to protect individuals at risk and to reduce detrimental effects of air pollution on the nervous system and mental health.
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Affiliation(s)
- Sermin Genc
- Department of Neuroscience, Health Science Institute, Dokuz Eylul University, Inciralti, 35340 Izmir, Turkey
| | - Zeynep Zadeoglulari
- Department of Neuroscience, Health Science Institute, Dokuz Eylul University, Inciralti, 35340 Izmir, Turkey
| | - Stefan H. Fuss
- Department of Molecular Biology and Genetics, Bogazici University, 34342 Istanbul, Turkey
| | - Kursad Genc
- Department of Neuroscience, Health Science Institute, Dokuz Eylul University, Inciralti, 35340 Izmir, Turkey
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Johnson JYM, Villeneuve PJ, Pasichnyk D, Rowe BH. A retrospective cohort study of stroke onset: implications for characterizing short term effects from ambient air pollution. Environ Health 2011; 10:87. [PMID: 21975181 PMCID: PMC3196689 DOI: 10.1186/1476-069x-10-87] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 10/06/2011] [Indexed: 05/05/2023]
Abstract
BACKGROUND Case-crossover studies used to investigate associations between an environmental exposure and an acute health response, such as stroke, will often use the day an individual presents to an emergency department (ED) or is admitted to hospital to infer when the stroke occurred. Similarly, they will use patient's place of residence to assign exposure. The validity of using these two data elements, typically extracted from administrative databases or patient charts, to define the time of stroke onset and to assign exposure are critical in this field of research as air pollutant concentrations are temporally and spatially variable. Our a priori hypotheses were that date of presentation differs from the date of stroke onset for a substantial number of patients, and that assigning exposure to ambient pollution using place of residence introduces an important source of exposure measurement error. The objective of this study was to improve our understanding on how these sources of errors influence risk estimates derived using a case-crossover study design. METHODS We sought to collect survey data from stroke patients presenting to hospital EDs in Edmonton, Canada on the date, time, location and nature of activities at onset of stroke symptoms. The daily mean ambient concentrations of NO₂ and PM(2.5) on the self-reported day of stroke onset was estimated from continuous fixed-site monitoring stations. RESULTS Of the 336 participating patients, 241 were able to recall when their stroke started and 72.6% (95% confidence interval [CI]: 66.9-78.3%) experienced stroke onset the same day they presented to the ED. For subjects whose day of stroke onset differed from the day of presentation to the ED, this difference ranged from 1 to 12 days (mean = 1.8; median = 1). In these subjects, there were no systematic differences in assigned pollution levels for either NO₂ or PM(2.5) when day of presentation rather than day of stroke onset was used. At the time of stroke onset, 89.9% (95% CI: 86.6-93.1%) reported that they were inside, while 84.5% (95% CI: 80.6 - 88.4%) reported that for most of the day they were within a 15 minute drive from home. We estimated that due to the mis-specification of the day of stroke onset, the risk of hospitalization for stroke would be understated by 15% and 20%, for NO₂ and PM(2.5), respectively. CONCLUSIONS Our data suggest that day of presentation and residential location data obtained from administrative records reasonably captures the time and location of stroke onset for most patients. Under these conditions, any associated errors are unlikely to be an important source of bias when estimating air pollution risks in this population.
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Affiliation(s)
- Julie YM Johnson
- Population Studies Division, Health Canada, Ottawa, Ontario, Canada, 50 Columbine Driveway, Tunney's Pasture, Room 165, PL0801A Ottawa, Ontario K1A 0K9, Canada
| | - Paul J Villeneuve
- Population Studies Division, Health Canada, Ottawa, Ontario, Canada, 50 Columbine Driveway, Tunney's Pasture, Room 165, PL0801A Ottawa, Ontario K1A 0K9, Canada
- Division of Occupation and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada, 155 College Street, Health Science Building, 6th floor, Toronto, Ontario, M5T 3M7, Canada
| | - Dion Pasichnyk
- Department of Emergency Medicine, Faculty of Medicine and Dentistry and School of Public Health, University of Alberta, Edmonton, Alberta, Canada, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton, Alberta, T6G 2R7, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, Faculty of Medicine and Dentistry and School of Public Health, University of Alberta, Edmonton, Alberta, Canada, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton, Alberta, T6G 2R7, Canada
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