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Wu S, Zhang H, Liu C, Yang Q, Sun J, Yuan C, Xiang H, Zhang J, Lu E, Guo J, Shao Q, Zhao B, Yang G. Impact of surface ultraviolet radiation intensity on hospital admissions for ischemic and hemorrhagic stroke: A large-scale database study using distributed lag nonlinear analysis, 2015-2022, in Harbin, China. J Stroke Cerebrovasc Dis 2024; 33:107908. [PMID: 39094717 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107908] [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: 01/15/2024] [Revised: 07/27/2024] [Accepted: 07/30/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVES Our aim is to evaluate the impact of surface ultraviolet radiation intensity on hospital admissions for stroke and to compare the correlation and differences among different subtypes of strokes. MATERIALS AND METHODS We collected daily data on surface ultraviolet radiation intensity, temperature, air pollution, and hospital admissions for stroke in Harbin from 2015 to 2022. Using a distributed lag non-linear model, we determined the correlation between daily surface ultraviolet radiation intensity and the stroke admission rate. Relative risks (RR) with 95% confidence intervals (CI) and attributable fractions (AF) with 95% CI were calculated based on stroke subtypes, gender, and age groups. RESULTS A total of 132,952 hospitalized stroke cases (including hemorrhagic and ischemic strokes) were included in the study. We assessed the non-linear effects of ultraviolet intensity on hospitalized patients with ischemic and hemorrhagic strokes. Compared to the maximum morbidity benchmark ultraviolet intensity (19.2 × 10^5 for ischemic stroke and 20.25 for hemorrhagic stroke), over the 0-10 day lag period, the RR for extreme low radiation (1st percentile) was 0.86 (95% CI: 0.77, 0.96), and the RR for extreme high radiation (99th percentile) was 0.86 (95% CI: 0.77, 0.96). In summary, -4.842% (95% CI: -7.721%, -2.167%) and -1.668% (95% CI: -3.061%, -0.33%) of ischemic strokes were attributed to extreme low radiation intensity with a lag of 0 to 10 days and extreme high radiation intensity with a lag of 0 to 5 days, respectively. The reduction in stroke hospitalization rates due to low or high ultraviolet intensity was more pronounced in females and younger individuals compared to males and older individuals. None of the mentioned ultraviolet intensity intensities and lag days had a statistically significant impact on hemorrhagic stroke. CONCLUSIONS Our study fundamentally suggests that both lower and higher levels of surface ultraviolet radiation intensity in Harbin, China, contribute to a reduced incidence of ischemic stroke, with this effect lasting approximately 10 days. This finding holds significant potential for public health and clinical relevance.
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Affiliation(s)
- Shouyue Wu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Heilongjiang Province Neuroscience Institute, Harbin, China
| | - Hongli Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Heilongjiang Province Neuroscience Institute, Harbin, China
| | - Chunyang Liu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Heilongjiang Province Neuroscience Institute, Harbin, China
| | - Qiunan Yang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Heilongjiang Province Neuroscience Institute, Harbin, China
| | - Jianda Sun
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Heilongjiang Province Neuroscience Institute, Harbin, China
| | - Chao Yuan
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Heilongjiang Province Neuroscience Institute, Harbin, China
| | - Huan Xiang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Heilongjiang Province Neuroscience Institute, Harbin, China
| | - Jian Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Heilongjiang Province Neuroscience Institute, Harbin, China
| | - Enzhou Lu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Heilongjiang Province Neuroscience Institute, Harbin, China
| | - Jinyi Guo
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Heilongjiang Province Neuroscience Institute, Harbin, China
| | - Qi Shao
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Heilongjiang Province Neuroscience Institute, Harbin, China
| | - Boxian Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Heilongjiang Province Neuroscience Institute, Harbin, China
| | - Guang Yang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China; Heilongjiang Province Neuroscience Institute, Harbin, China.
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Fang K, Hong L, Zhang Y, Cao N, Feng J, Hu M, Fu Q, Zheng Y, Yang Q, Wang Y, Wang J, Wang S, Cheng X, Dong Q. Hourly effect of atmospheric reactive nitrogen species on the onset of acute ischemic stroke: Insight from the Shanghai Stroke Service System Database. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 948:174896. [PMID: 39047832 DOI: 10.1016/j.scitotenv.2024.174896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
Acute ischemic stroke (AIS) is one of the most predominant causes of mortality and disability in China. Significant uncertainties in stroke diagnosis and time of onset have resulted in inconsistent evidence on the association between ambient air pollution and the risk of AIS. The present study aimed to evaluate the impact of air pollution on AIS onset based on high time-resolution air pollution data and a stroke-specific registry across the past five years. Hourly concentrations of PM2.5, PM10, O3, SO2, CO, NO2 and nitrous acid (HONO) were monitored from 2017 to 2021, with which a distributed lag non-linear model and conditional logistic regression models coupled with a time-stratified case-crossover design were applied to 106,623 AIS cases recorded in the Shanghai Stroke Service (4S) database during the study period. Results from the conditional logistic regression models indicate that acute exposure to PM2.5, PM10, SO2, NO2 and HONO was found to be associated with AIS onset, respectively. The corresponding cumulative excessive risks of AIS onset were 0.8 %, 1 %, 2.4 %, 2.1 % and 1.8 % for each interquartile range increase in the respective concentration. The longest lag-effect (up to 13 h) was observed for reactive nitrogen species (RNS), such as NO2 and HONO, which remained robust in two-pollutant models. Similar important role of RNS in AIS onset were confirmed by the distributed lag non-linear model. By demonstrating the transient effect of ambient air pollution on AIS, especially the relationships between RNS and AIS for the first time, our study provides stringent evidence for future mitigation strategies for pollution emission and public health.
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Affiliation(s)
- Kun Fang
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging in Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Lan Hong
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging in Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiran Zhang
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging in Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Nan Cao
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging in Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jialiang Feng
- School of Environmental and Chemical Engineering, Shanghai University, Shanghai, China
| | - Ming Hu
- Shanghai Environmental Monitoring Center, Shanghai, China
| | - Qingyan Fu
- Shanghai Academy of Environmental Sciences, Shanghai, China
| | - Yang Zheng
- Department of NCD Surveillance, Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, China
| | - Qundi Yang
- Department of NCD Surveillance, Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, China
| | - Yuzhuo Wang
- Department of NCD Surveillance, Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, China
| | - Jinyitao Wang
- School of Environmental and Chemical Engineering, Shanghai University, Shanghai, China
| | - Shunyao Wang
- School of Environmental and Chemical Engineering, Shanghai University, Shanghai, China.
| | - Xin Cheng
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging in Medicine, Huashan Hospital, Fudan University, Shanghai, China.
| | - Qiang Dong
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging in Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Yang C, Lei L, Li Y, Huang C, Chen K, Bao J. Bidirectional modification effects on nonlinear associations of summer temperature and air pollution with first-ever stroke morbidity. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 272:116034. [PMID: 38310820 DOI: 10.1016/j.ecoenv.2024.116034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/06/2024]
Abstract
High temperature and air pollution may induce stroke morbidity. However, whether associations between high temperature and air pollution with stroke morbidity are modified by each other is still unclear. Data on 23,578 first-ever stroke patients in Shenzhen, China, during the summers of 2014-2018 were collected. Distributed lag nonlinear models were used to assess the modifying effects of air pollution stratified by the median for the associations between summer temperature and stroke morbidity at 0-3 lag days; modifying effects of temperature stratified by the minimum morbidity temperature on the associations between air pollution and stroke morbidity at the same lags were also estimated. The attributable risks of high temperature and high pollution on stroke morbidity were quantified. Stratified analyses of gender, age, migration type, and complication type were conducted to assess vulnerable population characteristics. Summer high temperature may induce stroke morbidity at high-level PM2.5, PM10, O3, SO2, and NO2 conditions, with attributable fraction (AF) of 2.982% (95% empirical confidence interval [eCI]: 0.943, 4.929), 3.113% (0.948, 5.200), 2.841% (0.943, 4.620), 3.617% (1.539, 5.470), and 2.048% (0.279, 3.637), respectively. High-temperature effects were statistically insignificant at corresponding low-level air pollution conditions. High-level PM2.5, PM10, and O3 may induce stroke morbidity at high-temperature conditions, with AF of 3.664% (0.036, 7.196), 4.129% (0.076, 7.963), and 4.574% (1.009, 7.762), respectively. High-level PM2.5, PM10, and O3 were not associated with stroke morbidity at low-temperature conditions. The effects of high temperature and high pollution on stroke morbidity were statistically significant among immigrants and patients with hypertension, dyslipidemia, or diabetes but insignificant among natives and patients without complications. The associations of summer temperature and air pollution with first-ever stroke morbidity may be enhanced bidirectionally. Publicity on the health risks of combined high temperature and high pollution events should be strengthened to raise protection awareness of relevant vulnerable populations.
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Affiliation(s)
- Chenlu Yang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Lin Lei
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Yike Li
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kai Chen
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Junzhe Bao
- College of Public Health, Zhengzhou University, Zhengzhou, China.
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Pedde M, Larson TV, D’Souza J, Szpiro AA, Kloog I, Lisabeth LD, Jacobs D, Sheppard L, Allison M, Kaufman JD, Adar SD. Coarse Particulate Matter and Markers of Inflammation and Coagulation in the Multi-Ethnic Study of Atherosclerosis (MESA) Population: A Repeat Measures Analysis. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:27009. [PMID: 38381480 PMCID: PMC10880818 DOI: 10.1289/ehp12972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND In contrast to fine particles, less is known of the inflammatory and coagulation impacts of coarse particulate matter (PM 10 - 2.5 , particulate matter with aerodynamic diameter ≤ 10 μ m and > 2.5 μ m ). Toxicological research suggests that these pathways might be important processes by which PM 10 - 2.5 impacts health, but there are relatively few epidemiological studies due to a lack of a national PM 10 - 2.5 monitoring network. OBJECTIVES We used new spatiotemporal exposure models to examine associations of both 1-y and 1-month average PM 10 - 2.5 concentrations with markers of inflammation and coagulation. METHODS We leveraged data from 7,071 Multi-Ethnic Study of Atherosclerosis and ancillary study participants 45-84 y of age who had repeated plasma measures of inflammatory and coagulation biomarkers. We estimated PM 10 - 2.5 at participant addresses 1 y and 1 month before each of up to four exams (2000-2012) using spatiotemporal models that incorporated satellite, regulatory monitoring, and local geographic data and accounted for spatial correlation. We used random effects models to estimate associations with interleukin-6 (IL-6), C-reactive protein (CRP), fibrinogen, and D-dimer, controlling for potential confounders. RESULTS Increases in PM 10 - 2.5 were not associated with greater levels of inflammation or coagulation. A 10 - μ g / m 3 increase in annual average PM 10 - 2.5 was associated with a 2.5% decrease in CRP [95% confidence interval (CI): - 5.5 , 0.6]. We saw no association between annual average PM 10 - 2.5 and the other markers (IL-6: - 0.7 % , 95% CI: - 2.6 , 1.2; fibrinogen: - 0.3 % , 95% CI: - 0.9 , 0.3; D-dimer: - 0.2 % , 95% CI: - 2.6 , 2.4). Associations consistently showed that a 1 0 - μ g / m 3 increase in 1-month average PM 10 - 2.5 was associated with reduced inflammation and coagulation, though none were distinguishable from no association (IL-6: - 1.2 % , 95% CI: - 3.0 , 0.5; CRP: - 2.5 % , 95% CI: - 5.3 , 0.4; fibrinogen: - 0.4 % , 95% CI: - 1.0 , 0.1; D-dimer: - 2.0 % , 95% CI: - 4.3 , 0.3). DISCUSSION We found no evidence that PM 10 - 2.5 is associated with higher inflammation or coagulation levels. More research is needed to determine whether the inflammation and coagulation pathways are as important in explaining observed PM 10 - 2.5 health impacts in humans as they have been shown to be in toxicology studies or whether PM 10 - 2.5 might impact human health through alternative biological mechanisms. https://doi.org/10.1289/EHP12972.
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Affiliation(s)
- Meredith Pedde
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy V. Larson
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Civil and Environmental Engineering, University of Washington, Seattle, Washington, USA
| | - Jennifer D’Souza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam A. Szpiro
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Lynda D. Lisabeth
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - David Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Matthew Allison
- Division of Preventive Medicine, University of California San Diego, San Diego, California, USA
| | - Joel D. Kaufman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Sara D. Adar
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
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de Souza Fernandes Duarte E, Lucio PS, Costa MJ, Salgueiro V, Salgado R, Potes M, Hoelzemann JJ, Bortoli D. Pollutant-meteorological factors and cardio-respiratory mortality in Portugal: Seasonal variability and associations. ENVIRONMENTAL RESEARCH 2024; 240:117491. [PMID: 37884072 DOI: 10.1016/j.envres.2023.117491] [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: 05/13/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023]
Abstract
Seasonal variations in cardiorespiratory diseases may be influenced by air pollution and meteorological factors. This work aims to highlight the relevance of a complete seasonal characterization of the pollutant-meteorological factors and cardio-respiratory mortality in Portugal and the relationships between health outcomes and environmental risk factors. To this end, air pollution and meteorological variables along with health outcomes were analyzed at national level and on a monthly basis for the period of 2011-2020. It was found that cardiorespiratory mortality rates during winter were 44% higher than during the summer. Furthermore, particulate matter with aerodynamic diameters of 10 and 2.5 μm (μm) or smaller (PM10 and PM2.5), carbon monoxide (CO) and nitrogen dioxide (NO2) showed a seasonal variability with the highest concentrations during winter while ozone (O3) presented higher concentrations during spring and summer. PM10, PM2.5 and NO2, showed a positive correlation between seasons, indicating similar patterns of behavior. Canonical correlation analysis (CCA) applied to pollutant-meteorological and cardiorespiratory mortality data indicates a strong linear correlation between pollutant-meteorological factors and health outcomes. The first canonical correlation was 0.889, and the second was 0.545, both statistically significant (p-value < 0.001). The CCA results suggest that there is a strong association between near-surface temperature, relative humidity, PM10, PM2.5, CO and NO2 and health outcomes. The results of this study provide important information of the seasonal variability of air pollutants and meteorological factors in Portugal and their associations with cardiorespiratory mortality.
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Affiliation(s)
- Ediclê de Souza Fernandes Duarte
- Instituto de Ciências da Terra - ICT (Pólo de Évora), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, 7000-671, Évora, Portugal; Earth Remote Sensing Laboratory (EaRSLab), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, Évora, Portugal; Departamento de Física, Escola de Ciências e Tecnologia (ECT), Universidade de Évora, Évora, Portugal.
| | - Paulo Sérgio Lucio
- Departamento de Ciências Atmosféricas e Climáticas, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Maria João Costa
- Instituto de Ciências da Terra - ICT (Pólo de Évora), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, 7000-671, Évora, Portugal; Earth Remote Sensing Laboratory (EaRSLab), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, Évora, Portugal; Departamento de Física, Escola de Ciências e Tecnologia (ECT), Universidade de Évora, Évora, Portugal
| | - Vanda Salgueiro
- Instituto de Ciências da Terra - ICT (Pólo de Évora), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, 7000-671, Évora, Portugal; Earth Remote Sensing Laboratory (EaRSLab), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, Évora, Portugal; Departamento de Física, Escola de Ciências e Tecnologia (ECT), Universidade de Évora, Évora, Portugal
| | - Rui Salgado
- Instituto de Ciências da Terra - ICT (Pólo de Évora), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, 7000-671, Évora, Portugal; Earth Remote Sensing Laboratory (EaRSLab), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, Évora, Portugal; Departamento de Física, Escola de Ciências e Tecnologia (ECT), Universidade de Évora, Évora, Portugal
| | - Miguel Potes
- Instituto de Ciências da Terra - ICT (Pólo de Évora), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, 7000-671, Évora, Portugal; Earth Remote Sensing Laboratory (EaRSLab), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, Évora, Portugal; Departamento de Física, Escola de Ciências e Tecnologia (ECT), Universidade de Évora, Évora, Portugal
| | - Judith J Hoelzemann
- Departamento de Ciências Atmosféricas e Climáticas, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Daniele Bortoli
- Instituto de Ciências da Terra - ICT (Pólo de Évora), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, 7000-671, Évora, Portugal; Earth Remote Sensing Laboratory (EaRSLab), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, Évora, Portugal; Departamento de Física, Escola de Ciências e Tecnologia (ECT), Universidade de Évora, Évora, Portugal
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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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Jin JQ, Lin GZ, Wu SY, Zheng MR, Liu H, Liu XY, Yan MQ, Chen ZY, Ou CQ. Short-term effects of individual exposure to PM 2.5 on hospital admissions for myocardial infarction and stroke: a population-based case-crossover study in Guangzhou, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023:10.1007/s11356-023-28058-y. [PMID: 37273056 DOI: 10.1007/s11356-023-28058-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/29/2023] [Indexed: 06/06/2023]
Abstract
Some studies have investigated the effects of PM2.5 on cardiovascular diseases based on the population-average exposure data from several monitoring stations. No one has explored the short-term effect of PM2.5 on cardiovascular hospitalizations using individual-level exposure data. We assessed the short-term effects of individual exposure to PM2.5 on hospitalizations for myocardial infarction (MI) and stroke in Guangzhou, China, during 2014-2019. The population-based data on cardio-cerebrovascular events were provided by Guangzhou Center for Disease Control and Prevention. Average annual percent changes (AAPCs) were used to describe trends in the hospitalization rates of MI and stroke. The conditional logistic regression model with a time-stratified case-crossover design was applied to estimate the effects of satellite-retrieved PM2.5 with 1-km resolution as individual-level exposure. Furthermore, we performed stratified analyses by demographic characteristics and season. There were 28,346 cases of MI, 188,611, and 36,850 cases of ischemic stroke (IS) and hemorrhagic stroke (HS), respectively, with an annual average hospitalization rate of 37.2, 247, and 48.4 per 100,000 people. Over the six-year study period, significant increasing trends in the hospitalization rates were observed with AAPCs of 12.3% (95% confidence interval [CI]: 7.24%, 17.6%), 13.1% (95% CI: 9.54%, 16.7%), and 9.57% (95% CI: 6.27%, 13.0%) for MI, IS, and HS, respectively. A 10 μg/m3 increase in PM2.5 was associated with an increase of 1.15% (95% CI: 0.308%, 1.99%) in MI hospitalization and 1.29% (95% CI: 0.882%, 1.70%) in IS hospitalization. A PM2.5-associated reduction of 1.17% (95% CI: 0.298%, 2.03%) was found for HS hospitalization. The impact of PM2.5 was greater in males than in females for MI hospitalization, and greater effects were observed in the elderly (≥ 65 years) and in cold seasons for IS hospitalization. Our study added important evidence on the adverse effect of PM2.5 based on satellite-retrieved individual-level exposure data.
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Affiliation(s)
- Jie-Qi Jin
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Guo-Zhen Lin
- Guangzhou Center for Disease Control and Prevention, 15, Guangzhou, 510440, China
| | - Shuang-Ying Wu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Mu-Rui Zheng
- Guangzhou Center for Disease Control and Prevention, 15, Guangzhou, 510440, China
| | - Hui Liu
- Guangzhou Center for Disease Control and Prevention, 15, Guangzhou, 510440, China
| | - Xiang-Yi Liu
- Guangzhou Center for Disease Control and Prevention, 15, Guangzhou, 510440, China
| | - Min-Qian Yan
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Zhao-Yue Chen
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Chun-Quan Ou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, 510515, China.
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Koo GPY, Zheng H, Aik JCL, Tan BYQ, Sharma VK, Sia CH, Ong MEH, Ho AFW. Clustering of Environmental Parameters and the Risk of Acute Ischaemic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4979. [PMID: 36981888 PMCID: PMC10049712 DOI: 10.3390/ijerph20064979] [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: 01/11/2023] [Revised: 03/05/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
Acute ischaemic stroke (AIS) risk on days with similar environmental profiles remains unknown. We investigated the association between clusters of days with similar environmental parameters and AIS incidence in Singapore. We grouped calendar days from 2010 to 2015 with similar rainfall, temperature, wind speed, and Pollutant Standards Index (PSI) using k-means clustering. Three distinct clusters were formed 'Cluster 1' containing high wind speed, 'Cluster 2' having high rainfall, and 'Cluster 3' having high temperatures and PSI. We aggregated the number of AIS episodes over the same period with the clusters and analysed their association using a conditional Poisson regression in a time-stratified case-crossover design. Comparing the three clusters, Cluster 3 had the highest AIS occurrence (IRR 1.09; 95% confidence interval (CI) 1.05-1.13), with no significant difference between Clusters 1 and 2. Subgroup analyses in Cluster 3 showed that AIS risk was amplified in the elderly (≥65 years old), non-smokers, and those without a history of ischaemic heart disease/atrial fibrillation/vascular heart disease/peripheral vascular disease. In conclusion, we found that AIS incidence may be higher on days with higher temperatures and PSI. These findings have important public health implications for AIS prevention and health services delivery during at-risk days, such as during the seasonal transboundary haze.
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Affiliation(s)
| | - Huili Zheng
- National Registry of Diseases Officer, Health Promotion Board, Singapore 168937, Singapore
| | - Joel C. L. Aik
- Environmental Epidemiology and Toxicology Division, Environmental Health Institute, National Environment Agency, Singapore 228231, Singapore
- Pre-Hospital & Emergency Research Center, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Benjamin Y. Q. Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Vijay K. Sharma
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Ching Hui Sia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
| | - Marcus E. H. Ong
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Andrew F. W. Ho
- Pre-Hospital & Emergency Research Center, Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
- Centre of Population Health Research and Implementation, SingHealth Regional Health System, Singapore 168753, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
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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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Wu H, Zhang B, Wei J, Lu Z, Zhao M, Liu W, Bovet P, Guo X, Xi B. Short-term effects of exposure to ambient PM 1, PM 2.5, and PM 10 on ischemic and hemorrhagic stroke incidence in Shandong Province, China. ENVIRONMENTAL RESEARCH 2022; 212:113350. [PMID: 35487259 DOI: 10.1016/j.envres.2022.113350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Short-term exposure to ambient PM2.5 and PM10 is associated with increased risk of mortality and hospital admissions for stroke. However, there is less evidence regarding the effect of exposure to PM1 on stroke incidence. We estimated the incidence risk of stroke and the attributable fractions related to short-term exposure to ambient PM1, PM2.5 and PM10 in China. METHODS County-specific incidence of stroke was obtained from health statistics in years 2014-2019. We linked county-level mean daily concentrations of PM1, PM2.5 and PM10 with stroke incidence. We used the time stratified case-crossover design to estimate the associations between stroke incidence and exposure to PM1, PM2.5 and PM10. We also estimated the disease burden fractions attributable to PM1, PM2.5, and PM10. RESULTS The study included a total of 2,193,954 stroke, from which 1,861,331 were ischemic and 332,623 were hemorrhagic stroke. PM1, PM2.5, and PM10 levels were associated with increased risks of total stroke and ischemic stroke at when assessing the associations in exposure at lag0-4 days. The increase of 10 μg/m3 in PM1, PM2.5, and PM10 was associated with total stroke, and the relative risks were 1.012 (95% confidence interval: 1.008, 1.015), 1.006 (1.004, 1.007) and 1.003 (1.002, 1.004), while the associations with ischemic stroke were 1.013 (1.010, 1.017), 1.006 (1.005, 1.008) and 1.003 (1.002, 1.004), respectively. There was no significant association between PM and risk of hemorrhagic stroke. The attributable fractions of total stroke were 6.9% (5.1%, 8.5%), 5.6% (4.2%, 6.8%) and 5.6% (3.9%, 7.1%) for PM1, PM2.5, and PM10, respectively. CONCLUSIONS PM1 showed a stronger association with stroke, with a larger attributable fraction of outcomes, than PM2.5 and PM10. Clean air policies should target the whole scope of PM, including PM1.
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Affiliation(s)
- Han Wu
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
| | - Bingyin Zhang
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, Shandong, China.
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, USA.
| | - Zilong Lu
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, Shandong, China.
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
| | - Wenhui Liu
- Information and Data Analysis Lab, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
| | - Pascal Bovet
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
| | - Xiaolei Guo
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, Shandong, China.
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
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Long-Term Exposure to Ozone Increases Neurological Disability after Stroke: Findings from a Nationwide Longitudinal Study in China. BIOLOGY 2022; 11:biology11081216. [PMID: 36009843 PMCID: PMC9404899 DOI: 10.3390/biology11081216] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022]
Abstract
Simple Summary In China, ozone is a major air pollutant that has been linked to stroke incidence and mortality. However, how long-term exposure to ozone affects the life quality among stroke survivors is unknown. This study presents a longitudinal analysis of nationwide data of Chinese adults, and shows that exposure to ozone can increase the risk of post-stroke disability. Taking ambient O3 under control can delay the progression of neurological disability among stroke survivors. Abstract Exposure to ozone (O3) is associated with stroke incidence and mortality. However, whether long-term exposure to O3 is associated with post-stroke neurological disability remains unknown. This study investigated the relationship based on the longitudinal analysis of China National Stroke Screening Survey (CNSSS), which included 65,778 records of stroke patients. All of the analyzed patients were followed-up at least twice. Stroke disability was assessed using the modified Rankin scale (mRS). Long-term exposure was assessed by the peak-season or annual mean of maximum 8-h O3 concentrations for 365 days before the mRS measurement. We used fixed-effect models to evaluate the associations between O3 and mRS score, with adjustment for multiple confounders, and found a 10 µg/m3 increase in peak-season O3 concentration was associated with a 0.0186 (95% confidence interval [CI] 0.0115–0.0256) increment in the mRS score. The association was robust in various subpopulations. For secondary outcomes, for each 10 µg/m3 increment in peak-season O3, the odds ratio of an increased mRS score (vs. unchanged or decreased mRS score) increased by 23% (95% CI 9–37%). A nonlinear analysis showed a sublinear association between O3 exposure and risk for post-stroke disability. A saturation effect was observed at an O3 concentration of more than ~120 μg/m3. Our study adds to evidence that long-term exposure to O3 increases the risk of neurological disability after stroke.
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12
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Tian Y, Xiang M, Peng J, Duan Y, Wen Y, Huang S, Li L, Yu S, Cheng J, Zhang X, Wang P. Modification effects of seasonal and temperature variation on the association between exposure to nitrogen dioxide and ischemic stroke onset in Shenzhen, China. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:1747-1758. [PMID: 35750990 DOI: 10.1007/s00484-022-02315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/16/2022] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
The independent associations of extreme temperature and ambient air pollutant with the admission to hospital and mortality of ischemic stroke have been widely investigated. However, knowledge about the modification effects of variation in season and temperature on the association between exposure to nitrogen dioxide (NO2) and ischemic stroke onset is still limited. This study purposed to explore the effect of NO2 on daily ischemic stroke onset modified by season and ambient temperature, and identify the potential population that susceptible to ischemic stroke onset connected with NO2 and ambient temperature. Data on daily ischemic stroke counts, weather conditions, and ambient air pollutant concentrations in Shenzhen were collected between January 1, 2008, and December 31, 2014. The seasonal effect on the NO2-associated onset was measured by a distributed-lag linear model. Furthermore, a generalized additive model that incorporated with stratification analyses was used to calculate the interactive effects between NO2 and ambient temperature. During the winter, the average percentage increase in daily ischemic stroke onset for each 10 μg/m3 increment in NO2 concentration on lagged 2 days was 3.05% (95% CI: 1.31-4.82%), while there was no statistically significant effect of NO2 during summer. And the low-temperature days ([Formula: see text] mean temperature), with a 2.23% increase in incidence (95% CI: 1.18-3.29%) for the same concentration increase in NO2, were significant higher than high temperature days ([Formula: see text] mean temperature). The modification effects of temperature on the study association were more pronounced in individuals aged 65 years or more and in males. The adverse health effects of NO2 on ischemic stroke are more pronounced during winter or low temperature periods. Elderly adults or males presented higher risks with these exposures.
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Affiliation(s)
- Yuchen Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ming Xiang
- Department of Hospital Infection Control, Wuhan No. 1 Hospital (Wuhan Hospital of Integrated Traditional Chinese and Western Medicine), Wuhan, Hubei, China
| | - Ji Peng
- Shenzhen Center for Chronic Disease Control, 2021 Buxin Road, Shenzhen, 518020, Guangdong, China
| | - Yanran Duan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ying Wen
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen, 518055, Guangdong, China
| | - Suli Huang
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen, 518055, Guangdong, China
| | - Lei Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shuyuan Yu
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen, 518055, Guangdong, China
| | - Jinquan Cheng
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen, 518055, Guangdong, China.
| | - Xia Zhang
- The First People's Hospital of Jingzhou, 40 Daqing Rd, Jingzhou, 434000, Hubei, China.
| | - Peng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Tu WJ, Hua Y, Yan F, Bian H, Yang Y, Lou M, Kang D, He L, Chu L, Zeng J, Wu J, Chen H, Han J, Ma L, Cao L, Wang L. Prevalence of stroke in China, 2013-2019: A population-based study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 28:100550. [PMID: 36507089 PMCID: PMC9727498 DOI: 10.1016/j.lanwpc.2022.100550] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The stroke burden in China has increased during the past 40 years. The present study aimed to determine the recent trends in the prevalence of stroke from 2013 to 2019 stratified by sociodemographic characteristics, including sex, age, residence, ethnicity, and province within a population-based screening project in China. Methods We made use of data generated from 2013 to 2019 in the China Stroke High-risk Population Screening Program. All living subjects with confirmed stroke at interview were considered to have prevalent stroke. All analyses of prevalence of stroke were weighted and results were presented as percentage and 95% confidence interval (CI). Findings A total of 4229,616 Chinese adults aged ≥40 years from 227 cities in the 31 provinces were finally included. The enrollment rate ranged from 58.8% (2017) to 67.8% (2013). The weighted prevalence of stroke increased annually from 2013 to 2019, being 2.28% (95% CI: 2.28-2.28%) in 2013, 2.34% (2.34-2.35%) in 2014, 2.43% (2.43-2.43%) in 2015, 2.48% (2.48-2.48%) in 2016, 2.52% (2.52-2.52%) in 2017, 2.55% (2.55-2.55%) in 2018, and 2.58% (2.58-2.58%) in 2019 (p for trend <0.001). The weighted prevalence of stroke was higher for male sex, older age, and residence in rural and northeast areas. Interpretation The prevalence of stroke in China and most provinces has continued to increase in the past 7 years (2013-2019). These findings, especially in provinces with high stroke prevalence, can help public health officials to increase province capacity for stroke and related risk factors prevention. Fundings This study was supported by grants from the National Major Public Health Service Projects.
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Affiliation(s)
- Wen-Jun Tu
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China,Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yang Hua
- Department of Ultrasound Vascular, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Feng Yan
- Department of Neurosurgery, Capital Medical University Xuanwu Hospital, Beijing, China
| | - Hetao Bian
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China
| | - Yi Yang
- Department of Neurology, the First Bethune Hospital of Jilin University, Changchun, China
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Dezhi Kang
- Department of Neurosurgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Li He
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Lan Chu
- Department of Neurology, the Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jingsheng Zeng
- Department of Neurology, the First Affiliated Hospital of Sun Yat–sen University, Guangzhou, China
| | - Jian Wu
- Department of Neurology, Beijing Tsinghua Changgung Memoria Hospital, Beijing, China
| | - Huisheng Chen
- Department of Neurology, The General Hospital of Northern Theater Command of the Chinese People's Liberation Army, Shenyang, China
| | - Jianfeng Han
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lin Ma
- Department of Interventional Radiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Cao
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China
| | - Longde Wang
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China,Corresponding author at: The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China No. 118, Guang'anmen Inner Street, Beijing 100053, China.
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14
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Li L, Huang S, Tian Y, Ji J, Zhang Y, Hu J, Lv Z, Liu N, Wang P, Yin P, Yu S. Short-term exposure to nitrogen dioxide and ischemic stroke incidence in Shenzhen, China: Modification effects by season and temperature. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 239:113644. [PMID: 35588618 DOI: 10.1016/j.ecoenv.2022.113644] [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: 12/19/2021] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES China has experienced a serious public health burden because of the increased incidence of ischemic stroke. Evidence describing the association between short-term exposure to nitrogen dioxide (NO2) and ischemic stroke morbidity is limited, and few studies have focused on the effects of season and temperature. This study aimed to evaluate the acute effects of NO2 on ischemic stroke incidence in Shenzhen, a southeastern city of China, considering the modified effects of season and temperature. METHODS A time-stratified case-crossover study was conducted between 2003 and 2014 among 98,482 ischemic stroke hospitalizations. Conditional quasi-Poisson regression was used to estimate the percentage changes in ischemic stroke admissions in relation to each 10 μg/m3 increment in NO2. RESULTS NO2 was positively associated with ischemic stroke onset over the full year, as well as in the cold season (November through April) and on cold days (ambient temperature≤median temperature), with significant single-day effects within 3 days after the exposure, and significant cumulative effects within the delayed five days. The maximum percentage changes were obtained at lag0-5, with 1.81% (95% confidence interval (CI) was 0.86-2.76%) over the full year, 2.75% (1.48-4.03%) in the cold season, and 3.04% (1.74-4.35%) on cold days. Additionally, the effects of exposure were found to be greater in males and people with higher education, and were lasting longer in subgroups of older individuals. CONCLUSIONS Our findings provide evidence that reductions in NO2 levels might decrease ischemic stroke morbidity, and enhance the understanding of ischemic stroke occurrence associated with NO2 modified by season and temperature.
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Affiliation(s)
- Lei Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, Hubei, China
| | - Suli Huang
- Department of Environment and Health, Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, Guangdong, China
| | - Yuchen Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, Hubei, China
| | - Jiajia Ji
- Department of Environment and Health, Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, Guangdong, China
| | - Yu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, Hubei, China
| | - Jing Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, Hubei, China
| | - Ziquan Lv
- Department of Molecular Epidemiology, Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, Guangdong, China
| | - Ning Liu
- Department of Environment and Health, Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, Guangdong, China
| | - Peng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, Hubei, China.
| | - Ping Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, Hubei, China.
| | - Shuyuan Yu
- Department of Environment and Health, Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, Guangdong, China.
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15
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Ambient Air Pollution and Risk for Stroke Hospitalization: Impact on Susceptible Groups. TOXICS 2022; 10:toxics10070350. [PMID: 35878255 PMCID: PMC9324267 DOI: 10.3390/toxics10070350] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 02/05/2023]
Abstract
Stroke is a leading cause of death, and air pollution is associated with stroke hospitalization. However, the susceptibility factors are unclear. Retrospective studies from 2014 to 2018 in Kaohsiung, Taiwan, were analyzed. Adult patients (>17 years) admitted to a medical center with stroke diagnosis were enrolled and patient characteristics and comorbidities were recorded. Air pollutant measurements, including those of particulate matter (PM) with aerodynamic diameters < 10 μm (PM10) and < 2.5 μm (PM2.5), nitrogen dioxide (NO2), and ozone (O3), were collected from air quality monitoring stations. During the study period, interquartile range (IQR) increments in PM2.5 on lag3 and lag4 were 12.3% (95% CI, 1.1−24.7%) and 11.5% (95% CI, 0.3−23.9%) concerning the risk of stroke hospitalization, respectively. Subgroup analysis revealed that the risk of stroke hospitalization after exposure to PM2.5 was greater for those with advanced age (≥80 years, interaction p = 0.045) and hypertension (interaction p = 0.034), after adjusting for temperature and humidity. A dose-dependent effect of PM2.5 on stroke hospitalization was evident. This is one of few studies focusing on the health effects of PM2.5 for patients with risk factors of stroke. We found that patients with risk factors, such as advanced age and hypertension, are more susceptible to PM2.5 impacts on stroke hospitalization.
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16
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Chen H, Cheng Z, Li M, Luo P, Duan Y, Fan J, Xu Y, Pu K, Zhou L. Ambient Air Pollution and Hospitalizations for Ischemic Stroke: A Time Series Analysis Using a Distributed Lag Nonlinear Model in Chongqing, China. Front Public Health 2022; 9:762597. [PMID: 35118040 PMCID: PMC8804166 DOI: 10.3389/fpubh.2021.762597] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 12/02/2021] [Indexed: 01/11/2023] Open
Abstract
Short-term exposure to air pollution has been associated with ischemic stroke (IS) hospitalizations, but the evidence of its effects on IS in low- and middle-income countries is limited and inconsistent. We aimed to quantitatively estimate the association between air pollution and hospitalizations for IS in Chongqing, China. This time series study included 2,299 inpatients with IS from three hospitals in Chongqing from January 2015 to December 2016. Generalized linear regression models combined with a distributed lag nonlinear model (DLNM) were used to investigate the impact of air pollution on IS hospitalizations. Stratification analysis was further implemented by sex, age, and season. The maximum lag-specific and cumulative percentage changes of IS were 1.2% (95% CI: 0.4–2.1%, lag 3 day) and 3.6% (95% CI: 0.5–6.7%, lag 05 day) for each 10 μg/m3 increase in PM2.5; 1.0% (95% CI: 0.3–1.7%, lag 3 day) and 2.9% (95% CI: 0.6–5.2%, lag 05 day) for each 10 μg/m3 increase in PM10; 4.8% (95% CI: 0.1–9.7%, lag 4 day) for each 10 μg/m3 increase in SO2; 2.5% (95% CI: 0.3–4.7%, lag 3 day) and 8.2% (95% CI: 0.9–16.0%, lag 05 day) for each 10 μg/m3 increase in NO2; 0.7% (95% CI: 0.0–1.5%, lag 6 day) for each 10 μg/m3 increase in O3. No effect modifications were detected for sex, age, and season. Our findings suggest that short-term exposure to PM2.5, PM10, SO2, NO2, and O3 contributes to more IS hospitalizations, which warrant the government to take effective actions in addressing air pollution issues.
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Affiliation(s)
- Hao Chen
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Zheng Cheng
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Mengmeng Li
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Pan Luo
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Yong Duan
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Jie Fan
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Ying Xu
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Kexue Pu
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Li Zhou
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
- *Correspondence: Li Zhou
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Alghamdi SAM, Aldriweesh MA, Al Bdah BA, Alhasson MA, Alsaif SA, Alluhidan WA, Almutairi FM, Alskaini MA, Alotaibi N, Al Khathaami AM. Stroke Seasonality and Weather Association in a Middle East Country: A Single Tertiary Center Experience. Front Neurol 2021; 12:707420. [PMID: 34733227 PMCID: PMC8558216 DOI: 10.3389/fneur.2021.707420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/16/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Stroke is a medical condition that leads to major disability and mortality worldwide. Some evidence suggests that weather and seasonal variations could have an impact on stroke incidence and outcome. However, the current evidence is inconclusive. Therefore, this study examines the seasonal variations and meteorological influences on stroke incidence and outcome in the largest city in Saudi Arabia. Methods: From February 2016 to July 2019, we retrospectively reviewed data from all patients with acute ischemic (AIS) or hemorrhagic stroke (HS) admitted to the stroke unit in a tertiary academic center in Saudi Arabia. The corresponding daily meteorological data were obtained for the same period. We considered the months from November to March as the cold season and April to October as the hot season. Results: The final cohort included 1,271 stroke patients; 60.89% (n = 774) cases occurred in the hot season, while 39.1% (n = 497) in the cold season. Males accounted for 69.6% (n = 884) of the cases. The proportion of ischemic stroke was 83.2% [hot season 83.9% (n = 649) vs. cold season 82.3% (n = 409)]. We found no statistically significant difference between seasons (hot or cold) in stroke incidence, severity [National Institutes of Health Stroke Scale (NIHSS)], hospital course (pneumonia, thromboembolism, intensive care stay, or length of stay), or outcome [modified Rankin scale (mRS) on discharge and death]. Conclusions: In Riyadh, Saudi Arabia, our study found no impact of weather or seasonal variations on stroke incidence, hospital course, or outcomes. However, our findings warrant further research in different country regions.
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Affiliation(s)
- Saeed A M Alghamdi
- Division of Neurology, Department of Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Mohammed A Aldriweesh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Bayan A Al Bdah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Muath A Alhasson
- Unaizah College of Medicine, Qassim University, Qassim, Saudi Arabia
| | - Sultan A Alsaif
- College of Medicine, Almaarefa University, Riyadh, Saudi Arabia
| | - Waleed A Alluhidan
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Faisal M Almutairi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed A Alskaini
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Naser Alotaibi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Division of Neurology, Department of Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ali M Al Khathaami
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Division of Neurology, Department of Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
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18
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Weng L, Li N, Feng T, Zhu R, Zheng ZJ. Short-Term Association of Air Pollutant Levels and Hospital Admissions for Stroke and Effect Modification by Apparent Temperature: Evidence From Shanghai, China. Front Public Health 2021; 9:716153. [PMID: 34646803 PMCID: PMC8503471 DOI: 10.3389/fpubh.2021.716153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/23/2021] [Indexed: 11/19/2022] Open
Abstract
The epidemiological evidence on relationships between air pollution, temperature, and stroke remains inconclusive. Limited evidence is available for the effect modification by apparent temperature, an indicator reflecting reactions to the thermal environment, on short-term associations between air pollution and hospital admissions for stroke. We used a generalized additive model with Poisson regression to estimate the relative risk (RR) of stroke admissions in Shanghai, China, between 2014 and 2016 associated with air pollutants, with subgroup analyses by age, sex, apparent temperature, and season. During the study period, changes in the daily number of stroke admissions per 10 μg/m3 increase in nitrogen dioxide (at lags 0, 1, 0–1, and 0–2) ranged from 1.05 (95% CI: 0.82%, 2.88%) to 2.24% (95% CI: 0.84%, 3.65%). For each 10 μg/m3 increase in sulfur dioxide concentrations at lags 1, 2, 0–1, and 0–2, the RR of daily stroke admissions increased by 3.34 (95% CI: 0.955%, 5.79%), 0.32 (95% CI: −1.97%, 2.67%), 3.33 (95% CI: 0.38%, 6.37%), and 2.86% (95% CI: −0.45%, 6.28%), respectively. The associations of same-day exposure to nitrogen dioxide with stroke admissions remained significant after adjustment for ozone levels. These associations were not modified by sex, age, apparent temperature, or season. More research is warranted to determine whether apparent temperature modifies the associations between air pollution and stroke admissions.
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Affiliation(s)
- Lvkan Weng
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Chest Hospital, Shanghai, China
| | - Na Li
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Tienan Feng
- Clinic Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongjia Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University, Shanghai, China.,Clinic Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
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19
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Kim SY, Kim JH, Kim YH, Wee JH, Min C, Han SM, Kim S, Choi HG. Short- and long-term exposure to air pollution increases the risk of stroke. Int J Stroke 2021; 17:654-660. [PMID: 34427474 DOI: 10.1177/17474930211042118] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Many epidemiological studies have observed the association of air pollutant exposure with the onset, progression, and mortality of stroke. The aim of this study was to investigate the associations of air pollutants, including SO2, NO2, O3, CO, and PM10, with stroke according to exposure duration. METHODS Data from the Korean National Health Insurance Service-Health Screening Cohort from 2002 to 2015 were obtained. The 21,240 patients who were admitted for or died due to stroke were 1:4 matched for age, sex, income, and region of residence with 84,960 control participants. The meteorological factors of mean, highest, and lowest temperatures; relative humidity; ambient atmospheric pressure; and air pollutant concentrations (SO2, NO2, O3, CO, and PM10) were analyzed to determine their associations with stroke. The odds ratios for stroke after exposure to each meteorological factor and air pollutant at 7 and 30 days were calculated in the stroke and control groups. Subgroup analyses were conducted according to age, sex, income, and region of residence. RESULTS The odds ratio associated with seven days of exposure to CO was 1.16 (95% CI = 1.04-1.31) in stroke patients. For 30 days of exposure, the odds ratio associated with CO was 1.16 (95% CI = 1.02-1.32) in stroke patients. Seven and 30 days of NO2 exposure were inversely associated with stroke. The odds ratio associated with seven days of exposure to O3 was 1.16 (95% CI = 1.01-1.32) in ischemic stroke patients. Both ischemic and hemorrhagic stroke had negative associations with 7 and 30 days of NO2 exposure. CONCLUSION Both short- and long-term exposure to CO were related to stroke.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Joo-Hee Kim
- Department of Neurosurgery, Hallym University College of Medicine, Hallym University Medical Center, Seoul, Korea
| | - Yoo Hwan Kim
- Department of Neurology, Hallym University College of Medicine, Anyang, Korea
| | - Jee Hye Wee
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Chanyang Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea.,Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Sang-Min Han
- Department of Political Science (Climate and Environmental Policy), Graduate School of Global Cooperation, Hallym University, Chuncheon, Korea
| | - Seungdo Kim
- Research Center for Climate Change and Energy, Hallym University, Chuncheon, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea.,Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea.,Hallym Institute for Environmental Diseases (HIED), Chuncheon, Korea
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20
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Ho YN, Cheng FJ, Tsai MT, Tsai CM, Chuang PC, Cheng CY. Fine particulate matter constituents associated with emergency room visits for pediatric asthma: a time-stratified case-crossover study in an urban area. BMC Public Health 2021; 21:1593. [PMID: 34445977 PMCID: PMC8393716 DOI: 10.1186/s12889-021-11636-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 08/18/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Global asthma-related mortality tallies at around 2.5 million annually. Although asthma may be triggered or exacerbated by particulate matter (PM) exposure, studies investigating the relationship of PM and its components with emergency department (ED) visits for pediatric asthma are limited. This study aimed to estimate the impact of short-term exposure to PM constituents on ED visits for pediatric asthma. METHODS We retrospectively evaluated non-trauma patients aged younger than 17 years who visited the ED with a primary diagnosis of asthma. Further, measurements of PM with aerodynamic diameter of < 10 μm (PM10), PM with aerodynamic diameter of < 10 μm (PM2.5), and four PM2.5 components (i.e., nitrate (NO3-), sulfate (SO42-), organic carbon (OC), and elemental carbon (EC)) were collected between 2007 and 2010 from southern particulate matter supersites. These included one core station and two satellite stations in Kaohsiung City, Taiwan. A time-stratified case-crossover study was conducted to analyze the hazard effect of PM. RESULTS Overall, 1597 patients were enrolled in our study. In the single-pollutant model, the estimated risk increase for pediatric asthma incidence on lag 3 were 14.7% [95% confidence interval (CI), 3.2-27.4%], 13.5% (95% CI, 3.3-24.6%), 14.8% (95% CI, 2.5-28.6%), and 19.8% (95% CI, 7.6-33.3%) per interquartile range increments in PM2.5, PM10, nitrate, and OC, respectively. In the two-pollutant models, OC remained significant after adjusting for PM2.5, PM10, and nitrate. During subgroup analysis, children were more vulnerable to PM2.5 and OC during cold days (< 26 °C, interaction p = 0.008 and 0.012, respectively). CONCLUSIONS Both PM2.5 concentrations and its chemical constituents OC and nitrate are associated with ED visits for pediatric asthma. Among PM2.5 constituents, OC was most closely related to ED visits for pediatric asthma, and children are more vulnerable to PM2.5 and OC during cold days.
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Affiliation(s)
- Yu-Ni Ho
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, No.123, Dapi Rd, Niao-Sung Dist, Kaohsiung City, 833, Taiwan.,Chang Gung University College of Medicine, No.259, Wenhua 1st Road, Guishan District, Taoyuan City, 333, Taiwan
| | - Fu-Jen Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, No.123, Dapi Rd, Niao-Sung Dist, Kaohsiung City, 833, Taiwan. .,Chang Gung University College of Medicine, No.259, Wenhua 1st Road, Guishan District, Taoyuan City, 333, Taiwan.
| | - Ming-Ta Tsai
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, No.123, Dapi Rd, Niao-Sung Dist, Kaohsiung City, 833, Taiwan.,Chang Gung University College of Medicine, No.259, Wenhua 1st Road, Guishan District, Taoyuan City, 333, Taiwan
| | - Chih-Min Tsai
- Chang Gung University College of Medicine, No.259, Wenhua 1st Road, Guishan District, Taoyuan City, 333, Taiwan.,Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, No.123, Dapi Rd, Niao-Sung Dist, Kaohsiung City, 833, Taiwan
| | - Po-Chun Chuang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, No.123, Dapi Rd, Niao-Sung Dist, Kaohsiung City, 833, Taiwan.,Chang Gung University College of Medicine, No.259, Wenhua 1st Road, Guishan District, Taoyuan City, 333, Taiwan
| | - Chi-Yung Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, No.123, Dapi Rd, Niao-Sung Dist, Kaohsiung City, 833, Taiwan. .,Chang Gung University College of Medicine, No.259, Wenhua 1st Road, Guishan District, Taoyuan City, 333, Taiwan. .,Department of Computer Science and Engineering, National Sun Yat-sen University, No. 70, Lianhai Rd., Gushan Dist, Kaohsiung City, 804, Taiwan.
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21
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Verhoeven JI, Allach Y, Vaartjes ICH, Klijn CJM, de Leeuw FE. Ambient air pollution and the risk of ischaemic and haemorrhagic stroke. Lancet Planet Health 2021; 5:e542-e552. [PMID: 34390672 DOI: 10.1016/s2542-5196(21)00145-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 03/30/2021] [Accepted: 05/14/2021] [Indexed: 05/26/2023]
Abstract
Stroke is a leading cause of disability and the second most common cause of death worldwide. Increasing evidence suggests that air pollution is an emerging risk factor for stroke. Over the past decades, air pollution levels have continuously increased and are now estimated to be responsible for 14% of all stroke-associated deaths. Interpretation of previous literature is difficult because stroke was usually not distinguished as ischaemic or haemorrhagic, nor by cause. This Review summarises the evidence on the association between air pollution and the different causes of ischaemic stroke and haemorrhagic stroke, to clarify which people are most at risk. The risk for ischaemic stroke is increased after short-term or long-term exposure to air pollution. This effect is most pronounced in people with cardiovascular burden and stroke due to large artery disease or small vessel disease. Short-term exposure to air pollution increases the risk of intracerebral haemorrhage, a subtype of haemorrhagic stroke, whereas the effects of long-term exposure are less clear. Limitations of the current evidence are that studies are prone to misclassification of exposure, often rely on administrative data, and have insufficient clinical detail. In this Review, we provide an outlook on new research opportunities, such as those provided by the decreased levels of air pollution due to the current COVID-19 pandemic.
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Affiliation(s)
- Jamie I Verhoeven
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Youssra Allach
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ilonca C H Vaartjes
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.
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22
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Relationship between Air Pollution and Hospital Admissions for Chronic Obstructive Pulmonary Disease in Changchun, China: A Season-Stratified Case-Cross Study. Can Respir J 2021; 2021:3240785. [PMID: 34326908 PMCID: PMC8302390 DOI: 10.1155/2021/3240785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/16/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to explore the relationship between air pollution and hospital admissions for COPD in Changchun, a northeast city of China, in different seasons. Methods The data on a total of 1,733 hospitalized patients living in Changchun with acute exacerbation of COPD from September 2013 to April 2018 were collected from a comprehensive 3A hospital of Changchun. Daily average concentrations of PM2.5, PM10, SO2, NO2, CO, and O3 were collected from the Department of Ecology and Environment of Jilin Province. The conditional logistic regression model was adopted to analyze the effect of air pollutant concentration on the number of hospitalized patients with COPD in different seasons. Results The maximum OR value for most air pollutants emitted in spring was on lag day 4, in summer and autumn on lag day 3, and in winter on lag day 2. In spring, SO2 and NO2 were entered into the regression equation, and the OR (95%CI) was 0.992 (0.986-0.998) and 1.009 (1.002-1.017); in autumn, PM2.5, PM10, and SO2 were entered into the regression equation, and the OR (95%CI) was 1.005 (1.000-1.011), 0.995 (0.991-1.000), and 1.006 (1.001-1.011), respectively; and in winter, PM2.5 and PM10 were entered into the regression equation, and the OR (95%CI) was 1.008 (1.002-1.015) and 0.994 (0.988-0.999), respectively. Conclusion The relationship between air pollution and hospital admission for COPD in Northeast China varies with different seasons. In spring, NO2 is likely to be the major risk factor for hospital admissions for COPD; in autumn, PM2.5 and SO2 are the major risk factors; and in winter, PM2.5 is the major risk factor.
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23
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Huang F, Zhao Y, Wang P, Wang Y, Zhang L, Luo Y. Short-term exposure to particulate matter on heart rate variability in humans: a systematic review of crossover and controlled studies. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:35528-35536. [PMID: 34031827 DOI: 10.1007/s11356-021-14494-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/17/2021] [Indexed: 06/12/2023]
Abstract
As an indicator of cardiac autonomic function, heart rate variability (HRV) has been proven to decrease after short-term exposure to particulate matters (PM) based on controlled animal studies. In this study, we conducted a systematic review to investigate short-term effects of exposure with different particle sizes on HRV in humans. Both crossover and controlled studies of human which were published prior to February 2020 were searched on four electronic databases. The HRV parameters included standard deviation of normal-to-normal intervals (SDNN), root mean square of successive normal-to-normal intervals (RMSSD), percent of normal-to-normal intervals that differ by more than 50 milliseconds (PNN50), low frequency (LF), high frequency (HF), and LF/HF. This review included 14 studies with 300 participants. The short-term effects of PM exposure on HRV in humans are inconclusive. For time-domain parameters, one study showed higher SDNN values with 2-h exposure to PM, whereas another one showed lower SDNN values. One study found RMSSD increased after PM exposure. One study found PNN50 decreased after PM exposure. For frequency-domain parameters, two studies showed LF increased with 2-h exposure to PM, and two studies showed an increase of LF/HF after PM exposure. Four studies showed lower HF values after PM exposure, whereas two studies showed higher HF values. Five studies did not find statistically significant results for any HRV parameters. We could not conclude that short-term exposure to PM can influence autonomic nervous function. The inconsistent changes of HRV in response to PM exposure may have complex mechanisms, which remains to be elucidated.
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Affiliation(s)
- Fangfang Huang
- School of Basic Medical Sciences, Henan University of Science and Technology, Luoyang, China
| | - Yuhan Zhao
- School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
| | - Ping Wang
- School of Basic Medical Sciences, Henan University of Science and Technology, Luoyang, China
| | - Yingfang Wang
- School of Basic Medical Sciences, Henan University of Science and Technology, Luoyang, China
| | - Licheng Zhang
- School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
| | - Yanxia Luo
- School of Public Health, Capital Medical University & Beijing Municipal Key Laboratory of Clinical Epidemiology, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China.
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24
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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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25
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Huang YT, Chen CC, Ho YN, Tsai MT, Tsai CM, Chuang PC, Cheng FJ. Short-Term Effects of Particulate Matter and Its Constituents on Emergency Room Visits for Chronic Obstructive Pulmonary Disease: A Time-Stratified Case-Crossover Study in an Urban Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094400. [PMID: 33919089 PMCID: PMC8122505 DOI: 10.3390/ijerph18094400] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/25/2022]
Abstract
Background: PM2.5 exposure is associated with pulmonary and airway inflammation, and the health impact might vary by PM2.5 constitutes. This study evaluated the effects of increased short-term exposure to PM2.5 constituents on chronic obstructive pulmonary disease (COPD)-related emergency department (ED) visits and determined the susceptible groups. Methods: This retrospective observational study performed in a medical center from 2007 to 2010, and enrolled non-trauma patients aged >20 years who visited the emergency department (ED) and were diagnosed as COPD. Concentrations of PM2.5, PM10, and the four PM2.5 components, including organic carbon (OC), elemental carbon (EC), nitrate (NO3−), and sulfate (SO42−), were collected by three PM supersites in Kaohsiung City. We used an alternative design of the Poisson time series regression models called a time-stratified and case-crossover design to analyze the data. Results: Per interquartile range (IQR) increment in PM2.5 level on lag 2 were associated with increments of 6.6% (95% confidence interval (CI), 0.5–13.0%) in risk of COPD exacerbation. An IQR increase in elemental carbon (EC) was significantly associated with an increment of 3.0% (95% CI, 0.1–5.9%) in risk of COPD exacerbation on lag 0. Meanwhile, an IQR increase in sulfate, nitrate, and OC levels was not significantly associated with COPD. Patients were more sensitive to the harmful effects of EC on COPD during the warm season (interaction p = 0.019). The risk of COPD exacerbation after exposure to PM2.5 was higher in individuals who are currently smoking, with malignancy, or during cold season, but the differences did not achieve statistical significance. Conclusion: PM2.5 and EC may play an important role in COPD events in Kaohsiung, Taiwan. Patients were more susceptible to the adverse effects of EC on COPD on warm days.
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Affiliation(s)
- Yii-Ting Huang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan; (Y.-T.H.); (C.-C.C.); (Y.-N.H.); (M.-T.T.); (P.-C.C.)
- College of Medicine, Chang Gung University, Guishan District, Taoyuan City 333, Taiwan;
| | - Chien-Chih Chen
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan; (Y.-T.H.); (C.-C.C.); (Y.-N.H.); (M.-T.T.); (P.-C.C.)
- College of Medicine, Chang Gung University, Guishan District, Taoyuan City 333, Taiwan;
| | - Yu-Ni Ho
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan; (Y.-T.H.); (C.-C.C.); (Y.-N.H.); (M.-T.T.); (P.-C.C.)
- College of Medicine, Chang Gung University, Guishan District, Taoyuan City 333, Taiwan;
| | - Ming-Ta Tsai
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan; (Y.-T.H.); (C.-C.C.); (Y.-N.H.); (M.-T.T.); (P.-C.C.)
- College of Medicine, Chang Gung University, Guishan District, Taoyuan City 333, Taiwan;
| | - Chih-Min Tsai
- College of Medicine, Chang Gung University, Guishan District, Taoyuan City 333, Taiwan;
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan
| | - Po-Chun Chuang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan; (Y.-T.H.); (C.-C.C.); (Y.-N.H.); (M.-T.T.); (P.-C.C.)
- College of Medicine, Chang Gung University, Guishan District, Taoyuan City 333, Taiwan;
| | - Fu-Jen Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan; (Y.-T.H.); (C.-C.C.); (Y.-N.H.); (M.-T.T.); (P.-C.C.)
- College of Medicine, Chang Gung University, Guishan District, Taoyuan City 333, Taiwan;
- Correspondence:
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Yang X, Zhang L, Chen X, Liu F, Shan A, Liang F, Li X, Wu H, Yan M, Ma Z, Dong G, Liu Y, Chen J, Wang T, Zhao B, Liu Y, Gu D, Tang N. Long-term exposure to ambient PM 2.5 and stroke mortality among urban residents in northern China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 213:112063. [PMID: 33636465 PMCID: PMC8150861 DOI: 10.1016/j.ecoenv.2021.112063] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 05/09/2023]
Abstract
Evidence is still limited for the role of long-term PM2.5 exposure in cerebrovascular diseases among residents in high pollution regions. The study is aimed to investigate the long-term effects of PM2.5 exposure on stroke mortality, and further explore the effect modification of temperature variation on the PM2.5-mortality association in northern China. Based on a cohort data with an average follow-up of 9.8 years among 38,435 urban adults, high-resolution estimates of PM2.5 derived from a satellite-based model were assigned to each participant. A Cox regression model with time-varying exposures and strata of geographic regions was employed to assess the risks of stroke mortality associated with PM2.5, after adjusting for individual risk factors. The cross-product term of PM2.5 exposure and annual temperature range was further added into the regression model to test whether the long-term temperature variation would modify the association of PM2.5 with stroke mortality. Among the study participants, the annual mean level of PM2.5 concentration was 66.3 μg/m3 ranging from 39.0 μg/m3 to 100.6 μg/m3. For each 10 μg/m3 increment in PM2.5, the hazard ratio (HR) was 1.31 (95% CI: 1.04-1.65) for stroke mortality after multivariable adjustment. In addition, the HRs of PM2.5 decreased gradually as the increase of annual temperature range with the HRs of 1.95 (95% CI: 1.36-2.81), 1.53 (95% CI: 1.06-2.22), and 1.11 (95% CI: 0.75-1.63) in the low, middle, and high group of annual temperature range, respectively. The findings provided further evidence of long-term PM2.5 exposure on stroke mortality in high-exposure settings such as northern China, and also highlighted the view that assessing the adverse health effects of air pollution might not ignore the role of temperature variations in the context of climate change.
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Affiliation(s)
- Xueli Yang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China
| | - Liwen Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China
| | - Xi Chen
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China
| | - Fangchao Liu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Anqi Shan
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China
| | - Fengchao Liang
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xuejun Li
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China
| | - Hui Wu
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China
| | - Mengfan Yan
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China
| | - Zhao Ma
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China
| | - Guanghui Dong
- Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yamin Liu
- School of Medicine and Life Sciences, Shandong Academy of Medical Sciences, Jinan 250062, China
| | - Jie Chen
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, Shenyang 110122, China
| | - Tong Wang
- School of Public Health, Shanxi Medical University, Taiyuan 030001, China
| | - Baoxin Zhao
- Taiyuan Center for Disease Control and Prevention, Taiyuan 030001, China
| | - Yang Liu
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Dongfeng Gu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Naijun Tang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China.
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Wu J, Tian Y, Wu Y, Wang Z, Wu Y, Wu T, Qin X, Wang M, Wang X, Wang J, Hu Y. Seasonal association between ambient fine particulate matter and venous thromboembolism in Beijing, China: a time-series study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:10.1007/s11356-021-13035-0. [PMID: 33634399 DOI: 10.1007/s11356-021-13035-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
Little is known about the influence of ambient fine particulate matter (PM2.5) on the incidence of venous thromboembolism in areas with heavy air pollution. We examined seasonal associations between airborne concentrations of fine particulate matter and outpatient visits for venous thromboembolism in Beijing using a city-wide time-series design that covered a period of 30 months (January 1, 2010 to June 30, 2012). Generalized additive models were used to investigate the associations with adjustment of temperature for various time lags (lag 0 for the warm season and lag 0-10 for the cold season). Overall, 92,435 outpatient visits were recorded by the Beijing Medical Claim Data for Employees database during the study period. We found a significant association between PM2.5 levels and outpatient visits for venous thromboembolism. A 10-μg/m3 increase in PM2.5 concentrations on lag days 0-2 corresponded to a 0.64% (95% confidence interval: 0.55-0.73%; P < 0.001) increase in outpatient visits for venous thromboembolism during the cold season, and a 10-μg/m3 increase in PM2.5 concentrations on lag days 0-3 corresponded to a 0.82% (95% confidence interval: 0.67-0.96%; P < 0.001) increase in outpatient visits for venous thromboembolism during the warm season. Our findings suggest that PM2.5 exposure is associated with outpatient visits for venous thromboembolism in Beijing, and a more pronounced association was observed during the warm season. We propose that various temperature-adjustment strategies should be used when investigating seasonal associations.
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Affiliation(s)
- Junhui Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, No. 38 Xueyuan Road, Beijing, 100191, China
| | - Yaohua Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, No. 38 Xueyuan Road, Beijing, 100191, China
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yao Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, No. 38 Xueyuan Road, Beijing, 100191, China
| | - Zijing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, No. 38 Xueyuan Road, Beijing, 100191, China
| | - Yiqun Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, No. 38 Xueyuan Road, Beijing, 100191, China
| | - Tao Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, No. 38 Xueyuan Road, Beijing, 100191, China
| | - Xueying Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, No. 38 Xueyuan Road, Beijing, 100191, China
| | - Mengying Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, No. 38 Xueyuan Road, Beijing, 100191, China
| | - Xiaowen Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, No. 38 Xueyuan Road, Beijing, 100191, China
| | - Jiating Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, No. 38 Xueyuan Road, Beijing, 100191, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, No. 38 Xueyuan Road, Beijing, 100191, China.
- Medical Informatics Center, Peking University, Beijing, 100191, China.
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Zhang R, Jiang Y, Zhang G, Yu M, Wang Y, Liu G. Association between short-term exposure to ambient air pollution and hospital admissions for transient ischemic attacks in Beijing, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:6877-6885. [PMID: 33010014 PMCID: PMC7840640 DOI: 10.1007/s11356-020-10963-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/21/2020] [Indexed: 05/02/2023]
Abstract
Numerous studies have examined the associations between air pollution and stroke. However, little is known about the associations between air pollution and transient ischemic attack (TIA). In this study, we aimed to conduct a time-series study to systematically examine the associations between hospital admissions for TIA and air pollutants. Admissions for TIA (ICD-10: G45) from 1 January 2014 to 31 December 2016 were identified based on the primary diagnosis from 134 hospitals in Beijing, China. Hourly measurements of air pollutants were obtained from the National Air Pollution Monitoring System. Generalized additive models with quasi-Poisson regression were used to determine the associations for each pollutant. Additionally, stratified analysis was implemented to examine whether age, gender, temperature, and season were the potential effect modifiers. Restricted cubic spline was applied to investigate the exposure-response curve. In total, 109,975 hospital admissions for TIA were included. The positive associations were detected between PM2.5, PM10, SO2, NO2, and CO and hospital admissions for TIA. The effects of PM2.5 and PM10 in men are stronger than in women. Additionally, the effects of PM2.5, PM10, SO2, and O3 are more pronounced on warm days than cool days. From exposure-response curves, we observe a nearly linear relationship for PM2.5, PM10, CO, and NO2. Further studies are needed to verify the association. This research contributes evidence on the association between air pollution and admissions for TIA in the low- and middle-income countries and may promote related public health policy development.
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Affiliation(s)
- Runhua Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China
| | - Guitao Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China
| | - Miaoxin Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China.
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China.
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Song X, Jiang L, Wang S, Tian J, Yang K, Wang X, Guan H, Zhang N. The impact of main air pollutants on respiratory emergency department visits and the modification effects of temperature in Beijing, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:6990-7000. [PMID: 33025435 DOI: 10.1007/s11356-020-10949-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/20/2020] [Indexed: 06/11/2023]
Abstract
Research indicates that air pollution is a risk factor of an increased occurrence of diseases. However, evidence is limited on the effects of the pollution index on disease and whether temperature modifies the effects. The objectives were (i) to explore the effects of the Air Pollution Index (API) and specific indices for pollutants (PM10, NO2, and SO2) on respiratory emergency department (ED) visits in Beijing and (ii) to investigate whether temperature modified the effects of main air pollutants on respiratory ED visits. A quasi-Poisson generalized additive model was employed to examine the association of API and indices for pollutants with respiratory disease. Bivariate response surface model and stratification model (cold days, moderately cold days, moderately hot days, and hot days) were used to analyze the modification effects of temperature on air pollution and respiratory disease. The results showed that (i) the effects of API on respiratory diseases were similar to the index for PM10 in Beijing. (ii) API and PM10 were associated with increased respiratory ED visits on cold days and moderately cold days. Furthermore, the effects of PM10 on respiratory disease on moderately cold days [Relative risk (RR) = 1.006 per 10 μg/m3, 95% CI 1.002-1.009] were stronger than on cold days (RR = 1.004 per 10 μg/m3, 95% CI 1.000-1.008). (iii) PM10 (API) had a greater impact on children aged 10 to 17 years and females on moderately cold days, while the elderly had an increased risk of respiratory disease to PM10 (RR = 1.008 per 10 μg/m3, 95% CI 1.002-1.013) and API (RR = 1.013 per 10, 95% CI 1.004-1.022) on cold days. In conclusion, temperature can modify the association between API and respiratory morbidity. A stronger correlation existed between PM10 and respiratory diseases on moderately cold days, while the effects of cold days were less than that attributable to moderately cold days.
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Affiliation(s)
- Xuping Song
- Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China
- Evidence-based Medicine Center, School of Basic Medical Science, Lanzhou University, Lanzhou, 730000, China
| | - Liangzhen Jiang
- Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China
- Evidence-based Medicine Center, School of Basic Medical Science, Lanzhou University, Lanzhou, 730000, China
| | - Shigong Wang
- College of Atmospheric Sciences, Chengdu University of Information Technology, Chengdu, 610000, Sichuan, China.
| | - Jinhui Tian
- Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China
- Evidence-based Medicine Center, School of Basic Medical Science, Lanzhou University, Lanzhou, 730000, China
| | - Kehu Yang
- Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China
- Evidence-based Medicine Center, School of Basic Medical Science, Lanzhou University, Lanzhou, 730000, China
| | - Xinyi Wang
- Second Clinical College, Lanzhou University, Lanzhou, 730000, China
| | - Hongdan Guan
- Second Clinical College, Lanzhou University, Lanzhou, 730000, China
| | - Nan Zhang
- First Clinical College, Lanzhou University, Lanzhou, 730000, China
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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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Ruan Z, Qi J, Yin P, Qian Z(M, Liu J, Liu Y, Yang Y, Li H, Zhang S, Howard SW, Lin H, Wang L. Prolonged Life Expectancy for Those Dying of Stroke by Achieving the Daily PM 2.5 Targets. GLOBAL CHALLENGES (HOBOKEN, NJ) 2020; 4:2000048. [PMID: 33304609 PMCID: PMC7713556 DOI: 10.1002/gch2.202000048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Indexed: 05/11/2023]
Abstract
This time-series study collects data on stroke-related mortality, years of life lost (YLL), air pollution, and meteorological conditions in 96 Chinese cities from 2013 to 2016 and proposes a three-stage strategy to generate the national and regional estimations of avoidable YLL, gains in life expectancy and stroke-related population attributable fraction by postulating that the daily fine particulate matter (PM2.5) has been kept under certain standards. A total of 1 318 911 stroke deaths are analyzed. Each 10 µg m-3 increment in PM2.5 at lag03 is associated with a city-mean increase of 0.31 (95% CI: 0.19, 0.44) years of life lost from stroke. A number of 914.11 (95% CI: 538.28, 1288.94) years of city-mean life lost from stoke could be avoided by attaining the WHO's Air Quality Guidelines (AQG) (25 µg m-3). Moreover, by applying the AQG standard, 0.11 (0.08, 0.15) years of life lost might be prevented for each death, and about 0.91% (95% CI: 0.62%, 1.19%) of the total years of life lost from stroke might be explained by the daily excess PM2.5 exposure. This study indicates that stroke patients can have a longer life expectancy if stricter PM2.5 standards are put in place, especially ischemic stroke patients.
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Affiliation(s)
- Zengliang Ruan
- Department of EpidemiologySchool of Public HealthSun Yat‐Sen UniversityGuangzhou510080China
| | - Jinlei Qi
- National Center for Chronic and Noncommunicable Disease Control and PreventionChinese Center for Disease Control and PreventionBeijing100050China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and PreventionChinese Center for Disease Control and PreventionBeijing100050China
| | - Zhengmin (Min) Qian
- Department of Epidemiology and BiostatisticsCollege for Public Health & Social JusticeSaint Louis UniversitySaint LouisMO63104USA
| | - Jiangmei Liu
- National Center for Chronic and Noncommunicable Disease Control and PreventionChinese Center for Disease Control and PreventionBeijing100050China
| | - Yunning Liu
- National Center for Chronic and Noncommunicable Disease Control and PreventionChinese Center for Disease Control and PreventionBeijing100050China
| | - Yin Yang
- Department of EpidemiologySchool of Public HealthSun Yat‐Sen UniversityGuangzhou510080China
| | - Huan Li
- Department of EpidemiologySchool of Public HealthSun Yat‐Sen UniversityGuangzhou510080China
| | - Shiyu Zhang
- Department of EpidemiologySchool of Public HealthSun Yat‐Sen UniversityGuangzhou510080China
| | - Steven W. Howard
- Department of Health Management & PolicyCollege for Public Health & Social JusticeSaint Louis UniversitySaint LouisMO63104USA
| | - Hualiang Lin
- Department of EpidemiologySchool of Public HealthSun Yat‐Sen UniversityGuangzhou510080China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and PreventionChinese Center for Disease Control and PreventionBeijing100050China
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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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Short-term exposure to ambient air pollution and acute myocardial infarction attack risk. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01033-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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Cheng FJ, Wu KH, Hung SC, Lee KH, Lee CW, Liu KY, Hsu PC. Association between ambient air pollution and out-of-hospital cardiac arrest: are there potentially susceptible groups? JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2020; 30:641-649. [PMID: 31578416 DOI: 10.1038/s41370-019-0140-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/08/2019] [Accepted: 03/18/2019] [Indexed: 06/10/2023]
Abstract
This study aimed to examine the association between air pollution and out-of-hospital cardiac arrest (OHCA), and the effects of underlying diseases. Between January 2015 and December 2016, data on particulate matter (PM)2.5 and other air pollutants in Kaohsiung City were collected, and an emergency medical service database was used for information on patients who experienced OHCA. Overall, 3566 patients were analyzed and subgroup analyses by sex, age, and preexisting morbidities were performed. Interquartile increments in PM2.5, PM10, and O3 levels on lag 1 and NO2 level on lag 3 were associated with increments of 10.8%, 11.3%, 6.2%, and 1.7% in OHCA incidence, respectively. Subgroup analyses showed that patients with diabetes (1.363; interaction p = 0.009), heart disease (1.612; interaction p = 0.001), and advanced age (≥70 years, 1.297; interaction p = 0.003) were more susceptible to NO2 on lag 3. Moreover, patients were more susceptible to O3 during the cold season (1.194; interaction p = 0.001). We found that PM2.5, PM10, NO2, and O3 may play an important role in OHCA events, and the effects vary by underlying condition, age and season.
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Affiliation(s)
- Fu-Jen Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
- Department of Safety, Health and Environmental Engineering, National Kaohsiung University of Science and Technology, Kaohsiung City, Taiwan
| | - Kuan-Han Wu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Shih-Chiang Hung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Kuo-Hsin Lee
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Chia-Wei Lee
- Department of Safety, Health and Environmental Engineering, National Kaohsiung University of Science and Technology, Kaohsiung City, Taiwan
| | - Kun-Ying Liu
- Fire Bureau, Kaohsiung City Government, Kaohsiung City, Taiwan
| | - Ping-Chi Hsu
- Department of Safety, Health and Environmental Engineering, National Kaohsiung University of Science and Technology, Kaohsiung City, Taiwan.
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35
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Gu J, Shi Y, Chen N, Wang H, Chen T. Ambient fine particulate matter and hospital admissions for ischemic and hemorrhagic strokes and transient ischemic attack in 248 Chinese cities. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 715:136896. [PMID: 32007884 DOI: 10.1016/j.scitotenv.2020.136896] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/11/2020] [Accepted: 01/22/2020] [Indexed: 05/18/2023]
Abstract
Few studies have investigated the acute effects of fine particulate matter (PM2.5) on the risk of stroke subtypes and transient ischemic attack (TIA) in low- and middle-income countries. The primary aim of this study was to assess the associations between short-term exposure to PM2.5 and daily hospital admissions for total cerebrovascular disease, ischemic and hemorrhagic strokes, and TIA in China. A total of 8,359,162 hospital admissions in 248 Chinese cities from 2013 to 2017 were identified from the Hospital Quality Monitoring System of China. Generalized additive models with quasi-Poisson regression were used to estimate the associations in each city, and random-effect meta-analyses were conducted to combine the city-specific estimates. We found that a 10 μg/m3 increase in PM2.5 concentration was significantly associated with a 0.19% (95% CI, 0.13% to 0.25%), 0.26% (95% CI, 0.17% to 0.35%), and 0.26% (95% CI, 0.13% to 0.38%) increase in same-day hospital admissions for total cerebrovascular disease, ischemic stroke, and TIA, respectively. In contrast, a non-significant negative association with PM2.5 was observed for hemorrhagic stroke in the main analyses (lag 0 day), which became statistically significant when using other single-day exposures (lag 1 or 2 days) or moving average exposures (lag 0-1, 0-2, or 0-3 days) as exposure metric. These associations were robust to adjustment for other criteria air pollutants in two-pollutant models. For ischemic stroke, the effect estimates were significantly larger in people aged 65-74 years, in cool season, and in cities with lower annual average PM2.5 concentrations. The exposure-response curves were nonlinear with a leveling off at high concentrations. These results contribute to the relatively limited literature on the PM2.5-related risks of cerebrovascular events in low- and middle-income countries.
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Affiliation(s)
- Jiangshao Gu
- Center for Big Data Research in Health and Medicine, Institute for Data Sciences, Tsinghua University, Beijing 100084, China; Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing 100084, China; Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Department of Computer Science and Technology, Tsinghua University, Beijing 100084, China
| | - Ying Shi
- China Standard Medical Information Research Center, Shenzhen 518054, China
| | - Ning Chen
- Center for Big Data Research in Health and Medicine, Institute for Data Sciences, Tsinghua University, Beijing 100084, China; Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing 100084, China; Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Department of Computer Science and Technology, Tsinghua University, Beijing 100084, China
| | - Haibo Wang
- China Standard Medical Information Research Center, Shenzhen 518054, China; Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Ting Chen
- Center for Big Data Research in Health and Medicine, Institute for Data Sciences, Tsinghua University, Beijing 100084, China; Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing 100084, China; Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Department of Computer Science and Technology, Tsinghua University, Beijing 100084, China.
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36
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Lokotola CL, Wright CY, Wichmann J. Temperature as a modifier of the effects of air pollution on cardiovascular disease hospital admissions in Cape Town, South Africa. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:16677-16685. [PMID: 32133609 DOI: 10.1007/s11356-020-07938-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 01/29/2020] [Indexed: 05/20/2023]
Abstract
Climate change and air pollution are two independent risk factors to cardiovascular diseases (CVD). Few studies investigated their interaction and potential effect modification of one another in developing countries. Individual level CVD hospital admission (ICD10: I00-I99) data for 1 January 2011 to 31 October 2016 were obtained from seven private hospitals in Cape Town. NO2, SO2, PM10, temperature and relative humidity data were obtained from the South African Weather Services and the City of Cape Town. A case-crossover epidemiological study design and conditional logistic regression model were applied. Various cut-off values were applied to classify cold and warm days. In total, 54,818 CVD hospital admissions were included in the study. In general, on warm and cold days the 15-64 years old group was more at risk for CVD hospitalization with increasing air pollution levels compared to all ages combined or the ≥ 65 years old group. Females appeared to be more at risk than males with increasing PM10 levels. In contrast, males were more vulnerable to the effects of NO2 and SO2 than females. The study showed the modification effect of temperature on air pollution associated with CVD hospital admissions. The consideration of such interaction will help in policy making and public health interventions dealing with climate change-related health risks.
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Affiliation(s)
- Christian L Lokotola
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Caradee Y Wright
- South African Medical Research Council, Pretoria, South Africa
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa
| | - Janine Wichmann
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
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37
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Yao C, Wang Y, Williams C, Xu C, Kartsonaki C, Lin Y, Zhang P, Yin P, Lam KBH. The association between high particulate matter pollution and daily cause-specific hospital admissions: a time-series study in Yichang, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:5240-5250. [PMID: 31848968 DOI: 10.1007/s11356-019-06734-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/10/2019] [Indexed: 06/10/2023]
Abstract
Particulate matter (PM) air pollution is one of the major causes of morbidity and mortality in China. In this study, we estimated the short-term effects of PM on cause-specific hospitalization in Yichang, China. Daily data for PM level, meteorological factors, and hospital admissions (total hospitalization counts = 391,960) in Yichang between 2015 and 2017 were collected. We conducted a time-series study and applied a generalized additive model to evaluate the association between every 10 μg/m3 increment of PM and percent increase of hospitalization. We found positive and statistically significant associations between PM and hospital admissions for multiple outcomes, including all-cause, total respiratory, total cardiovascular diseases, and disease subcategories (hypertensive disease, coronary heart disease, stroke and the stroke subtype, chronic obstructive pulmonary disease, and lower respiratory infection). Each 10 μg/m3 increase in PM2.5 at Lag01 (a moving average of Lag0 to Lag1), was significantly associated with an increase of 1.31% (95% CI: 0.79%, 1.83%), 1.12% (95% CI: 0.40%, 1.84%), and 1.14% (95% CI: 0.53%, 1.75%) in hospitalizations for all-cause, CVD, and respiratory, respectively. The association for PM10 with all-cause, CVD, and respiratory admissions was similar but weaker than PM2.5. The effect on admissions persisted for up to 7 days, and peaked at Lag01. The associations between PM and all-cause hospitalizations were stronger among older individuals and in cold seasons. It is therefore important to continue implementation of emission abatement and other effective measures in Yichang and other cities in China.
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Affiliation(s)
- Chengye Yao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yu Wang
- Department of Anesthesiology, Institute of Anesthesia and Critical Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1277, Jiefang Avenue, Wuhan, 430022, China
| | | | - Chengzhong Xu
- Yichang Center for Disease Control and Prevention, 3 Dalian Road, Yichang, 443000, China
| | - Christiana Kartsonaki
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Yun Lin
- Department of Anesthesiology, Institute of Anesthesia and Critical Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1277, Jiefang Avenue, Wuhan, 430022, China.
| | - Pei Zhang
- Yichang Center for Disease Control and Prevention, 3 Dalian Road, Yichang, 443000, China.
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
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38
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Wang Z, Peng J, Liu P, Duan Y, Huang S, Wen Y, Liao Y, Li H, Yan S, Cheng J, Yin P. Association between short-term exposure to air pollution and ischemic stroke onset: a time-stratified case-crossover analysis using a distributed lag nonlinear model in Shenzhen, China. Environ Health 2020; 19:1. [PMID: 31898503 PMCID: PMC6941275 DOI: 10.1186/s12940-019-0557-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 12/20/2019] [Indexed: 05/03/2023]
Abstract
BACKGROUND Stroke, especially ischemic stroke (IS), has been a severe public health problem around the world. However, the association between air pollution and ischemic stroke remains ambiguous. METHODS A total of 63, 997 IS cases aged 18 years or above in Shenzhen were collected from 2008 to 2014. We used the time-stratified case-crossover design combining with distributed lag nonlinear model (DLNM) to estimate the association between air pollution and IS onset. Furthermore, this study explored the variability across gender and age groups. RESULTS The cumulative exposure-response curves were J-shaped for SO2, NO2 and PM10, and V-shaped for O3, and crossed over the relative risk (RR) of one. The 99th, 50th (median) and 1st percentiles of concentration (μg/m3) respectively were 37.86, 10.06, 3.71 for SO2, 116.26, 41.29, 18.51 for NO2, 145.94, 48.29, 16.14 for PM10, and 111.57, 49.82, 16.00 for O3. Extreme high-SO2, high-NO2, high-PM10, high-O3, and low-O3 concentration increased the risk of IS, with the maximum RR values and 95% CIs: 1.50(1.22, 1.84) (99th vs median) at 0-12 lag days, 1.37(1.13, 1.67) (99th vs median) at 0-10 lag days, 1.26(1.04, 1.53) (99th vs median) at 0-12 lag days, 1.25(1.04, 1.49) (99th vs median) at 0-14 lag days, and 1.29(1.03, 1.61) (1st vs median) at 0-14 lag days, respectively. The statistically significant minimal RR value and 95% CI was 0.79(0.66,0.94) at 0-10 lag days for extreme low-PM10. The elderly aged over 65 years were susceptible to extreme pollution conditions. Difference from the vulnerability of males to extreme high-SO2, high-NO2 and low-O3, females were vulnerable to extreme high-PM10 and high-O3. Comparing with the elderly, adults aged 18-64 year were immune to extreme low-NO2 and low-PM10. However, no association between CO and IS onset was found. CONCLUSIONS SO2, NO2, PM10 and O3 exerted non-linear and delayed influence on IS, and such influence varied with gender and age. These findings may have significant public health implications for the prevention of IS.
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Affiliation(s)
- Zhinghui Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, Hubei, China
| | - Ji Peng
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Peiyi Liu
- Department of Molecular Epidemiology, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
- Department of Occupational and Environment Health, Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanran Duan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, Hubei, China
| | - Suli Huang
- Department of Molecular Epidemiology, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Ying Wen
- Department of Molecular Epidemiology, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Yi Liao
- Department of Public Health Promotion, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Hongyan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, Hubei, China
| | - Siyu Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, Hubei, China
| | - Jinquan Cheng
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen, 518055, Guangdong, China.
| | - Ping Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, Hubei, China.
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen, 518055, Guangdong, China.
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39
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Gao J, Yu F, Xu Z, Duan J, Cheng Q, Bai L, Zhang Y, Wei Q, Yi W, Pan R, Su H. The association between cold spells and admissions of ischemic stroke in Hefei, China: Modified by gender and age. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 669:140-147. [PMID: 30878922 DOI: 10.1016/j.scitotenv.2019.02.452] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Some studies have discovered that low ambient temperatures were associated with increased risk of the incidence of ischemic stroke. Although the frequency of extreme weather events is increasing, few studies have studied the effects of cold wave on ischemic stroke. OBJECTIVE The purpose of this study was to explore the association between cold waves and ischemic stroke onset and further to explore how this association was modified by cold spell characteristics and individual-level factors. METHODS A Poisson regression with a distributed lag nonlinear model was used to investigate the association between cold spells under 9 different definitions and daily admissions of ischemic stroke in 2013-2015 in Hefei. RESULTS By comparing the attribution risk and the results of the sensitivity analysis of different models, the local optimal cold spell was defined as the day between November to March when daily mean temperature was less than 10th for 2 or more consecutive days (backward attributable risk fraction (b-AF) = 4.19%, 95% empirical confidence intervals (eCI): 0.87%, 6.66%, backward attributable number (b-AN) = 278). On the basis of optimal model, the single-day effect of cold waves on ischemic stroke occurred on 5th day after exposure and continued until 17th day, and the maximum effect appeared on the 5th day with relative risk (RR) = 1.050 (95% confidence interval (CI) = 1.008, 1.094). The significant cumulative effect lasted from day 9 after exposure to cold spells to day 21. The maximum cumulative effect was observed on the 21st day with RR = 2.378 (95% CI = 1.304, 4.337). The female and the young and middle-aged people were susceptible to the local cold waves. CONCLUSION This study suggests that cold spell is a risk factor for ischemic stroke in Hefei, and there is a certain lag effect. Targeted measures should be taken to protect susceptible populations during cold spell days, including women and young and middle-aged people.
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Affiliation(s)
- Jiaojiao Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Feng Yu
- Anhui Provincial Hospital, China
| | - Zihan Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Jun Duan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Qiang Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Lijun Bai
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Yanwu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Qiannan Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China.
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40
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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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41
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Wu Y, Li M, Tian Y, Cao Y, Song J, Huang Z, Wang X, Hu Y. Short-term effects of ambient fine particulate air pollution on inpatient visits for myocardial infarction in Beijing, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:14178-14183. [PMID: 30859442 DOI: 10.1007/s11356-019-04728-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 02/27/2019] [Indexed: 06/09/2023]
Abstract
The effects of ambient fine particulate matter (PM2.5) on the incidence of myocardial infarction have been reported, but little is known about this association in China. We conducted a time-series study of ambient PM2.5 concentrations and inpatient visits for myocardial infarction in Beijing. A generalized additive model with a Poisson link was applied to estimate the percentage change in inpatient visits for myocardial infarction following a 10-μg/m3 increase in PM2.5 concentrations. A total of 15,432 inpatient visits for myocardial infarction were identified between January 1, 2010, and June 30, 2012. A 10-μg/m3 increase in PM2.5 concentrations was associated with a 0.46% (P ≤ 0.001) increase in daily inpatient visits for myocardial infarction. Males were more sensitive to the adverse effects, and the association was more significant during the warm season (May through October). Short-term exposure to PM2.5 was associated with increased risk of inpatient visits for myocardial infarction in Beijing. The findings may be useful in developing more accurate targeted interventions.
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Affiliation(s)
- Yao Wu
- School of Public Health, Peking University, Beijing, 100191, China
| | - Man Li
- School of Public Health, Peking University, Beijing, 100191, China
| | - Yaohua Tian
- School of Public Health, Peking University, Beijing, 100191, China
| | - Yaying Cao
- School of Public Health, Peking University, Beijing, 100191, China
| | - Jing Song
- School of Public Health, Peking University, Beijing, 100191, China
| | - Zhe Huang
- School of Public Health, Peking University, Beijing, 100191, China
| | - Xiaowen Wang
- School of Public Health, Peking University, Beijing, 100191, China
| | - Yonghua Hu
- School of Public Health, Peking University, Beijing, 100191, China.
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42
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Tian Y, Liu H, Xiang X, Zhao Z, Juan J, Li M, Song J, Cao Y, Wu Y, Wang X, Chen L, Wei C, Gao P, Hu Y. Ambient Coarse Particulate Matter and Hospital Admissions for Ischemic Stroke. Stroke 2019; 50:813-819. [DOI: 10.1161/strokeaha.118.022687] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background and Purpose—
Evidence on the effects of coarse particulate matter (PM
10–2.5
) on ischemic stroke is limited and inconsistent. We evaluated the acute effects of PM
10–2.5
exposure on hospital admissions for ischemic stroke in China.
Methods—
We conducted a national time-series analysis of associations between daily PM
10–2.5
concentrations and daily hospital admissions for ischemic stroke in China between January 2014 and December 2016. Hospital admissions for ischemic stroke were identified from the database of Urban Employee Basic Medical Insurance, which contains data from 0.28 billion beneficiaries. We applied a city-specific Poisson regression to examine the associations of PM
10–2.5
and daily ischemic stroke admissions. We combined the city-specific effect estimates with a random effects meta-analysis, and further evaluated the exposure-response relationship curve and potential effect modifiers.
Results—
We identified >2 million hospital admissions for ischemic stroke in 172 Chinese cities. A 10 μg/m
3
increase in PM
10–2.5
concentrations (lag day 0) was associated with a 0.91% (95% CI, 0.73–1.10) increase in hospital admissions for ischemic stroke. The association remained significant after adjusting for PM
2.5
(percentage change, 0.96%; 95% CI, 0.75–1.18). The exposure-response relationship was approximately linear, with a moderate response at lower levels (<200 μg/m
3
) and a steeper response at higher levels. The association was stronger in cities with lower PM
10–2.5
concentrations, higher temperatures, or higher relative humidity.
Conclusions—
This nationwide study provides robust evidence of the short-term association between exposure to PM
10–2.5
and increased hospital admissions for ischemic stroke and supports the hypothesis that the association differs by city characteristics.
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Affiliation(s)
- Yaohua Tian
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Hui Liu
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
- Medical Informatics Center (H.L.), Peking University, Beijing, China
| | - Xiao Xiang
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Zuolin Zhao
- Beijing HealthCom Data Technology Co, Ltd, Beijing, China (Z.Z., L.C., C.W.)
| | - Juan Juan
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Man Li
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Jing Song
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Yaying Cao
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Yao Wu
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Xiaowen Wang
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Libo Chen
- Beijing HealthCom Data Technology Co, Ltd, Beijing, China (Z.Z., L.C., C.W.)
| | - Chen Wei
- Beijing HealthCom Data Technology Co, Ltd, Beijing, China (Z.Z., L.C., C.W.)
| | - Pei Gao
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Yonghua Hu
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
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Zhu X, Qiu H, Wang L, Duan Z, Yu H, Deng R, Zhang Y, Zhou L. Risks of hospital admissions from a spectrum of causes associated with particulate matter pollution. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 656:90-100. [PMID: 30502738 DOI: 10.1016/j.scitotenv.2018.11.240] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 05/04/2023]
Abstract
Ambient particulate matter (PM) pollution has been linked to elevated hospital admissions (HAs), especially from respiratory and cardiovascular diseases. However, few studies have estimated the associations between PM pollution and HAs for a wider range of broad disease categories. This study aimed to evaluate the effects of PM with aerodynamic diameter ≤ 2.5 μm (PM2.5) and ≤10 μm (PM10) on a range of broad and specific causes of HAs in Chengdu, China during 2015-2016, using a generalized additive model (GAM). Age-, gender- and season-specific analyses were also performed on the broad categories. We further calculated the corresponding morbidity burden due to PM exposure. During the study period, the daily mean level for PM2.5 and PM10 was 57.3 μg/m3 and 94.7 μg/m3, respectively. For broad disease categories, each 10 μg/m3 increase in PM10 at lag06 was associated with increments of 0.65% (95% CI: 0.32%-0.99%) in HAs from respiratory, 0.49% (95% CI: 0.04%-0.95%) from circulatory and 0.91% (95% CI: 0.15%-1.69%) from skin and subcutaneous tissue diseases. By contrast, only respiratory HAs showed a significant positive association with elevated PM2.5 at lag06 (1.03% increase per 10 μg/m3, 95% CI: 0.50%-1.56%, p < 0.001). Increased HAs risks for several more refined specific causes within respiratory, circulatory, skin and subcutaneous tissue, nervous and genitourinary diseases were also observed. Subgroup analyses indicated that effect estimates were modified by age, gender and season. Overall, the largest morbidity burden was observed in myocardial infarction, about 11.27% (95% CI: 3.45%-18.07%) and 11.11% (95% CI: 4.07%-17.27%) of HAs for myocardial infarction could be attributable to PM2.5 and PM10 levels exceeding the WHO's air quality guidelines (24-h mean: 25 μg/m3 for PM2.5 and 50 μg/m3 for PM10). Our study suggests that both PM2.5 and PM10 increase risks of morbidity from broad range of causes of HAs in Chengdu, and result in substantial morbidity burden.
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Affiliation(s)
- Xiaojuan Zhu
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China; Center for Artificial Intelligence and Smart Health, School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Hang Qiu
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China; Center for Artificial Intelligence and Smart Health, School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China.
| | - Liya Wang
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhanqi Duan
- Health and Family Planning Information Center of Sichuan Province, Chengdu, China
| | - Haiyan Yu
- School of Economics and Management, Chongqing University of Posts and Telecommunications, Chongqing, China; Department of Statistics, The Pennsylvania State University, University Park, PA, USA
| | - Ren Deng
- Health and Family Planning Information Center of Sichuan Province, Chengdu, China
| | - Yanlong Zhang
- Chengdu Shulianyikang Technology Co., Ltd, Chengdu, China
| | - Li Zhou
- Health and Family Planning Information Center of Sichuan Province, Chengdu, China.
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Yitshak-Sade M, Bobb JF, Schwartz JD, Kloog I, Zanobetti A. The association between short and long-term exposure to PM 2.5 and temperature and hospital admissions in New England and the synergistic effect of the short-term exposures. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 639:868-875. [PMID: 29929325 PMCID: PMC6051434 DOI: 10.1016/j.scitotenv.2018.05.181] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 04/25/2018] [Accepted: 05/15/2018] [Indexed: 05/04/2023]
Abstract
BACKGROUND Particulate matter < 2.5 μm in diameter (PM2.5) and heat are strong predictors of morbidity, yet few studies have examined the effects of long-term exposures on non-fatal events, or assessed the short and long-term effect on health simultaneously. OBJECTIVE We jointly investigated the association of short and long-term exposures to PM2.5 and temperature with hospital admissions, and explored the modification of the associations with the short-term exposures by one another and by temperature variability. METHODS Daily ZIP code counts of respiratory, cardiac and stroke admissions of adults ≥65 (N = 2,015,660) were constructed across New-England (2001-2011). Daily PM2.5 and temperature exposure estimates were obtained from satellite-based spatio-temporally resolved models. For each admission cause, a Poisson regression was fit on short and long-term exposures, with a random intercept for ZIP code. Modifications of the short-term effects were tested by adding interaction terms with temperature, PM2.5 and temperature variability. RESULTS Associations between short and long-term exposures were observed for all of the outcomes, with stronger effects of long-term exposures to PM2.5. For respiratory admissions, the short-term PM2.5 effect (percent increase per IQR) was larger on warmer days (1.12% versus -0.53%) and in months of higher temperature variability (1.63% versus -0.45%). The short-term temperature effect was higher in months of higher temperature variability as well. For cardiac admissions, the PM2.5 effect was larger on colder days (0.56% versus -0.30%) and in months of higher temperature variability (0.99% versus -0.56%). CONCLUSIONS We observed synergistic effects of short-term exposures to PM2.5, temperature and temperature variability. Long-term exposures to PM2.5 were associated with larger effects compared to short-term exposures.
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Affiliation(s)
- Maayan Yitshak-Sade
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer F Bobb
- Biostatistics Unit, Kaiser Permanent Washington Health Research Institute, Seattle, WA, USA
| | - Joel D Schwartz
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Itai Kloog
- Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Antonella Zanobetti
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Tian Y, Liu H, Zhao Z, Xiang X, Li M, Juan J, Song J, Cao Y, Wang X, Chen L, Wei C, Hu Y, Gao P. Association between ambient air pollution and daily hospital admissions for ischemic stroke: A nationwide time-series analysis. PLoS Med 2018; 15:e1002668. [PMID: 30286080 PMCID: PMC6171821 DOI: 10.1371/journal.pmed.1002668] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 09/07/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Evidence of the short-term effects of ambient air pollution on the risk of ischemic stroke in low- and middle-income countries is limited and inconsistent. We aimed to examine the associations between air pollution and daily hospital admissions for ischemic stroke in China. METHODS AND FINDINGS We identified hospital admissions for ischemic stroke in 2014-2016 from the national database covering up to 0.28 billion people who received Urban Employee Basic Medical Insurance (UEBMI) in China. We examined the associations between air pollution and daily ischemic stroke admission using a two-stage method. Poisson time-series regression models were firstly fitted to estimate the effects of air pollution in each city. Random-effects meta-analyses were then conducted to combine the estimates. Meta-regression models were applied to explore potential effect modifiers. More than 2 million hospital admissions for ischemic stroke were identified in 172 cities in China. In single-pollutant models, increases of 10 μg/m3 in particulate matter with aerodynamic diameter <2.5 μm (PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3) and 1 mg/m3 in carbon monoxide (CO) concentrations were associated with 0.34% (95% confidence interval [CI], 0.20%-0.48%), 1.37% (1.05%-1.70%), 1.82% (1.45%-2.19%), 0.01% (-0.14%-0.16%), and 3.24% (2.05%-4.43%) increases in hospital admissions for ischemic stroke on the same day, respectively. SO2 and NO2 associations remained significant in two-pollutant models, but not PM2.5 and CO associations. The effect estimates were greater in cities with lower air pollutant levels and higher air temperatures, as well as in elderly subgroups. The main limitation of the present study was the unavailability of data on individual exposure to ambient air pollution. CONCLUSIONS As the first national study in China to systematically examine the associations between short-term exposure to ambient air pollution and ischemic stroke, our findings indicate that transient increase in air pollution levels may increase the risk of ischemic stroke, which may have significant public health implications for the reduction of ischemic stroke burden in China.
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Affiliation(s)
- Yaohua Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Hui Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Medical Informatics Center, Peking University, Beijing, China
| | - Zuolin Zhao
- Beijing HealthCom Data Technology Co. Ltd, Beijing, China
| | - Xiao Xiang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Man Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Juan Juan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jing Song
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yaying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Xiaowen Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Libo Chen
- Beijing HealthCom Data Technology Co. Ltd, Beijing, China
| | - Chen Wei
- Beijing HealthCom Data Technology Co. Ltd, Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- * E-mail: (YH); (PG)
| | - Pei Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- * E-mail: (YH); (PG)
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Lee JY, Kim JW, Kim EJ, Lee MY, Nam CW, Chung IS. Spatial analysis between particulate matter and emergency room visits for conjunctivitis and keratitis. Ann Occup Environ Med 2018; 30:41. [PMID: 29942521 PMCID: PMC5996503 DOI: 10.1186/s40557-018-0252-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/31/2018] [Indexed: 12/21/2022] Open
Abstract
Background The concentration of particulate matter in the air varies depending on the region because it is lightweight and generated from a variety of sources. To assess the relationship between particulate matter and eye disease, this study analyzes the concentration data obtained from spatial analysis of particulate matter and emergency visit data. Methods The study included 769 residents of Daegu, Korea who had visited an emergency room for the problem of conjunctivitis or keratitis. Concentrations of PM10 and other air pollutants were obtained from the Korean Ministry of the Environment. PM10 concentrations and the number of patients from each of 143 administrative dongs (sub-municipal level administrative units) of the city of Daegu were obtained using spatial analysis. The patient distribution and PM10 concentration were mapped for comparison, and their relationship was examined using scatter plot, regression analysis, and the independent sample t-test. Results The number of patients with conjunctivitis and keratitis was significantly higher in the regions of the top 20% areas than the bottom 20% areas in terms of PM10 concentration. The distribution of PM10 concentration and number of patients was visually similar on the map. The concentration of PM10 and the number of patients showed a dose–response relationship. When the concentrations of other air polluta9nts were controlled for, the numbers of conjunctivitis and keratitis patients were 0.04 per 1000 ER patients and 0.10 per 1000 ER patients, respectively. Conclusion As PM10 is associated with the prevalence of conjunctivitis and keratitis, measures to reduce particulate matter through environmental methods are needed. Electronic supplementary material The online version of this article (10.1186/s40557-018-0252-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jung-Youb Lee
- 1Division of Occupational and Environmental Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Jung-Won Kim
- 1Division of Occupational and Environmental Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Eun-Jung Kim
- 2Department of Urban Planning, Keimyung University School of Engineering, Daegu, South Korea
| | - Mi-Young Lee
- 1Division of Occupational and Environmental Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea.,3Department of Preventive Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Chang-Wook Nam
- 4Division of Cardiology, Keimyung University School of Medicine, Daegu, South Korea
| | - In-Sung Chung
- 1Division of Occupational and Environmental Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea.,3Department of Preventive Medicine, Keimyung University School of Medicine, Daegu, South Korea
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Newell K, Kartsonaki C, Lam KBH, Kurmi O. Cardiorespiratory health effects of gaseous ambient air pollution exposure in low and middle income countries: a systematic review and meta-analysis. Environ Health 2018; 17:41. [PMID: 29669550 PMCID: PMC5907176 DOI: 10.1186/s12940-018-0380-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/29/2018] [Indexed: 05/16/2023]
Abstract
BACKGROUND Lack of research on the effects of gaseous pollutants (nitrogen oxides [NOx], sulfur dioxide [SO2], carbon monoxide [CO] and ozone [O3]) in the ambient environment on health outcomes from within low and middle income countries (LMICs) is leading to reliance on results from studies performed within high income countries (HICs). This systematic review and meta-analysis examines the cardiorespiratory health effects of gaseous pollutants in LMICs exclusively. METHODS Systematic searching was carried out and estimates pooled by pollutant, lag and outcome, and presented as excess relative risk per 10 μg/m3 (NOx, SO2, O3) or 1 ppm (CO) increase pollutant. Sub-group analysis was performed examining estimates by specific outcomes, city and co-pollutant adjustment. RESULTS Sixty studies met the inclusion criteria, most (44) from the East Asia and Pacific region. A 10 μg/m3 increase in same day NOx was associated with 0.92% (95% CI: 0.44, 1.39), and 0.70% (0.01, 1.40) increases in cardiovascular and respiratory mortality respectively, same day NOx was not associated with morbidity. Same day sulfur dioxide was associated with 0.73% (0.04, 1.42) and 0.50% (0.01, 1.00) increases in respiratory morbidity and in cardiovascular mortality respectively. CONCLUSIONS Acute exposure to gaseous ambient air pollution (AAP) is associated with increases in morbidity and mortality in LMICs, with greatest associations observed for cardiorespiratory mortality.
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Affiliation(s)
- Katherine Newell
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Christiana Kartsonaki
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kin Bong Hubert Lam
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Om Kurmi
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Guo P, Feng W, Zheng M, Lv J, Wang L, Liu J, Zhang Y, Luo G, Zhang Y, Deng C, Shi T, Liu P, Zhang L. Short-term associations of ambient air pollution and cause-specific emergency department visits in Guangzhou, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 613-614:306-313. [PMID: 28917169 DOI: 10.1016/j.scitotenv.2017.09.102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/23/2017] [Accepted: 09/11/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Evidence of association of ambient air pollution with cause-specific emergency department visits in China is still limited. This study aimed to investigate short-term associations between exposures to air pollutants and daily cause-specific emergency department visits using a large-scale multicenter database involving a total of 65 sentinel hospitals in Guangzhou, the most densely-populated city in south China, during 2013-2015. MATERIAL AND METHODS We obtained data on 162,771 emergency department visits from 65 hospitals from the Emergency Medical Command Center in Guangzhou between January 1, 2013 and December 31, 2015. Daily air pollution data on particulate matter (PM) of aerodynamic diameter<10 and 2.5μm (PM10, and PM2.5, respectively), sulfur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O3) were collected from the Daily Quality Report of the Guangzhou Environmental Protection Bureau during the study period. Visits for neurologic, respiratory and circulatory diseases were assessed in relation to air pollutants using Poisson generalized additive models. RESULTS Mean daily number of emergency department visits for neurologic, respiratory and circulatory diseases was 89, 24 and 35, respectively. After adjustment for other pollutants (PM2.5, PM10, NO2 and O3), meteorological factors and time-varying confounders, a 7.98-μg/m3 (interquartile range) increment in 2-day moving average of same-day and previous-day SO2 concentrations was associated with the statistically significant increase of 4.89% (95% confidence interval: 2.86, 6.95) in neurologic emergency department visits; elevation in SO2 level (per 7.98μg/m3) was linked to a 5.19% (95% confidence interval: 2.03, 8.44) increase in circulatory emergency department visits. Most positive links were seen during the cold season. CONCLUSIONS The results of this study contribute to the evidence of the significant associations between SO2 and specific neurologic and circulatory conditions, and also provide insight into the planning of clinical services and emergency contingency response for air pollution exposures in Guangzhou.
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Affiliation(s)
- Pi Guo
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Wenru Feng
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Murui Zheng
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Jiayun Lv
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Li Wang
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Ju Liu
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Yanhong Zhang
- Shantou University Medical College, Shantou 515041, China
| | - Gangfeng Luo
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Yanting Zhang
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Changyu Deng
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Tongxing Shi
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Pengda Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Lin Zhang
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China.
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Newell K, Kartsonaki C, Lam KBH, Kurmi OP. Cardiorespiratory health effects of particulate ambient air pollution exposure in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Planet Health 2017; 1:e368-e380. [PMID: 29851649 DOI: 10.1016/s2542-5196(17)30166-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 10/17/2017] [Accepted: 11/20/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Most prospective studies on the health effects of particulate ambient air pollution exposure have focused on high-income countries, which have much lower pollutant concentrations than low-income and middle-income countries (LMICs) and different sources of pollution. We aimed to investigate the cardiorespiratory health effects of particulate ambient air pollution exposure in LMICs exclusively. METHODS For this systematic review and meta-analysis, we searched PubMed, Web of Science, Embase, LILACS, Global Health, and Proquest for studies published between database inception and Nov 28, 2016, investigating the cardiorespiratory health effects of particulate ambient air pollution exposure in LMICs. Data were extracted from published studies by one author, and then checked and verified by all authors independently. We pooled estimates by pollutant type (particulate matter with a diameter of <2·5 μm [PM2·5] or 2·5-10 μm [PM10]), lag, and outcome, and presented them as excess relative risk per 10 μg/m3 increase in particulate ambient air pollution. We used a random-effects model to derive overall excess risk. The study protocol is registered with PROSPERO, number CRD42016051733. FINDINGS Of 1553 studies identified, 91 met the full eligibility criteria. Only four long-term exposure studies from China were identified and not included in the meta-analysis. A 10 μg/m3 increase in same-day PM2·5 was associated with a 0·47% (95% CI 0·34-0·61) increase in cardiovascular mortality and a 0·57% (0·28-0·86) increase in respiratory mortality. A 10 μg/m3 increase in same-day PM10 was associated with a 0·27% (0·11-0·44) increase in cardiovascular mortality and a 0·56% (0·24-0·87) increase in respiratory mortality. INTERPRETATION Short-term exposure to particulate ambient air pollution is associated with increases in cardiorespiratory morbidity and mortality in LMIC's, with apparent regional-specific variations. FUNDING None.
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Affiliation(s)
- Katherine Newell
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Christiana Kartsonaki
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kin Bong Hubert Lam
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Om P Kurmi
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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50
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Han MH, Kim J, Choi KS, Kim CH, Kim JM, Cheong JH, Yi HJ, Lee SH. Monthly variations in aneurysmal subarachnoid hemorrhage incidence and mortality: Correlation with weather and pollution. PLoS One 2017; 12:e0186973. [PMID: 29073210 PMCID: PMC5658131 DOI: 10.1371/journal.pone.0186973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/11/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Although the effect of weather and air pollution on the occurrence of subarachnoid hemorrhage (SAH) has been investigated, results have remained inconsistent. The present study aimed to determine the seasonality of aneurysmal subarachnoid hemorrhage occurrence and mortality. METHODS We used the National Inpatient Sample database to evaluate the effect of meteorological factors and air pollutants on patients with subarachnoid hemorrhage in Korea between 2011 and 2014. Monthly variations in SAH occurrence and mortality were analyzed using locally weighted scatter plot smoothing curves. Multivariate Poisson generalized linear regression models were used to evaluate potential independent meteorological and pollutant variables associated with SAH occurrence and mortality. RESULTS In total, 21,407 patients who underwent clip or coil treatment owing to aneurysmal SAH in Korea from January 1, 2011, to December 31, 2014, were included. The crude incidence rate of SAH in Korea was 10.5 per 100,000 people per year. An approximately 0.5% lower risk of SAH was observed per 1°C increase in mean monthly temperature (relative risk, 0.995; 95% confidence interval [CI], 0.992-0.997; p < 0.001), while an approximately 2.3% higher risk of SAH was observed per 1°C increase in mean monthly diurnal temperature. CONCLUSIONS We showed distinct patterns of seasonal and monthly variation in the occurrence and mortality of SAH. Our findings suggest that meteorological factors may play an important role in monthly variations in the occurrence of aneurysmal SAH.
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Affiliation(s)
- Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Jinhee Kim
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University Medical Center, Wangsimni-ro, Seongdong-gu, Seoul, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, Wangsimni-ro, Seongdong-gu, Seoul, Korea
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Hambangmoe-ro, Yeonsu-gu, Incheon, Korea
- * E-mail:
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