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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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Xu J, Yin X, Jiang T, Wang S, Wang D. Effects of air pollution control policies on intracerebral hemorrhage mortality among residents in Tianjin, China. BMC Public Health 2023; 23:858. [PMID: 37170126 PMCID: PMC10173217 DOI: 10.1186/s12889-023-15735-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/22/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Exposure to air pollution is an important risk factor for intracerebral hemorrhage (ICH), which is a major cause of death worldwide. However, the relationship between ICH mortality and air quality improvement has been poorly studied. This study aims to evaluate the impact of the air pollution control policies in the Beijing-Tianjin-Hebei region on ICH mortality among Tianjin residents. METHODS This study used an interrupted time series analysis. We fitted autoregressive integrated moving average (ARIMA) models to assess the changes in ICH deaths before and after the interventions of air pollution control policies based on the data of ICH deaths in Tianjin collected by the Tianjin Center for Disease Control and Prevention. RESULTS Between 2009 and 2020, there were 63,944 ICH deaths in Tianjin, and there was an overall decreasing trend in ICH mortality. The intervention conducted in June 2014 resulted in a statistically significant (p = 0.03) long-term trend change, reducing the number of deaths from ICH by 0.69 (95% confidence interval [CI]: -1.30 to -0.07) per month. The intervention in October 2017 resulted in a statistically significant (p = 0.04) immediate decrease of 25.74 (95% CI: -50.62 to -0.85) deaths from ICH in that month. The intervention in December 2017 caused a statistically significant (p = 0.04) immediate reduction of 26.58 (95% CI: -52.02 to -1.14) deaths from ICH in that month. The intervention in March 2018 resulted in a statistically significant (p = 0.02) immediate decrease of 30.40 (95% CI: -56.41 to -4.40) deaths from ICH in that month. No significant differences were observed in the changes of male ICH mortality after any of the four interventions. However, female ICH deaths showed statistically significant long-term trend change after the intervention in June 2014 and immediate changes after the interventions in December 2017 and March 2018. Overall, the interventions prevented an estimated 5984.76 deaths due to ICH. CONCLUSION During the study period, some interventions of air pollution control policies were significantly associated with the reductions in the number of deaths from ICH among residents in Tianjin. ICH survivors and females were more sensitive to the protective effects of the interventions. Interventions for air pollution control can achieve public health gains in cities with high levels of air pollution.
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Affiliation(s)
- Jiahui Xu
- School of Public Health, Tianjin Medical University, Tianjin, China
- NCDs Preventive Department, Tianjin Centers for Disease Control and Prevention, No. 6 Huayue Road, Hedong District, Tianjin, 300011, China
| | - Xiaolin Yin
- School of Public Health, Tianjin Medical University, Tianjin, China
- NCDs Preventive Department, Tianjin Centers for Disease Control and Prevention, No. 6 Huayue Road, Hedong District, Tianjin, 300011, China
| | - Tingting Jiang
- School of Public Health, Tianjin Medical University, Tianjin, China
- NCDs Preventive Department, Tianjin Centers for Disease Control and Prevention, No. 6 Huayue Road, Hedong District, Tianjin, 300011, China
| | - Shiyu Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
- NCDs Preventive Department, Tianjin Centers for Disease Control and Prevention, No. 6 Huayue Road, Hedong District, Tianjin, 300011, China
| | - Dezheng Wang
- School of Public Health, Tianjin Medical University, Tianjin, China.
- NCDs Preventive Department, Tianjin Centers for Disease Control and Prevention, No. 6 Huayue Road, Hedong District, Tianjin, 300011, China.
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Kulick ER, Eliot MN, Szpiro AA, Coull BA, Tinker LF, Eaton CB, Whitsel EA, Stewart JD, Kaufman JD, Wellenius GA. Long-term exposure to ambient particulate matter and stroke etiology: Results from the Women's Health Initiative. ENVIRONMENTAL RESEARCH 2023; 224:115519. [PMID: 36813070 PMCID: PMC10074439 DOI: 10.1016/j.envres.2023.115519] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/03/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Ambient particulate matter (PM) air pollution is a leading cause of global disability and accounts for an annual 2.9 million deaths globally. PM is established as an important risk factor for cardiovascular disease, however the evidence supporting a link specifically between long-term exposure to ambient PM and incident stroke is less clear. We sought to evaluate the association of long-term exposure to different size fractions of ambient PM with incident stroke (overall and by etiologic subtypes) and cerebrovascular deaths within the Women's Health Initiative, a large prospective study of older women in the US. METHODS We studied 155,410 postmenopausal women without previous cerebrovascular disease enrolled into the study between 1993 and 1998, with follow-up through 2010. We assessed geocoded participant address-specific concentrations of ambient PM (fine [PM2.5], respirable [PM10] and coarse [PM10-2.5]), as well as nitrogen dioxide [NO2] using spatiotemporal models. We classified hospitalization events into ischemic, hemorrhagic, or other/unclassified stroke. Cerebrovascular mortality was defined as death from any stroke etiology. We used Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI), adjusting for individual and neighborhood-level characteristics. RESULTS During a median follow-up time of 15 years, participants experienced 4,556 cerebrovascular events. The hazard ratio for all cerebrovascular events was 2.14 (95% CI: 1.87, 2.44) comparing the top versus bottom quartiles of PM2.5. Similarly, there was a statistically significant increase in events comparing the top versus bottom quartiles of PM10 and NO2 (HR: 1.17; 95% CI: 1.03, 1.33 and HR:1.26; 95% CI: 1.12, 1.42). The strength of association did not vary substantially by stroke etiology. There was little evidence of an association between PMcoarse and incident cerebrovascular events. CONCLUSIONS Long-term exposure to fine (PM2.5) and respirable (PM10) particulate matter as well as NO2 was associated with a significant increase of cerebrovascular events among postmenopausal women. Strength of the associations were consistent by stroke etiology.
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Affiliation(s)
- Erin R Kulick
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | - Melissa N Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Adam A Szpiro
- Department of Biostatistics, University of Washington, Seattle, WA, 98195, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Charles B Eaton
- Department of Family Medicine and Epidemiology, Memorial Hospital of Rhode Island and Alpert Medical School of Brown University, Pawtucket, RI, USA
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA; Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - James D Stewart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Joel D Kaufman
- Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
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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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Zhang G, Liu X, Zhai S, Song G, Song H, Liang L, Kong Y, Ma R, He X. Rural-urban differences in associations between air pollution and cardiovascular hospital admissions in Guangxi, southwest China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:40711-40723. [PMID: 35083669 DOI: 10.1007/s11356-021-18196-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
Epidemiological studies found that exposure to air pollution increases cardiovascular hospitalizations. However, studies on rural-urban differences in associations between hospitalizations for cardiovascular diseases and air pollution are limited. The generalized linear model (GLM) was applied to investigate the associations between cardiovascular hospitalizations and air pollution (SO2, NO2, PM2.5, PM10, CO, and O3) in Guangxi, southwest China, in 2015 (January 1-December 31). The relative risk of pollutants (SO2, NO2) on cardiovascular hospital admissions was significantly different between urban and rural areas. The effect of SO2 on cardiovascular hospitalizations was higher in urban areas than in rural areas at lag0 to lag3 and cumulative lag01 to lag03. In urban areas, there were positive associations between NO2 and cardiovascular hospitalizations at lag0, lag1 and cumulative lag01, lag02. In contrast, the effect of NO2 on cardiovascular hospitalizations was not significant in rural areas. Urban residents were more sensitive than rural residents to SO2 and NO2. Subgroup analyses showed statistically significant differences between rural and urban areas in the association between SO2 and NO2 and cardiovascular hospitalizations for males. For age groups, people aged ≥ 65 years appeared to be more vulnerable to SO2 and NO2 in urban areas. The effects of PM2.5 PM10, CO, and O3 on cardiovascular hospitalizations were consistently negative for all groups. Our findings indicated that there were rural-urban differences in associations between cardiovascular hospitalizations and air pollutants. In rural areas, the risk of cardiovascular hospitalizations was mainly influenced by SO2. Therefore, we expect to pay attention to protecting people from air pollution, particularly for those aged ≥ 65 years in urban areas.
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Affiliation(s)
- Guangli Zhang
- College of Geography and Environmental Science, Henan University, Kaifeng, 475004, Henan, China
| | - Xiaoxiao Liu
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary AQ2, Calgary, Canada
| | - Shiyan Zhai
- College of Geography and Environmental Science, Henan University, Kaifeng, 475004, Henan, China.
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions (Henan University), Ministry of Education, Henan University, Kaifeng, 475004, Henan, China.
| | - Genxin Song
- College of Geography and Environmental Science, Henan University, Kaifeng, 475004, Henan, China
| | - Hongquan Song
- College of Geography and Environmental Science, Henan University, Kaifeng, 475004, Henan, China
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions (Henan University), Ministry of Education, Henan University, Kaifeng, 475004, Henan, China
| | - Lizhong Liang
- The Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Yunfeng Kong
- College of Geography and Environmental Science, Henan University, Kaifeng, 475004, Henan, China
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions (Henan University), Ministry of Education, Henan University, Kaifeng, 475004, Henan, China
| | - Rui Ma
- College of Geography and Environmental Science, Henan University, Kaifeng, 475004, Henan, China
| | - Xinxin He
- College of Geography and Environmental Science, Henan University, Kaifeng, 475004, Henan, China
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Mahmudimanesh M, Mirzaee M, Dehghan A, Bahrampour A. Forecasts of cardiac and respiratory mortality in Tehran, Iran, using ARIMAX and CNN-LSTM models. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:28469-28479. [PMID: 34993813 DOI: 10.1007/s11356-021-18205-8] [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: 08/03/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
Cardiovascular diseases belong to the leading causes of disability and premature death worldwide, including in Iran. It is predicted that the burden of the disease in Iran in 2025 will be more than doubled compared to 2005. Therefore, many forecasting models have been used to predict disease progression, estimate mortality rates, and assess risk factors. Our study focused on two time series prediction on models: autoregressive integrated moving average with exogenous variable (ARIMAX) and Convolutional neural network-long short-term memory network (CNN-LSTM). ARIMAX (6,1,6) had the best MSE of 0.655 among time series regression models. The prediction of this model shows a significant association in lag 4 and lag 6. Nitrogen dioxide (NO2) was also significant in lag 6, while CNN-LSTM had a much better MSE of 0.21. For the time series analysis and forecasts studied in this paper, deep learning models provided more accurate results than classical methods such as ARIMAX.
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Affiliation(s)
- Marzieh Mahmudimanesh
- Department of Biostatistics and Epidemiology, Kerman University of Medical Sciences, Kerman, Iran
| | - Moghaddameh Mirzaee
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Azizallah Dehghan
- Noncommunicable Disease Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Abbas Bahrampour
- Department of Biostatistics and Epidemiology, Faculty of Health, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
- Griffith University, Brisbane, QLD, Australia.
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Elser H, Chen KT, Arteaga D, Reimer R, Picciotto S, Costello S, Eisen EA. Metalworking Fluid Exposure and Stroke Mortality Among US Autoworkers. Am J Epidemiol 2022; 191:1040-1049. [PMID: 35029630 PMCID: PMC9393063 DOI: 10.1093/aje/kwac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/26/2021] [Accepted: 01/05/2022] [Indexed: 01/16/2023] Open
Abstract
Although air pollution is an important risk factor for stroke, few studies have considered the impact of workplace exposure to particulate matter (PM). We examined implications of exposure to PM composed of metalworking fluids (MWFs) for stroke mortality in the United Autoworkers-General Motors cohort. Cox proportional hazards models with age as the timescale were used to estimate the association of cumulative straight, soluble, and synthetic MWF exposure with stroke mortality, controlling for sex, race, plant, calendar year, and hire year. Among 38,553 autoworkers followed during 1941-1995, we identified 114 ischemic stroke deaths and 113 hemorrhagic stroke deaths. Overall stroke mortality risk was increased among workers in the middle exposure category for straight MWF (hazard ratio (HR) = 1.31, 95% confidence interval (CI): 0.87, 1.98) and workers in the highest exposure category for synthetic MWF (HR = 1.94, 95% CI: 1.13, 3.16) compared with workers who had no direct exposure. Ischemic stroke mortality risk was increased among workers in the highest exposure categories for straight MWF (HR = 1.45, 95% CI: 0.83, 2.52) and synthetic MWF (HR = 2.39, 95% CI: 1.39, 4.50). We observed no clear relationship between MWF exposure and hemorrhagic stroke mortality. Our results support a potentially important role for occupational PM exposures in stroke mortality and indicate the need for further studies of PM exposure and stroke in varied occupational settings.
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Affiliation(s)
- Holly Elser
- Correspondence to Dr. Holly Elser, Department of Neurology, 3 Gates, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (e-mail: )
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Xu Y, Chen JT, Holland I, Yanosky JD, Liao D, Coull BA, Wang D, Rexrode K, Whitsel EA, Wellenius GA, Laden F, Hart JE. Analysis of long- and medium-term particulate matter exposures and stroke in the US-based Health Professionals Follow-up Study. Environ Epidemiol 2021; 5:e178. [PMID: 34909558 PMCID: PMC8663831 DOI: 10.1097/ee9.0000000000000178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/14/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Stroke is a leading cause of mortality worldwide, and air pollution is the third largest contributor to global stroke burden. Existing studies investigating the association between long-term exposure to particulate matter (PM) and stroke incidence have been mixed and very little is known about the associations with medium-term exposures. Therefore, we wanted to evaluate these associations in an cohort of male health professionals. METHODS We assessed the association of PM exposures in the previous 1 and 12 months with incident total, ischemic, and hemorrhagic stroke in 49,603 men in the prospective US-based Health Professionals' Follow-up Study 1988-2007. We used spatiotemporal prediction models to estimate monthly PM less than 10 (PM10) and less than 2.5 (PM2.5), and PM2.5-10 at all mailing addresses. We used time-varying Cox proportional hazards models adjusted for potential confounders based on previous literature to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for each 10-μg/m3 increase in exposure in the preceding 1 and 12 months. We explored possible effect modification by age, obesity, smoking, aspirin use, diet quality, physical activity, diabetes, and Census region. RESULTS We observed 1,467 cases of incident stroke. Average levels of 12-month PM10, PM2.5-10, and PM2.5 were 20.7, 8.4, and 12.3 µg/m3, respectively. In multivariable adjusted models, we did not observe consistent associations between PM and overall or ischemic stroke. There was a suggestion of increased risk of hemorrhagic stroke (12-month PM10 multivariable HR: 1.13 [0.86, 1.48]; PM2.5-10: 1.12 [0.78, 1.62]; PM2.5:1.17 [0.76, 1.81], all per 10 µg/m3). There was little evidence of effect modification. CONCLUSIONS We observed only weak evidence of an association between long-term exposure to PM and risks of overall incident stroke. There was a suggestion of increasing hemorrhagic stroke risk.
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Affiliation(s)
- Yenan Xu
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA
| | - Jarvis T. Chen
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA
| | - Isabel Holland
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Jeff D. Yanosky
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Duanping Liao
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Brent A. Coull
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA
| | - Dong Wang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA
| | - Kathryn Rexrode
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Eric A. Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Gregory A. Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Francine Laden
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA
| | - Jaime E. Hart
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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Yu S, Alper HE, Nguyen A, Maqsood J, Brackbill RM. Stroke hospitalizations, posttraumatic stress disorder, and 9/11-related dust exposure: Results from the World Trade Center Health Registry. Am J Ind Med 2021; 64:827-836. [PMID: 34558721 DOI: 10.1002/ajim.23271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Few studies have examined the association between disaster-related factors and stroke by subtype or number. We investigated the association between 9/11-related posttraumatic stress disorder (PTSD), dust exposure, and stroke subtype as well as recurrent strokes. METHODS The study included 29,012 individuals enrolled in the World Trade Center Health Registry. Stroke cases were obtained by matching Registry enrollees to the New York State Department of Health's discharge records for inpatient visits between 2000 and 2016. Cox proportional hazards regression models were performed to examine the association between 9/11-related risk factors and stroke by subtype. Multinomial logistic regression models were conducted to assess the associations between the same risk factors and the number of stroke hospitalizations. RESULTS Having PTSD significantly increased the risk of developing ischemic and hemorrhagic stroke, with adjusted hazards ratios (AHRs) of 1.64 (95% confidence interval [CI]: 1.28-2.10) and 1.73 (95% CI: 1.10-2.71), respectively. The point estimate for dust cloud exposure, although not significant statistically, suggested an increased risk of ischemic stroke (AHR = 1.20, 95% CI: 0.96-1.50). PTSD was significantly associated with recurrent strokes with an adjusted odds ratio of 1.79 (95% CI: 1.09-2.95). CONCLUSIONS PTSD is a risk factor for both ischemic and hemorrhagic stroke and is associated with recurrent strokes. Dust exposure on 9/11 is a possible risk factor for ischemic stroke but not for hemorrhagic stroke, and was not associated with recurrent strokes. Our findings warrant additional research on stroke-morbidity and mortality associated with 9/11-related PTSD and dust exposure.
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Affiliation(s)
- Shengchao Yu
- New York City Department of Health and Mental Hygiene Long Island City New York USA
| | - Howard E. Alper
- New York City Department of Health and Mental Hygiene Long Island City New York USA
| | - Angela‐Maithy Nguyen
- Interdisciplinary Division, School of Public Health University of California‐Berkeley Berkeley California USA
| | - Junaid Maqsood
- New York City Department of Health and Mental Hygiene Long Island City New York USA
| | - Robert M. Brackbill
- New York City Department of Health and Mental Hygiene Long Island City New York USA
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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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11
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Margaryan S. Low emission zones and population health. JOURNAL OF HEALTH ECONOMICS 2021; 76:102402. [PMID: 33383264 DOI: 10.1016/j.jhealeco.2020.102402] [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: 12/12/2019] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 06/12/2023]
Abstract
Air pollution has a detrimental impact on population health, but the effectiveness of policy measures targeting pollution is underexplored. I exploit the natural experiment generated by the staggered implementation of low emission zones in large cities across Germany to assess their impact on health. Using register data on outpatient and inpatient health care, I find that low emission zones reduce the number of patients with cardiovascular disease by 2-3%. This effect is particularly pronounced for those over the age of 65. The findings suggest that low emission zones can be an effective way to reduce air pollution and improve health.
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Affiliation(s)
- Shushanik Margaryan
- Universität Hamburg, Department of Economics and Hamburg Center for Health Economics (hche), Esplanade 36, 20354 Hamburg, Germany.
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12
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Effects of PM10 and Weather on Respiratory and Cardiovascular Diseases in the Ciuc Basin (Romanian Carpathians). ATMOSPHERE 2021. [DOI: 10.3390/atmos12020289] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study presents the PM10 concentration, respiratory and cardiovascular disease hospital admissions evolution in the Ciuc basin for a period of 9 years (2008–2016), taking into consideration different meteorological conditions: boundary layer, lifting condensation level, temperature-humidity index, and wind chill equivalent chart index. The PM10 and hospital admissions evolution showed a very fluctuated hourly, weekly, monthly, yearly tendency. The PM10 concentration in winter (34.72 μg/m3) was 82% higher than the multiannual average (19.00 μg/m3), and almost three times higher than in summer (11.71 μg/m3). During the winter, PM10 concentration increased by an average of 9.36 μg/m3 due to the increased household heating. Climatological parameters have a demonstrable effect on the PM10 concentration variation. Children, the elderly and men are more sensitive to air pollution, the calculated relative risk for men was (RR = 1.45), and for women (RR = 1.37), respectively. A moderate correlation (0.51) was found between PM10 and pneumonia (P), while a relatively weak correlation (0.39) was demonstrated in the case of PM10 and upper respiratory tract infections (URTI). Furthermore, except thermal humidity index (THI), strong negative correlations were observed between the multiannual monthly mean PM10 and the meteorological data. The PM10 followed a moderate negative correlation with the boundary layer (−0.61). In the case of URTI and P, the highest number of hospital admissions occurred with a 5 to 7-day lag, while the 10 μg/m3 PM10 increase resulted in a 2.04% and 8.28% morbidity increase. For lung cancer (LC) and cardiovascular diseases (AMI, IHD, CCP), a maximum delay of 5–6 months was found. Three-month delay and an average growth of 1.51% was observed in the case of chronic obstructive pulmonary disease (COPD). Overall, these findings revealed that PM10 was and it is responsible for one-third of the diseases.
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13
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Zeng S, Luo L, Chen F, Li Y, Chen M, He X. Association of outdoor air pollution with the medical expense of ischemic stroke: The case study of an industrial city in western China. Int J Health Plann Manage 2021; 36:715-728. [PMID: 33474742 DOI: 10.1002/hpm.3115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 11/05/2020] [Accepted: 12/28/2020] [Indexed: 11/11/2022] Open
Abstract
Ischemic stroke, the most frequent cause of severe disability, imposes a significant mental and economic burden on patients and their families. There is increasing evidence to indicate that air pollution contributes to the risk of ischemic stroke. This study aimed to examine the correlation between air pollution and the expense imposed by an ischemic stroke. Data were obtained from hospitals and environmental monitoring stations in an industry city, Longspring, in western China. We used a generalized additive model to estimate the associations between the two factors, measured during 2015-2017. Counter-intuitively, the medical expenses arising from ischemia were negatively associated with the level of air pollution. The corresponding ER for per interquartile range increase of PM2.5, PM10, SO2 , and NO2 in lag10 was -0.17% (95% confidence interval (95% CI -0.31%, -0.03%), -0.11% (95% CI -0.2%, -0.02%), -1.04% (95% CI -1.92%, -0.17%) and -0.44% (95% CI -0.66%, -0.22%), respectively (p < 0.05). Subgroups based on gender, age, and season were considered in the analysis. The results indicated that pollutants had significant effects on ischaemia's medical expenses, which were stronger for older people, patients who survived, and warm seasons. This study is the first step in optimizing medical resources, which are essential for policymaking and service planning.
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Affiliation(s)
- Siyu Zeng
- Business School, Sichuan University, Chengdu, China
| | - Li Luo
- Business School, Sichuan University, Chengdu, China
| | - Fang Chen
- Department of Neurosurgery, First People's Hospital of Longquan, Chengdu, China
| | - Yue Li
- Business School, Sichuan University, Chengdu, China
| | - Mei Chen
- Department of Record Room, First People's Hospital of Longquan, Chengdu, China
| | - Xiaozhou He
- Business School, Sichuan University, Chengdu, China
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14
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Higham J, Ramírez CA, Green M, Morse AP. UK COVID-19 lockdown: 100 days of air pollution reduction? AIR QUALITY, ATMOSPHERE, & HEALTH 2021; 14:325-332. [PMID: 32952739 PMCID: PMC7485429 DOI: 10.1007/s11869-020-00937-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/01/2020] [Indexed: 05/18/2023]
Abstract
On the 23 March 2020, a country-wide COVID-19 lockdown was imposed on the UK. The following 100 days saw anthropogenic movements quickly halt, before slowly easing back to a "new" normality. In this short communication, we use data from official UK air-quality sensors (DEFRA AURN) and the UK Met Office stations to show how lockdown measures affected air quality in the UK. We compare the 100 days post-lockdown (23 March to 30 June 2020) with the same period from the previous 7 years. We find, as shown in numerous studies of other countries, the nitrogen oxides levels across the country dropped substantially (∼ 50%). However, we also find the ozone levels increased (∼ 10%), and the levels of sulphur dioxide more than doubled across the country. These changes, driven by a complex balance in the air chemistry near the surface, may reflect the influence of low humidity as suggested by Met Office data, and potentially, the reduction of nitrogen oxides and their interactions with multiple pollutants.
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Affiliation(s)
- J.E. Higham
- School of Environmental Sciences, University of Liverpool, Roxby Building, Liverpool, UK
| | - C. Acosta Ramírez
- School of Environmental Sciences, University of Liverpool, Roxby Building, Liverpool, UK
| | - M.A. Green
- School of Environmental Sciences, University of Liverpool, Roxby Building, Liverpool, UK
| | - A. P. Morse
- School of Environmental Sciences, University of Liverpool, Roxby Building, Liverpool, UK
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15
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Ban J, Wang Q, Ma R, Zhang Y, Shi W, Zhang Y, Chen C, Sun Q, Wang Y, Guo X, Li T. Associations between short-term exposure to PM 2.5 and stroke incidence and mortality in China: A case-crossover study and estimation of the burden. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 268:115743. [PMID: 33022547 DOI: 10.1016/j.envpol.2020.115743] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 05/17/2023]
Abstract
Stroke and fine particulate matter (PM2.5) are two important public health concerns worldwide. Although numerous studies have reported the associations between PM2.5 and stroke, scientific evidence in China is incomplete, particularly the effect of PM2.5 on the acute incidence and national acute health burdens of stroke attributed to PM2.5 pollution. This study identified about 131,947 registered patients and 23,018 deaths due to stroke in 10 counties located in various regions from 2013 to 2017. Using a time-stratified case-crossover design, this study evaluated the associations between short-term exposure to PM2.5 and the risks of acute incidence and mortality for different types of stroke on the same spatiotemporal scale. With a 10 μg/m3 increase in the PM2.5 concentration, the acute incidence risk increased by 0.37% (0.15%, 0.60%) for stroke, 0.46% (0.21%, 0.72%) for ischemic stroke, and -0.13% (-0.73%, 0.48%) for hemorrhagic stroke. The corresponding values for the mortality risk were 0.71% (0.08%, 1.33%), 1.09% (0.05%, 2.14%), and 0.43% (-0.44%, 1.31%) for stroke, ischemic stroke and hemorrhagic stroke, respectively. Compared with the other groups, females and patients aged over 64 years presented higher incidence and mortality risks, while the group aged >75 years may exhibit a greater risk of mortality. Based on the estimated effects, we evaluated 43,300 excess deaths and 48,800 acute incidences attributed to short-term PM2.5 exposure across China in 2015. This study provided robust estimates of PM2.5-induced stroke incidence and mortality risks, and susceptible populations were identified. Excess mortality and morbidity attributed to short-term PM2.5 exposure indicate the necessity to implement health care and prevention strategies, as well as medical resource allocation for noncommunicable diseases in regions with high levels of air pollution.
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Affiliation(s)
- Jie Ban
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, No. 38 Xueyuan Road, Beijing, 100191, China; China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No.7 Panjiayuan Nanli Chaoyang District, Beijing, 100021, China
| | - Qing Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No.7 Panjiayuan Nanli Chaoyang District, Beijing, 100021, China
| | - Runmei Ma
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No.7 Panjiayuan Nanli Chaoyang District, Beijing, 100021, China
| | - Yingjian Zhang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No.7 Panjiayuan Nanli Chaoyang District, Beijing, 100021, China; Jinan Center for Disease Control and Prevention, No.2 Weiliu Road Huaiyin District, Jinan, 250021, China
| | - Wangying Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No.7 Panjiayuan Nanli Chaoyang District, Beijing, 100021, China
| | - Yayi Zhang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No.7 Panjiayuan Nanli Chaoyang District, Beijing, 100021, China
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No.7 Panjiayuan Nanli Chaoyang District, Beijing, 100021, China
| | - Qinghua Sun
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No.7 Panjiayuan Nanli Chaoyang District, Beijing, 100021, China
| | - Yanwen Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No.7 Panjiayuan Nanli Chaoyang District, Beijing, 100021, China
| | - Xinbiao Guo
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, No. 38 Xueyuan Road, Beijing, 100191, China.
| | - Tiantian Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No.7 Panjiayuan Nanli Chaoyang District, Beijing, 100021, China
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16
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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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17
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Xie B, Jiao J, An Z, Zheng Y, Li Z. Deciphering the stroke-built environment nexus in transitional cities: Conceptual framework, empirical evidence, and implications for proactive planning intervention. CITIES (LONDON, ENGLAND) 2019; 94:116-128. [PMID: 38239895 PMCID: PMC10795972 DOI: 10.1016/j.cities.2019.05.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Adverse lifestyle-associated health outcomes, and stroke in particular, have been aggravated in transitional countries under high-speed urbanisation. Against this backdrop, deciphering the nexus between built environments (BEs) and lifestyle-associated health outcomes is of importance for crafting proactive interventions. The existing literature on this topic, however, fails to sufficiently capture the multiplicity of health-related BEs and, in turn, the complexity of such a nexus, largely challenging the applicability of established frameworks and the reliability of relevant findings. Looking at the case of stroke in Wuhan, China, this research aims to flesh out the understanding of the nexus between multidimensional BEs and lifestyle-associated health outcomes in transitional cities, with regards to conceptual framework and empirical evidence. To this end, we clarified stroke-related BE elements and integrated them into one conceptual framework. We then visualised stroke risk and examined its BE determinants using the Bayesian conditional autoregressive model. The visualisation results showed that stroke risks exhibited significant clustering in the high-density urban core. The statistical analysis found that, after the data were controlled for sociodemographic characteristics, net population density and building density were positively associated with stroke risk. In contrast, an abundance of public parks and institutional land use and access to medical care facilities have presented negative correlations with stroke risk, regardless of urban density. Our research reveals that compact urban developments might not be a silver bullet for health promotion in transitional cities, calling for an urgent need to scrutinise their applicability. To offset the adverse effects of increasingly dense urban environments, more efforts should also be made to provide better access to the identified salubrious resources. Furthermore, we argue that the establishment of comprehensive conceptual frameworks that connect BEs and lifestyle-associated health outcomes deserves to be highlighted in further research, planning intervention schemes, and health impact assessment projects.
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Affiliation(s)
- Bo Xie
- School of Urban Design, Wuhan University, Wuhan 430072, China
| | - Junfeng Jiao
- School of Architecture, The University of Texas at Austin, 310 Inner Campus Drive, Austin, TX 78712, United States of America
| | - Zihao An
- Institute for Transport Studies, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Yiling Zheng
- School of Urban Design, Wuhan University, Wuhan 430072, China
| | - Zhigang Li
- School of Urban Design, Wuhan University, Wuhan 430072, China
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18
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Aghababaeian H, Dastoorpoor M, Ghasemi A, Kiarsi M, Khanjani N, Araghi Ahvazi L. Cardiovascular and respiratory emergency dispatch due to short-term exposure to ambient PM10 in Dezful, Iran. J Cardiovasc Thorac Res 2019; 11:264-271. [PMID: 31824607 PMCID: PMC6891034 DOI: 10.15171/jcvtr.2019.44] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 09/15/2019] [Indexed: 11/15/2022] Open
Abstract
Introduction: This study was conducted to determine the relation between exposure to particulate matter less than 10 microns (PM10) caused by dust storms and the risk of cardiovascular, respiratory and traffic accident missions carried out by Emergency Medical Services (EMS).
Methods: This was a time-series study conducted in Dezful city, Iran. Daily information on the number of missions by the EMS due to cardiovascular, respiratory and crash problems and data on PM10 were inquired from March 2013 until March 2016. A generalized linear model (GLM) with distributed lag models (DLMs) was used to evaluate the relation between the number of EMS missions and the average daily PM10. The latent effects of PM10 were estimated in single and cumulative lags, up to 14 days.
Results: In the adjusted model, for each IQR increase in the average daily PM10 concentration, the risk of EMS missions in the total population in single lags of 2 to 7 days, and the cumulative lags of 0-7 and 0-14 days after exposure had a 0.8, 0.8, 0.8, 0.8, 0.7, 0.6, 6.7 and 1.4% significant increase. Also, for each IQR increase in the daily mean concentration of PM10 in single 1 to 7, and cumulative lags of 0-2, 0-7, and 0-14 days after exposure, respectively, a 2.4, 2.7, 2.8, 2.9, 2.9, 2.7, 2.5, 7.4, 23.5 and 33. 3 % increase was observed in the risk of EMS cardiovascular missions.
Conclusion: Increase in daily PM10 concentrations in Dezful is associated with an increase in the risk of EMS missions in lags up to two weeks after exposure.
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Affiliation(s)
- Hamidreza Aghababaeian
- Nursing and Emergency Department, Dezful University of Medical Sciences, Dezful, Iran.,Department of Health in Emergencies and Disaster, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Dastoorpoor
- Department of Biostatistics and Epidemiology, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Afsaneh Ghasemi
- Department of Public Health, School of Public Health, Fasa University of Medical Sciences, Fasa, Iran
| | - Maryam Kiarsi
- Nursing and Emergency Department, Dezful University of Medical Sciences, Dezful, Iran
| | - Narges Khanjani
- Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Ladan Araghi Ahvazi
- Nursing and Emergency Department, Dezful University of Medical Sciences, Dezful, Iran
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19
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Yuan S, Wang J, Jiang Q, He Z, Huang Y, Li Z, Cai L, Cao S. Long-term exposure to PM 2.5 and stroke: A systematic review and meta-analysis of cohort studies. ENVIRONMENTAL RESEARCH 2019; 177:108587. [PMID: 31326714 DOI: 10.1016/j.envres.2019.108587] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/10/2019] [Accepted: 07/14/2019] [Indexed: 05/07/2023]
Abstract
BACKGROUND Stroke is one of the world's leading causes of death. Many studies have checked the relationship between short-term exposure to particulate matter (PM) and stroke, but few have focused on the effect of long-term exposure to PM2.5 (particulate matters with an aerodynamic diameter of ≤2.5 μm). This study aimed to quantitatively examine the relationship of long-term exposure to PM2.5 with stroke incidence and mortality. METHODS We identified relevant studies by searching the PubMed, EMBASE and MEDLINE. After the systematical review of pertinent studies, random-effect meta-analysis was conducted to investigate the association between long-term exposure to PM2.5 and stroke. RESULTS Our meta-analysis included 16 cohort studies with more than 2.2 million people and above 49 149 endpoint events (incident stroke and death from stroke). The pooled hazard ratio (HR) for each 5 μg/m3 increment in PM2.5 was 1.11 (95% CI: 1.05, 1.17) (CI for confidence interval) for incidence of stroke and 1.11 (95% CI:1.05, 1.17) for mortality of stroke. In the region-specific analysis, significant association between PM2.5 and incidence of stroke was found in North America (HR=1.09, 95% CI:1.05, 1.14) and Europe (HR=1.07, 95% CI:1.05, 1.10), while the pooled result of Asia showed no significance (HR=2.31, 95% CI:0.49, 10.95). CONCLUSIONS Long-term exposure to PM2.5 is an important risk factor for stroke. Since air quality is intimately related to everyone, policies aimed at reducing particulate matters will benefit public health a lot.
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Affiliation(s)
- Sheng Yuan
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China; FuWai Hospital & Key Laboratory of Pulmonary Vascular Medicine, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy Medical Sciences, Beijing, China
| | - Jiaxin Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Qingqing Jiang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ziyu He
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Yuchai Huang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhengyang Li
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Luyao Cai
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Shiyi Cao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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20
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Dehghan A, Khanjani N, Bahrampour A, Goudarzi G, Yunesian M. Short-term effects of ambient (outdoor) air pollution on cardiovascular death in Tehran, Iran – a time series study. TOXIN REV 2019. [DOI: 10.1080/15569543.2018.1488263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Azizallah Dehghan
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Narges Khanjani
- Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Monash Centre for Occupational & Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Abbas Bahrampour
- Physiology Research Center & Department of Biostatistics and Epidemiology, Faculty of Health, Kerman University of Medical Sciences Kerman, Iran
| | - Gholamreza Goudarzi
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Environmental Technologies Research Center (ETRC), Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Masoud Yunesian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research & Department of Research Methodology and Data Analysis, Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
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21
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Long-term Effects of Cumulative Average PM2.5 Exposure on the Risk of Hemorrhagic Stroke. Epidemiology 2019; 30 Suppl 1:S90-S98. [DOI: 10.1097/ede.0000000000001001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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22
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Abstract
The conference "Climate change, air pollution and health" was held at the Pontifical Academy of Sciences. The data presented highlighted that air pollution is a major, under-recognized and modifiable risk factor for stroke and heart disease. Air pollution causes 7.6% of all deaths making it the fifth cause of death globally, and this figure is expected to increase by 50% by 2050. Particulate matter causes endothelial dysfunction and induces thrombosis by altering reactive oxygen species, nitric oxide, insulin resistance, and lipid levels. Thirty-three articles published since 2002 were reviewed to assess the relation between air pollution and stroke with age, geographical location, particulate and gaseous matter type, duration of exposure, previous stroke, and comorbidities. It remains to be defined if air pollution has pathophysiological effects that preferentially predispose individuals to ischemic or hemorrhagic stroke. There is ample evidence showing an association between acute and chronic exposure to PM2.5 or gaseous pollutants with stroke. This potentially avoidable scenario and its dramatic consequences are heavily under-recognized by health professionals and the wider public. Preventive measures in people at high vascular risk are warranted. Procrastination in implementing efforts to stop the current worldwide course of worsening air pollution is the seed of a potential global health catastrophe.
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Affiliation(s)
- Conrado J Estol
- Stroke Unit, Sanatorio Guemes, Francisco Acuña de Figueroa 1240, C1180, CABA, Argentina
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23
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Dastoorpoor M, Sekhavatpour Z, Masoumi K, Mohammadi MJ, Aghababaeian H, Khanjani N, Hashemzadeh B, Vahedian M. Air pollution and hospital admissions for cardiovascular diseases in Ahvaz, Iran. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 652:1318-1330. [PMID: 30586817 DOI: 10.1016/j.scitotenv.2018.10.285] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/16/2018] [Accepted: 10/21/2018] [Indexed: 04/13/2023]
Abstract
Cardiovascular disease is one of the main causes of death in Iran. The aim of this study was to determine the relation between air pollution and cardiovascular hospital admissions in Ahwaz, Iran. Daily information about cardiovascular hospital admissions (based on the ICD-10) and data on air pollutants during 2008-2018 were inquired. A quasi-Poisson regression combined with linear distributed lag models; adjusted for trend, seasonality, temperature, relative humidity, weekdays and holidays was used to assess the relation between hospital admission for cardiovascular diseases and the average daily air pollution. The results of this study showed a significant increase in cardiovascular hospital admissions in the total population and women's population in relation to O3. There was a significant increase in hospital admissions for cardiovascular diseases in the whole population as well as gender and age groups associated with NO2 and NO. A significant increase was found in hospital admissions for cardiovascular diseases in relation to CO in the 65-74-year-old population. Finally, the results of this study showed that there was a significant increase in hospital admissions for cardiovascular disease associated with SO2. The main results of the present study confirm the deleterious short term impact of air pollution on cardiovascular morbidity in Ahvaz city. This evidence empasizes the need to implement policies for reducing air pollution.
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Affiliation(s)
- Maryam Dastoorpoor
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zohreh Sekhavatpour
- Department of Anesthesiology, School of Paramedicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Kambiz Masoumi
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Emergency Medicine, Imam Khomeini General Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Narges Khanjani
- Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Mostafa Vahedian
- Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom, Iran.
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24
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Zhang R, Liu G, Jiang Y, Li G, Pan Y, Wang Y, Wei Z, Wang J, Wang Y. Acute Effects of Particulate Air Pollution on Ischemic Stroke and Hemorrhagic Stroke Mortality. Front Neurol 2018; 9:827. [PMID: 30333790 PMCID: PMC6176083 DOI: 10.3389/fneur.2018.00827] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/13/2018] [Indexed: 12/29/2022] Open
Abstract
Background and Purpose: A large body of literature reported the association of particulate matter (PM) with stroke in high-income countries. Few studies have examined the association between PM and stroke in middle- and low-income countries and considered the types of stroke. In this study, we examined the short-term effects of particulate matter <2.5 μm in diameter (PM2.5) and particulate matter <10 μm in diameter (PM10) on ischemic stroke mortality and hemorrhagic stroke mortality in Beijing, China. Methods: We used an ecological study design and quasi-Poisson generalized additive models to evaluate the association of PM2.5 and PM10 and cerebrovascular diseases mortality, as well as ischemic- and hemorrhagic stroke mortality. In the model, we controlled long-term and season trends, temperature, and relative humidity, the day of the week and air pollution. For cerebrovascular diseases mortality, we examined the effects stratified by sex and age with different lag days. Results: A total of 48,122 deaths for cerebrovascular disease (32,799 deaths for ischemic stroke and 13,051 deaths for hemorrhagic stroke) were included in the study. PM2.5 was associated with stroke mortality. The 10 μg/m3 increase of PM2.5 was associated with the increase of mortality, 0.27% (95% CI, 0.12–0.43%) for cerebrovascular diseases, 0.23% (95% CI, 0.04–0.42%) for ischemic stroke and 0.37% (95% CI, 0.07–0.67%) for hemorrhagic stroke -. The associations between PM10 and mortality were also detected for cerebrovascular diseases and ischemic stroke, but not in hemorrhagic stroke. The stratified analysis suggested age and gender did not modify the effects of PM on mortality significantly. Conclusions: Our study suggested that short-term exposure to ambient PM was associated with the risk of stroke mortality.
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Affiliation(s)
- Runhua Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Gang Li
- Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Zaihua Wei
- Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Jing Wang
- Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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25
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Béjot Y, Reis J, Giroud M, Feigin V. A review of epidemiological research on stroke and dementia and exposure to air pollution. Int J Stroke 2018; 13:687-695. [DOI: 10.1177/1747493018772800] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Outdoor air pollution is now a well-known risk factor for morbidity and mortality, and is increasingly being identified as a major risk factor for stroke. Methods A narrative literature review of the effects of short and long-term exposure to air pollution on stroke and dementia risk and cognitive functioning. Results Ten papers on stroke and 17 on dementia were selected. Air pollution, and in particular small particulate matter, contributes to about one-third of the global stroke burden and about one-fifth of the global burden of dementia. It particularly affects vulnerable patients with other vascular risk factors or a prior history of stroke in low- and medium-income countries. New pathophysiological mechanisms of the cause-effect associations are suggested. Conclusion Air pollution should be considered as a new modifiable cerebrovascular and neurodegenerative risk factor. This massive worldwide public health problem requires environmental health policies able to reduce air pollution and thus the stroke and dementia burden.
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Affiliation(s)
- Yannick Béjot
- Dijon Stroke Registry (Inserm, Santé Publique France), EA 7460, University Hospital of Dijon – University of Burgundy, Dijon, France
| | - Jacques Reis
- Neurology Service (Pr C. Tranchant), University Hospital of Strasbourg, Strasbourg, France
| | - Maurice Giroud
- Dijon Stroke Registry (Inserm, Santé Publique France), EA 7460, University Hospital of Dijon – University of Burgundy, Dijon, France
| | - Valery Feigin
- Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
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26
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Karjalainen M, Kontunen A, Saari S, Rönkkö T, Lekkala J, Roine A, Oksala N. The characterization of surgical smoke from various tissues and its implications for occupational safety. PLoS One 2018; 13:e0195274. [PMID: 29649244 PMCID: PMC5896939 DOI: 10.1371/journal.pone.0195274] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/19/2018] [Indexed: 01/12/2023] Open
Abstract
Electrosurgery produces surgical smoke. Different tissues produce different quantities and types of smoke, so we studied the particle characteristics of this surgical smoke in order to analyze the implications for the occupational health of the operation room personnel. We estimated the deposition of particulate matter (PM) from surgical smoke on the respiratory tract of operation room personnel using clinically relevant tissues from Finnish landrace porcine tissues including skeletal muscle, liver, subcutaneous fat, renal pelvis, renal cortex, lung, bronchus, cerebral gray and white matter, and skin. In order to standardize the electrosurgical cuts and smoke concentrations, we built a customized computer-controlled platform. The smoke particles were analyzed with an electrical low pressure impactor (ELPI), which measures the concentration and aerodynamic size distribution of particles with a diameter between 7 nm and 10 μm. There were significant differences in the mass concentration and size distribution of the surgical smoke particles depending on the electrocauterized tissue. Of the various tissues tested, liver yielded the highest number of particles. In order to better estimate the health hazard, we propose that the tissues can be divided into three distinct classes according to their surgical smoke production: 1) high-PM tissue for liver; 2) medium-PM tissues for renal cortex, renal pelvis, and skeletal muscle; and 3) low-PM tissues for skin, gray matter, white matter, bronchus, and subcutaneous fat.
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Affiliation(s)
- Markus Karjalainen
- BioMediTech Institute and Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
- * E-mail:
| | - Anton Kontunen
- BioMediTech Institute and Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Sampo Saari
- Aerosol Physics, Faculty of Natural Sciences, Tampere University of Technology, Tampere, Finland
| | - Topi Rönkkö
- Aerosol Physics, Faculty of Natural Sciences, Tampere University of Technology, Tampere, Finland
| | - Jukka Lekkala
- BioMediTech Institute and Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Antti Roine
- Department of Surgery, Hatanpää Hospital, Tampere, Tampere, Finland
| | - Niku Oksala
- Division of Vascular Surgery, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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Qiu H, Sun S, Tsang H, Wong CM, Lee RSY, Schooling CM, Tian L. Fine particulate matter exposure and incidence of stroke. Neurology 2017; 88:1709-1717. [DOI: 10.1212/wnl.0000000000003903] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 02/07/2017] [Indexed: 11/15/2022] Open
Abstract
Objective:We aimed to assess the association of long-term residential exposure to fine particulate matter (PM) with aerodynamic diameter less than 2.5 μm (PM2.5) with the incidence of stroke and its major subtypes.Methods:We ascertained the first occurrence of emergency hospital admission for stroke in a Hong Kong Chinese cohort of 66,820 older people (65+ years) who enrolled during 1998–2001 (baseline) and were followed up to December 31, 2010. High-resolution (1 × 1 km) yearly mean concentrations of PM2.5 were predicted from local monitoring data and US National Aeronautics and Space Administration satellite data using linear regression. Baseline residential PM2.5 exposure was used as a proxy for long-term exposure. We used Cox proportional hazards to evaluate the risk of incident stroke associated with PM2.5 exposure adjusted for potential confounders, including individual and neighborhood factors.Results:Over a mean follow-up of 9.4 years, we ascertained 6,733 cases of incident stroke, of which 3,526 (52.4%) were ischemic and 1,175 (17.5%) were hemorrhagic. The hazard ratio for every 10 μg/m3 higher PM2.5 concentration was statistically significant at 1.21 (95% confidence interval [CI] 1.04–1.41) for ischemic and non-statistically significant at 0.90 (95% CI 0.70–1.17) for hemorrhagic stroke in fully adjusted model 3. The estimates for ischemic stroke were higher in older participants (>70 years), less educated participants, and in men for current smokers.Conclusion:Long-term PM2.5 exposure was associated with higher risk of incident ischemic stroke, but the association with incident hemorrhagic stroke was less clear.
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28
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Pannullo F, Lee D, Neal L, Dalvi M, Agnew P, O’Connor FM, Mukhopadhyay S, Sahu S, Sarran C. Quantifying the impact of current and future concentrations of air pollutants on respiratory disease risk in England. Environ Health 2017; 16:29. [PMID: 28347336 PMCID: PMC5368918 DOI: 10.1186/s12940-017-0237-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 03/20/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Estimating the long-term health impact of air pollution in a spatio-temporal ecological study requires representative concentrations of air pollutants to be constructed for each geographical unit and time period. Averaging concentrations in space and time is commonly carried out, but little is known about how robust the estimated health effects are to different aggregation functions. A second under researched question is what impact air pollution is likely to have in the future. METHODS We conducted a study for England between 2007 and 2011, investigating the relationship between respiratory hospital admissions and different pollutants: nitrogen dioxide (NO2); ozone (O3); particulate matter, the latter including particles with an aerodynamic diameter less than 2.5 micrometers (PM2.5), and less than 10 micrometers (PM10); and sulphur dioxide (SO2). Bayesian Poisson regression models accounting for localised spatio-temporal autocorrelation were used to estimate the relative risks (RRs) of pollution on disease risk, and for each pollutant four representative concentrations were constructed using combinations of spatial and temporal averages and maximums. The estimated RRs were then used to make projections of the numbers of likely respiratory hospital admissions in the 2050s attributable to air pollution, based on emission projections from a number of Representative Concentration Pathways (RCP). RESULTS NO2 exhibited the largest association with respiratory hospital admissions out of the pollutants considered, with estimated increased risks of between 0.9 and 1.6% for a one standard deviation increase in concentrations. In the future the projected numbers of respiratory hospital admissions attributable to NO2 in the 2050s are lower than present day rates under 3 Representative Concentration Pathways (RCPs): 2.6, 6.0, and 8.5, which is due to projected reductions in future NO2 emissions and concentrations. CONCLUSIONS NO2 concentrations exhibit consistent substantial present-day health effects regardless of how a representative concentration is constructed in space and time. Thus as concentrations are predicted to remain above limits set by European Union Legislation until the 2030s in parts of urban England, it will remain a substantial health risk for some time.
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Affiliation(s)
- Francesca Pannullo
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G12 8QW UK
| | - Duncan Lee
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G12 8QW UK
| | - Lucy Neal
- Met Office, FitzRoy Road, Exeter, EX1 3PB UK
| | - Mohit Dalvi
- Met Office Hadley Centre, FitzRoy Road, Exeter, EX1 3PB UK
| | - Paul Agnew
- Met Office, FitzRoy Road, Exeter, EX1 3PB UK
| | | | | | - Sujit Sahu
- Mathematical Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ UK
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29
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Lin H, Guo Y, Zheng Y, Di Q, Liu T, Xiao J, Li X, Zeng W, Cummings-Vaughn LA, Howard SW, Vaughn MG, Qian ZM, Ma W, Wu F. Long-Term Effects of Ambient PM 2.5 on Hypertension and Blood Pressure and Attributable Risk Among Older Chinese Adults. Hypertension 2017; 69:806-812. [PMID: 28348017 DOI: 10.1161/hypertensionaha.116.08839] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/15/2016] [Accepted: 02/24/2017] [Indexed: 11/16/2022]
Abstract
Long-term exposure to ambient fine particulate pollution (PM2.5) has been associated with cardiovascular diseases. Hypertension, a major risk factor for cardiovascular diseases, has also been hypothesized to be linked to PM2.5 However, epidemiological evidence has been mixed. We examined long-term association between ambient PM2.5 and hypertension and blood pressure. We interviewed 12 665 participants aged 50 years and older and measured their blood pressures. Annual average PM2.5 concentrations were estimated for each community using satellite data. We applied 2-level logistic regression models to examine the associations and estimated hypertension burden attributable to ambient PM2.5 For each 10 μg/m3 increase in ambient PM2.5, the adjusted odds ratio of hypertension was 1.14 (95% confidence interval, 1.07-1.22). Stratified analyses found that overweight and obesity could enhance the association, and consumption of fruit was associated with lower risk. We further estimated that 11.75% (95% confidence interval, 5.82%-18.53%) of the hypertension cases (corresponding to 914, 95% confidence interval, 453-1442 cases) could be attributable to ambient PM2.5 in the study population. Findings suggest that long-term exposure to ambient PM2.5 might be an important risk factor of hypertension and is responsible for significant hypertension burden in adults in China. A higher consumption of fruit may mitigate, whereas overweight and obesity could enhance this effect.
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Affiliation(s)
- Hualiang Lin
- From the Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, China (H.L., T.L., J.X., X.L., W.Z., W.M.); Shanghai Municipal Centre for Disease Control and Prevention, China (Y.G., Y.Z., F.W.); Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA (Q.D.); Division of Geriatrics and Nutritional Science, School of Medicine, Washington University in St. Louis, MO (L.A.C.-V.); and Department of Health Management and Policy (S.W.H.), School of Social Work (M.G.V.), and Department of Epidemiology (Z.M.Q.), College for Public Health and Social Justice, Saint Louis University, MO
| | - Yanfei Guo
- From the Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, China (H.L., T.L., J.X., X.L., W.Z., W.M.); Shanghai Municipal Centre for Disease Control and Prevention, China (Y.G., Y.Z., F.W.); Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA (Q.D.); Division of Geriatrics and Nutritional Science, School of Medicine, Washington University in St. Louis, MO (L.A.C.-V.); and Department of Health Management and Policy (S.W.H.), School of Social Work (M.G.V.), and Department of Epidemiology (Z.M.Q.), College for Public Health and Social Justice, Saint Louis University, MO
| | - Yang Zheng
- From the Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, China (H.L., T.L., J.X., X.L., W.Z., W.M.); Shanghai Municipal Centre for Disease Control and Prevention, China (Y.G., Y.Z., F.W.); Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA (Q.D.); Division of Geriatrics and Nutritional Science, School of Medicine, Washington University in St. Louis, MO (L.A.C.-V.); and Department of Health Management and Policy (S.W.H.), School of Social Work (M.G.V.), and Department of Epidemiology (Z.M.Q.), College for Public Health and Social Justice, Saint Louis University, MO
| | - Qian Di
- From the Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, China (H.L., T.L., J.X., X.L., W.Z., W.M.); Shanghai Municipal Centre for Disease Control and Prevention, China (Y.G., Y.Z., F.W.); Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA (Q.D.); Division of Geriatrics and Nutritional Science, School of Medicine, Washington University in St. Louis, MO (L.A.C.-V.); and Department of Health Management and Policy (S.W.H.), School of Social Work (M.G.V.), and Department of Epidemiology (Z.M.Q.), College for Public Health and Social Justice, Saint Louis University, MO
| | - Tao Liu
- From the Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, China (H.L., T.L., J.X., X.L., W.Z., W.M.); Shanghai Municipal Centre for Disease Control and Prevention, China (Y.G., Y.Z., F.W.); Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA (Q.D.); Division of Geriatrics and Nutritional Science, School of Medicine, Washington University in St. Louis, MO (L.A.C.-V.); and Department of Health Management and Policy (S.W.H.), School of Social Work (M.G.V.), and Department of Epidemiology (Z.M.Q.), College for Public Health and Social Justice, Saint Louis University, MO
| | - Jianpeng Xiao
- From the Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, China (H.L., T.L., J.X., X.L., W.Z., W.M.); Shanghai Municipal Centre for Disease Control and Prevention, China (Y.G., Y.Z., F.W.); Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA (Q.D.); Division of Geriatrics and Nutritional Science, School of Medicine, Washington University in St. Louis, MO (L.A.C.-V.); and Department of Health Management and Policy (S.W.H.), School of Social Work (M.G.V.), and Department of Epidemiology (Z.M.Q.), College for Public Health and Social Justice, Saint Louis University, MO
| | - Xing Li
- From the Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, China (H.L., T.L., J.X., X.L., W.Z., W.M.); Shanghai Municipal Centre for Disease Control and Prevention, China (Y.G., Y.Z., F.W.); Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA (Q.D.); Division of Geriatrics and Nutritional Science, School of Medicine, Washington University in St. Louis, MO (L.A.C.-V.); and Department of Health Management and Policy (S.W.H.), School of Social Work (M.G.V.), and Department of Epidemiology (Z.M.Q.), College for Public Health and Social Justice, Saint Louis University, MO
| | - Weilin Zeng
- From the Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, China (H.L., T.L., J.X., X.L., W.Z., W.M.); Shanghai Municipal Centre for Disease Control and Prevention, China (Y.G., Y.Z., F.W.); Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA (Q.D.); Division of Geriatrics and Nutritional Science, School of Medicine, Washington University in St. Louis, MO (L.A.C.-V.); and Department of Health Management and Policy (S.W.H.), School of Social Work (M.G.V.), and Department of Epidemiology (Z.M.Q.), College for Public Health and Social Justice, Saint Louis University, MO
| | - Lenise A Cummings-Vaughn
- From the Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, China (H.L., T.L., J.X., X.L., W.Z., W.M.); Shanghai Municipal Centre for Disease Control and Prevention, China (Y.G., Y.Z., F.W.); Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA (Q.D.); Division of Geriatrics and Nutritional Science, School of Medicine, Washington University in St. Louis, MO (L.A.C.-V.); and Department of Health Management and Policy (S.W.H.), School of Social Work (M.G.V.), and Department of Epidemiology (Z.M.Q.), College for Public Health and Social Justice, Saint Louis University, MO
| | - Steven W Howard
- From the Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, China (H.L., T.L., J.X., X.L., W.Z., W.M.); Shanghai Municipal Centre for Disease Control and Prevention, China (Y.G., Y.Z., F.W.); Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA (Q.D.); Division of Geriatrics and Nutritional Science, School of Medicine, Washington University in St. Louis, MO (L.A.C.-V.); and Department of Health Management and Policy (S.W.H.), School of Social Work (M.G.V.), and Department of Epidemiology (Z.M.Q.), College for Public Health and Social Justice, Saint Louis University, MO
| | - Michael G Vaughn
- From the Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, China (H.L., T.L., J.X., X.L., W.Z., W.M.); Shanghai Municipal Centre for Disease Control and Prevention, China (Y.G., Y.Z., F.W.); Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA (Q.D.); Division of Geriatrics and Nutritional Science, School of Medicine, Washington University in St. Louis, MO (L.A.C.-V.); and Department of Health Management and Policy (S.W.H.), School of Social Work (M.G.V.), and Department of Epidemiology (Z.M.Q.), College for Public Health and Social Justice, Saint Louis University, MO
| | - Zhengmin Min Qian
- From the Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, China (H.L., T.L., J.X., X.L., W.Z., W.M.); Shanghai Municipal Centre for Disease Control and Prevention, China (Y.G., Y.Z., F.W.); Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA (Q.D.); Division of Geriatrics and Nutritional Science, School of Medicine, Washington University in St. Louis, MO (L.A.C.-V.); and Department of Health Management and Policy (S.W.H.), School of Social Work (M.G.V.), and Department of Epidemiology (Z.M.Q.), College for Public Health and Social Justice, Saint Louis University, MO.
| | - Wenjun Ma
- From the Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, China (H.L., T.L., J.X., X.L., W.Z., W.M.); Shanghai Municipal Centre for Disease Control and Prevention, China (Y.G., Y.Z., F.W.); Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA (Q.D.); Division of Geriatrics and Nutritional Science, School of Medicine, Washington University in St. Louis, MO (L.A.C.-V.); and Department of Health Management and Policy (S.W.H.), School of Social Work (M.G.V.), and Department of Epidemiology (Z.M.Q.), College for Public Health and Social Justice, Saint Louis University, MO
| | - Fan Wu
- From the Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, China (H.L., T.L., J.X., X.L., W.Z., W.M.); Shanghai Municipal Centre for Disease Control and Prevention, China (Y.G., Y.Z., F.W.); Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA (Q.D.); Division of Geriatrics and Nutritional Science, School of Medicine, Washington University in St. Louis, MO (L.A.C.-V.); and Department of Health Management and Policy (S.W.H.), School of Social Work (M.G.V.), and Department of Epidemiology (Z.M.Q.), College for Public Health and Social Justice, Saint Louis University, MO
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30
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Boehme AK, Esenwa C, Elkind MSV. Stroke Risk Factors, Genetics, and Prevention. Circ Res 2017; 120:472-495. [PMID: 28154098 PMCID: PMC5321635 DOI: 10.1161/circresaha.116.308398] [Citation(s) in RCA: 795] [Impact Index Per Article: 113.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 12/18/2022]
Abstract
Stroke is a heterogeneous syndrome, and determining risk factors and treatment depends on the specific pathogenesis of stroke. Risk factors for stroke can be categorized as modifiable and nonmodifiable. Age, sex, and race/ethnicity are nonmodifiable risk factors for both ischemic and hemorrhagic stroke, while hypertension, smoking, diet, and physical inactivity are among some of the more commonly reported modifiable risk factors. More recently described risk factors and triggers of stroke include inflammatory disorders, infection, pollution, and cardiac atrial disorders independent of atrial fibrillation. Single-gene disorders may cause rare, hereditary disorders for which stroke is a primary manifestation. Recent research also suggests that common and rare genetic polymorphisms can influence risk of more common causes of stroke, due to both other risk factors and specific stroke mechanisms, such as atrial fibrillation. Genetic factors, particularly those with environmental interactions, may be more modifiable than previously recognized. Stroke prevention has generally focused on modifiable risk factors. Lifestyle and behavioral modification, such as dietary changes or smoking cessation, not only reduces stroke risk, but also reduces the risk of other cardiovascular diseases. Other prevention strategies include identifying and treating medical conditions, such as hypertension and diabetes, that increase stroke risk. Recent research into risk factors and genetics of stroke has not only identified those at risk for stroke but also identified ways to target at-risk populations for stroke prevention.
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Affiliation(s)
- Amelia K Boehme
- From the Department of Epidemiology, Mailman School of Public Health (A.K.B., M.S.V.E.) and Department of Neurology, College of Physicians and Surgeons (A.K.B., C.E., M.S.V.E.), Columbia University, New York, NY
| | - Charles Esenwa
- From the Department of Epidemiology, Mailman School of Public Health (A.K.B., M.S.V.E.) and Department of Neurology, College of Physicians and Surgeons (A.K.B., C.E., M.S.V.E.), Columbia University, New York, NY
| | - Mitchell S V Elkind
- From the Department of Epidemiology, Mailman School of Public Health (A.K.B., M.S.V.E.) and Department of Neurology, College of Physicians and Surgeons (A.K.B., C.E., M.S.V.E.), Columbia University, New York, NY.
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Desikan A, Crichton S, Hoang U, Barratt B, Beevers SD, Kelly FJ, Wolfe CDA. Effect of Exhaust- and Nonexhaust-Related Components of Particulate Matter on Long-Term Survival After Stroke. Stroke 2016; 47:2916-2922. [PMID: 27811334 DOI: 10.1161/strokeaha.116.014242] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/09/2016] [Accepted: 09/28/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Outdoor air pollution represents a potentially modifiable risk factor for stroke. We examined the link between ambient pollution and mortality up to 5 years poststroke, especially for pollutants associated with vehicle exhaust. METHODS Data from the South London Stroke Register, a population-based register covering an urban, multiethnic population, were used. Hazard ratios (HR) for a 1 interquartile range increase in particulate matter <2.5 µm diameter (PM2.5) and PM <10 µm (PM10) were estimated poststroke using Cox regression, overall and broken down into exhaust and nonexhaust components. Analysis was stratified for ischemic and hemorrhagic strokes and was further broken down by Oxford Community Stroke Project classification. RESULTS The hazard of death associated with PM2.5 up to 5 years after stroke was significantly elevated (P=0.006) for all strokes (HR=1.28; 95% confidence interval [CI], 1.08-1.53) and ischemic strokes (HR, 1.32; 95% CI, 1.08-1.62). Within ischemic subtypes, PM2.5 pollution increased mortality risk for total anterior circulation infarcts by 2-fold (HR, 2.01; 95% CI, 1.17-3.48; P=0.012) and by 78% for lacunar infarcts (HR, 1.78; 95% CI, 1.18-2.66; P=0.006). PM10 pollution was associated with 45% increased mortality risk for lacunar infarct strokes (HR, 1.45; 95% CI, 1.06-2.00; P=0.022). Separating PM2.5 and PM10 into exhaust and nonexhaust components did not show increased mortality. CONCLUSIONS Exposure to certain outdoor PM pollution, particularly PM2.5, increased mortality risk poststroke up to 5 years after the initial stroke.
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Affiliation(s)
- Anita Desikan
- From the Division of Health and Social Care Research (A.D., S.C., U.H., C.D.A.W.), Analytical and Environmental Sciences Division and MRC-PHE Centre for Environment and Health (B.B., S.D.B., F.J.K.), King's College London, United Kingdom; NIHR Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust and King's College London, United Kingdom (U.H., B.B., F.J.K., C.D.A.W.); and National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, United Kingdom (C.D.A.W.).
| | - Siobhan Crichton
- From the Division of Health and Social Care Research (A.D., S.C., U.H., C.D.A.W.), Analytical and Environmental Sciences Division and MRC-PHE Centre for Environment and Health (B.B., S.D.B., F.J.K.), King's College London, United Kingdom; NIHR Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust and King's College London, United Kingdom (U.H., B.B., F.J.K., C.D.A.W.); and National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, United Kingdom (C.D.A.W.)
| | - Uy Hoang
- From the Division of Health and Social Care Research (A.D., S.C., U.H., C.D.A.W.), Analytical and Environmental Sciences Division and MRC-PHE Centre for Environment and Health (B.B., S.D.B., F.J.K.), King's College London, United Kingdom; NIHR Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust and King's College London, United Kingdom (U.H., B.B., F.J.K., C.D.A.W.); and National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, United Kingdom (C.D.A.W.)
| | - Benjamin Barratt
- From the Division of Health and Social Care Research (A.D., S.C., U.H., C.D.A.W.), Analytical and Environmental Sciences Division and MRC-PHE Centre for Environment and Health (B.B., S.D.B., F.J.K.), King's College London, United Kingdom; NIHR Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust and King's College London, United Kingdom (U.H., B.B., F.J.K., C.D.A.W.); and National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, United Kingdom (C.D.A.W.)
| | - Sean D Beevers
- From the Division of Health and Social Care Research (A.D., S.C., U.H., C.D.A.W.), Analytical and Environmental Sciences Division and MRC-PHE Centre for Environment and Health (B.B., S.D.B., F.J.K.), King's College London, United Kingdom; NIHR Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust and King's College London, United Kingdom (U.H., B.B., F.J.K., C.D.A.W.); and National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, United Kingdom (C.D.A.W.)
| | - Frank J Kelly
- From the Division of Health and Social Care Research (A.D., S.C., U.H., C.D.A.W.), Analytical and Environmental Sciences Division and MRC-PHE Centre for Environment and Health (B.B., S.D.B., F.J.K.), King's College London, United Kingdom; NIHR Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust and King's College London, United Kingdom (U.H., B.B., F.J.K., C.D.A.W.); and National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, United Kingdom (C.D.A.W.)
| | - Charles D A Wolfe
- From the Division of Health and Social Care Research (A.D., S.C., U.H., C.D.A.W.), Analytical and Environmental Sciences Division and MRC-PHE Centre for Environment and Health (B.B., S.D.B., F.J.K.), King's College London, United Kingdom; NIHR Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust and King's College London, United Kingdom (U.H., B.B., F.J.K., C.D.A.W.); and National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, United Kingdom (C.D.A.W.)
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Crichton S, Barratt B, Spiridou A, Hoang U, Liang SF, Kovalchuk Y, Beevers SD, Kelly FJ, Delaney B, Wolfe CDA. Associations between exhaust and non-exhaust particulate matter and stroke incidence by stroke subtype in South London. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 568:278-284. [PMID: 27295599 DOI: 10.1016/j.scitotenv.2016.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/27/2016] [Accepted: 06/03/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND Airborne particulate matter (PM) consists of particles from diverse sources, including vehicle exhausts. Associations between short-term PM changes and stroke incidence have been shown. Cumulative exposures over several months, or years, are less well studied; few studies examined ischaemic subtypes or PM source. AIMS This study combines a high resolution urban air quality model with a population-based stroke register to explore associations between long-term exposure to PM and stroke incidence. METHOD Data from the South London Stroke Register from 2005-2012 were included. Poisson regression explored association between stroke incidence and long-term (averaged across the study period) exposure to PM2.5(PM<2.5μm diameter) and PM10(PM<10μm), nitric oxide, nitrogen dioxide, nitrogen oxides and ozone, at the output area level (average population=309). Estimates were standardised for age and sex and adjusted for socio-economic deprivation. Models were stratified for ischaemic and haemorrhagic strokes and further broken down by Oxford Community Stroke Project classification and Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. RESULTS 1800 strokes were recorded (incidence=42.6/100,000 person-years). No associations were observed between PM and overall ischaemic or haemorrhagic incidence. For an interquartile range increase in PM2.5, there was a 23% increase in incidence (Incidence rate ratio=1.23 (95%CI: 1.03-1.44)) of total anterior circulation infarcts (TACI) and 20% increase for PM2.5 from exhausts (1.20(1.01-1.41)). There were similar associations with PM10, overall (1.21(1.01-1.44)) and from exhausts (1.20(1.01-1.41)). TACI incidence was not associated with non-exhaust sources. There were no associations with other stroke subtypes or pollutants. CONCLUSION Outdoor air pollution, particularly that arising from vehicle exhausts, may increase risk of TACI but not other stroke subtypes.
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Affiliation(s)
- Siobhan Crichton
- Division of Health and Social Care Research, King's College London, London, UK; National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, London, UK
| | - Benjamin Barratt
- Analytical and Environmental Sciences Division and MRC-PHE Centre for Environment and Health, King's College London, UK; NIHR Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Anastassia Spiridou
- NIHR Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Uy Hoang
- Division of Health and Social Care Research, King's College London, London, UK; National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, London, UK; NIHR Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Shao Fen Liang
- Division of Health and Social Care Research, King's College London, London, UK; NIHR Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Yevgeniya Kovalchuk
- NIHR Biomedical Research Centre for Mental Health & Biomedical Research Unit for Dementia, King's College London, UK
| | - Sean D Beevers
- Analytical and Environmental Sciences Division and MRC-PHE Centre for Environment and Health, King's College London, UK
| | - Frank J Kelly
- Analytical and Environmental Sciences Division and MRC-PHE Centre for Environment and Health, King's College London, UK; NIHR Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Brendan Delaney
- Department of Cancer and Surgery, Imperial College, London, UK
| | - Charles DA Wolfe
- Division of Health and Social Care Research, King's College London, London, UK; National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, London, UK; NIHR Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust and King's College London, London, UK
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Air Pollution and Subtypes, Severity and Vulnerability to Ischemic Stroke-A Population Based Case-Crossover Study. PLoS One 2016; 11:e0158556. [PMID: 27362783 PMCID: PMC4928841 DOI: 10.1371/journal.pone.0158556] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/19/2016] [Indexed: 12/02/2022] Open
Abstract
Background and Purpose Few studies have examined the association between air pollutants and ischemic stroke subtypes. We examined acute effects of outdoor air pollutants (PM10, NO2, O3, CO, SO2) on subtypes and severity of incident ischemic stroke and investigated if pre-existing risk factors increased susceptibility. Methods We used a time stratified case-crossover study and stroke cases from the South London Stroke Register set up to capture all incident cases of first ever stroke occurring amongst residents in a geographically defined area. The Oxford clinical and TOAST etiological classifications were used to classify subtypes. A pragmatic clinical classification system was used to assess severity. Air pollution concentrations from the nearest background air pollution monitoring stations to patients’ residential postcode centroids were used. Lags from 0 to 6 days were investigated. Results There were 2590 incident cases of ischemic stroke (1995–2006). While there were associations at various lag times with several pollutants, overall, there was no consistent pattern between exposure and risk of ischemic stroke subtypes or severity. The possible exception was the association between NO2 exposure and small vessel disease stroke—adjusted odds ratio of 1.51 (1.12–2.02) associated with an inter-quartile range increase in the lag 0–6 day average for NO2. There were no clear associations in relation to pre-existing risk factors. Conclusions Overall, we found little consistent evidence of association between air pollutants and ischemic stroke subtypes and severity. There was however a suggestion that increasing NO2 exposure might be associated with higher risk of stroke caused by cerebrovascular small vessel disease.
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How robust are the estimated effects of air pollution on health? Accounting for model uncertainty using Bayesian model averaging. Spat Spatiotemporal Epidemiol 2016; 18:53-62. [PMID: 27494960 PMCID: PMC4985538 DOI: 10.1016/j.sste.2016.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/16/2016] [Accepted: 04/01/2016] [Indexed: 11/22/2022]
Abstract
We explored the sensitivity of the pollution-health effect to three factors. Estimation of NO2, choice of deprivation and choice of spatial autocorrelation model. Choice of these factors leads to a wide variation in pollution-health effects. BMA is utilised to estimate an overall effect while accounting for model uncertainty. Overall, a positive but borderline pollution-health effect was obtained.
The long-term impact of air pollution on human health can be estimated from small-area ecological studies in which the health outcome is regressed against air pollution concentrations and other covariates, such as socio-economic deprivation. Socio-economic deprivation is multi-factorial and difficult to measure, and includes aspects of income, education, and housing as well as others. However, these variables are potentially highly correlated, meaning one can either create an overall deprivation index, or use the individual characteristics, which can result in a variety of pollution-health effects. Other aspects of model choice may affect the pollution-health estimate, such as the estimation of pollution, and spatial autocorrelation model. Therefore, we propose a Bayesian model averaging approach to combine the results from multiple statistical models to produce a more robust representation of the overall pollution-health effect. We investigate the relationship between nitrogen dioxide concentrations and cardio-respiratory mortality in West Central Scotland between 2006 and 2012.
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Maheswaran R. Air pollution and stroke - an overview of the evidence base. Spat Spatiotemporal Epidemiol 2016; 18:74-81. [PMID: 27494962 DOI: 10.1016/j.sste.2016.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/31/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
Abstract
Air pollution is being increasingly recognized as a significant risk factor for stroke. There are numerous sources of air pollution including industry, road transport and domestic use of biomass and solid fuels. Early reports of the association between air pollution and stroke come from studies investigating health effects of severe pollution episodes. Several daily time series and case-crossover studies have reported associations with stroke. There is also evidence linking chronic air pollution exposure with stroke and with reduced survival after stroke. A conceptual framework linking air pollution exposure and stroke is proposed. It links acute and chronic exposure to air pollution with pathways to acute and chronic effects on stroke risk. Current evidence regarding potential mechanisms mainly relate to particulate air pollution. Whilst further evidence would be useful, there is already sufficient evidence to support consideration of reduction in air pollution as a preventative measure to reduce the stroke burden globally.
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Affiliation(s)
- Ravi Maheswaran
- Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
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Pearson T, Campbell MJ, Maheswaran R. Acute effects of aircraft noise on cardiovascular admissions - an interrupted time-series analysis of a six-day closure of London Heathrow Airport caused by volcanic ash. Spat Spatiotemporal Epidemiol 2016; 18:38-43. [PMID: 27494958 DOI: 10.1016/j.sste.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 10/22/2022]
Abstract
Acute noise exposure may acutely increase blood pressure but the hypothesis that acute exposure to aircraft noise may trigger cardiovascular events has not been investigated. This study took advantage of a six-day closure of a major airport in April 2010 caused by volcanic ash to examine if there was a decrease in emergency cardiovascular hospital admissions during or immediately after the closure period, using an interrupted daily time-series study design. The population living within the 55dB(A) noise contour was substantial at 0.7 million. The average daily admission count was 13.9 (SD 4.4). After adjustment for covariates, there was no evidence of a decreased risk of hospital admission from cardiovascular disease during the closure period (relative risk 0.97 (95% CI 0.75-1.26)). Using lags of 1-7 days gave similar results. Further studies are needed to investigate if transient aircraft noise exposure can trigger acute cardiovascular events.
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Affiliation(s)
- Tim Pearson
- Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Michael J Campbell
- Design, Trials and Statistics Section, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Ravi Maheswaran
- Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
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Montresor-López JA, Yanosky JD, Mittleman MA, Sapkota A, He X, Hibbert JD, Wirth MD, Puett RC. Short-term exposure to ambient ozone and stroke hospital admission: A case-crossover analysis. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2016; 26:162-6. [PMID: 26329139 DOI: 10.1038/jes.2015.48] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 06/04/2015] [Indexed: 05/13/2023]
Abstract
We evaluated the association between short-term exposure to ambient ozone air pollution and stroke hospital admissions among adult residents of South Carolina (SC). Data on all incident stroke hospitalizations from 2002 to 2006 were obtained from the SC Office of Research and Statistics. Ozone exposure data were obtained from the US Environmental Protection Agency's Hierarchical Bayesian Model. A semi-symmetric bidirectional case-crossover design was used to examine the association between ozone exposure on lag days 0-2 (0 to 2 days before admission) and stroke hospitalization. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). No significant associations were observed between short-term ozone exposure and hospitalization for all stroke (e.g., lag day 0: OR=0.98; 95% CI=0.96, 1.00) or ischemic stroke (lag day 0: OR=0.98; 95% CI=0.96, 1.01). Risk of hospitalization for hemorrhagic stroke appeared to be higher among African Americans than European Americans; however, the majority of these associations did not reach statistical significance. Among adults in SC from 2002 to 2006, there was no evidence of an association between ozone exposure and risk of hospitalization for all stroke or ischemic stroke; however, African Americans may have an increased risk of hemorrhagic stroke.
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Affiliation(s)
- Jessica A Montresor-López
- Department of Epidemiology and Biostatistics, Maryland Institute of Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Jeff D Yanosky
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Murray A Mittleman
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Department of Epidemiology, Harvard University School of Public Health, Boston, Massachusetts, USA
| | - Amir Sapkota
- Department of Epidemiology and Biostatistics, Maryland Institute of Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Xin He
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA
| | - James D Hibbert
- Center for Research and Nutrition and Health Disparities, University of South Carolina School of Public Health, Columbia, South Carolina, USA
| | - Michael D Wirth
- Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, University of South Carolina School of Public Health, Columbia, South Carolina, USA
| | - Robin C Puett
- Department of Epidemiology and Biostatistics, Maryland Institute of Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
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Scheers H, Jacobs L, Casas L, Nemery B, Nawrot TS. Long-Term Exposure to Particulate Matter Air Pollution Is a Risk Factor for Stroke. Stroke 2015; 46:3058-66. [DOI: 10.1161/strokeaha.115.009913] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 09/11/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Hans Scheers
- From the Environmental Health Unit, Department of Public Health and Primary Care (H.S., L.C., B.N., T.S.N.) and Hypertension and Cardiovascular Epidemiology Unit, Department of Cardiovascular Sciences (L.J.), KULeuven, Leuven, Belgium; and Centre for Environmental Sciences, UHasselt, Hasselt, Belgium (T.S.N.)
| | - Lotte Jacobs
- From the Environmental Health Unit, Department of Public Health and Primary Care (H.S., L.C., B.N., T.S.N.) and Hypertension and Cardiovascular Epidemiology Unit, Department of Cardiovascular Sciences (L.J.), KULeuven, Leuven, Belgium; and Centre for Environmental Sciences, UHasselt, Hasselt, Belgium (T.S.N.)
| | - Lidia Casas
- From the Environmental Health Unit, Department of Public Health and Primary Care (H.S., L.C., B.N., T.S.N.) and Hypertension and Cardiovascular Epidemiology Unit, Department of Cardiovascular Sciences (L.J.), KULeuven, Leuven, Belgium; and Centre for Environmental Sciences, UHasselt, Hasselt, Belgium (T.S.N.)
| | - Benoit Nemery
- From the Environmental Health Unit, Department of Public Health and Primary Care (H.S., L.C., B.N., T.S.N.) and Hypertension and Cardiovascular Epidemiology Unit, Department of Cardiovascular Sciences (L.J.), KULeuven, Leuven, Belgium; and Centre for Environmental Sciences, UHasselt, Hasselt, Belgium (T.S.N.)
| | - Tim S. Nawrot
- From the Environmental Health Unit, Department of Public Health and Primary Care (H.S., L.C., B.N., T.S.N.) and Hypertension and Cardiovascular Epidemiology Unit, Department of Cardiovascular Sciences (L.J.), KULeuven, Leuven, Belgium; and Centre for Environmental Sciences, UHasselt, Hasselt, Belgium (T.S.N.)
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Wing JJ, Adar SD, Sánchez BN, Morgenstern LB, Smith MA, Lisabeth LD. Ethnic differences in ambient air pollution and risk of acute ischemic stroke. ENVIRONMENTAL RESEARCH 2015; 143:62-7. [PMID: 26451880 PMCID: PMC4641766 DOI: 10.1016/j.envres.2015.09.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/05/2015] [Accepted: 09/29/2015] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To investigate the association between short-term changes in ambient pollution (particulate matter <2.5 μm in aerodynamic diameter (PM2.5) and ozone (O3)) and the risk of ischemic stroke among individuals living in a bi-ethnic community and whether this association is modified by ethnicity. METHODS We identified incident ischemic stroke cases from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project between 2000 and 2012. Associations between PM2.5 (mean 24-h) and O3 (maximal 8-h) levels, measured on the same-day and lags of 1-3 days, and odds of ischemic stroke were assessed using a time-stratified case-crossover design and modeled using conditional logistic regression. We explored race/ethnicity (Mexican American versus non-Hispanic white) as a modifier by including interaction terms in the models. RESULTS There were 2948 ischemic strokes with median age 71 years (IQR: 59-80). We observed no overall associations between the air pollutants and odds of ischemic stroke at any lag. When stratified by ethnicity, higher O3 was consistently associated with greater odds of ischemic stroke for non-Hispanic whites, but not for Mexican Americans. Higher PM2.5 was generally associated with lower odds of ischemic stroke for non-Hispanic whites but modestly greater odds for Mexican Americans. CONCLUSION Ethnic differences in the associations between ischemic stroke and short-term exposures to O3 and PM2.5 were suggested indicating that further study in diverse populations may be warranted.
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Affiliation(s)
- Jeffrey J Wing
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, United States.
| | - Sara D Adar
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, United States
| | - Brisa N Sánchez
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, United States
| | - Lewis B Morgenstern
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, United States; Department of Neurology, Stroke Program, University of Michigan, Ann Arbor, United States
| | - Melinda A Smith
- Department of Neurology, Stroke Program, University of Michigan, Ann Arbor, United States
| | - Lynda D Lisabeth
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, United States; Department of Neurology, Stroke Program, University of Michigan, Ann Arbor, United States
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Lary DJ, Lary T, Sattler B. Using Machine Learning to Estimate Global PM2.5 for Environmental Health Studies. ENVIRONMENTAL HEALTH INSIGHTS 2015; 9:41-52. [PMID: 26005352 PMCID: PMC4431482 DOI: 10.4137/ehi.s15664] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 05/05/2023]
Abstract
With the increasing awareness of health impacts of particulate matter, there is a growing need to comprehend the spatial and temporal variations of the global abundance of ground-level airborne particulate matter (PM2.5). Here we use a suite of remote sensing and meteorological data products together with ground based observations of PM2.5 from 8,329 measurement sites in 55 countries taken between 1997 and 2014 to train a machine learning algorithm to estimate the daily distributions of PM2.5 from 1997 to the present. We demonstrate that the new PM2.5 data product can reliably represent global observations of PM2.5 for epidemiological studies. An analysis of Baltimore schizophrenia emergency room admissions is presented in terms of the levels of ambient pollution. PM2.5 appears to have an impact on some aspects of mental health.
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Affiliation(s)
- Petter L Ljungman
- From the Department of Medicine Cardiovascular Epidemiology Research Unit, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (P.L.L., M.A.M.); and Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.)
| | - Murray A Mittleman
- From the Department of Medicine Cardiovascular Epidemiology Research Unit, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (P.L.L., M.A.M.); and Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.).
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Sørensen M, Lühdorf P, Ketzel M, Andersen ZJ, Tjønneland A, Overvad K, Raaschou-Nielsen O. Combined effects of road traffic noise and ambient air pollution in relation to risk for stroke? ENVIRONMENTAL RESEARCH 2014; 133:49-55. [PMID: 24906068 DOI: 10.1016/j.envres.2014.05.011] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/05/2014] [Accepted: 05/07/2014] [Indexed: 05/06/2023]
Abstract
Exposure to road traffic noise and air pollution have both been associated with risk for stroke. The few studies including both exposures show inconsistent results. We aimed to investigate potential mutual confounding and combined effects between road traffic noise and air pollution in association with risk for stroke. In a population-based cohort of 57,053 people aged 50-64 years at enrollment, we identified 1999 incident stroke cases in national registries, followed by validation through medical records. Mean follow-up time was 11.2 years. Present and historical residential addresses from 1987 to 2009 were identified in national registers and road traffic noise and air pollution were modeled for all addresses. Analyses were done using Cox regression. A higher mean annual exposure at time of diagnosis of 10 µg/m(3) nitrogen dioxide (NO2) and 10 dB road traffic noise at the residential address was associated with ischemic stroke with incidence rate ratios (IRR) of 1.11 (95% CI: 1.03, 1.20) and 1.16 (95% CI: 1.07, 1.24), respectively, in single exposure models. In two-exposure models road traffic noise (IRR: 1.15) and not NO2 (IRR: 1.02) was associated with ischemic stroke. The strongest association was found for combination of high noise and high NO2 (IRR=1.28; 95% CI=1.09-1.52). Fatal stroke was positively associated with air pollution and not with traffic noise. In conclusion, in mutually adjusted models road traffic noise and not air pollution was associated ischemic stroke, while only air pollution affected risk for fatal strokes. There were indications of combined effects.
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Affiliation(s)
- Mette Sørensen
- Diet, Genes and Environment, Danish Cancer Society Research Centre, Strandboulevarden 49, 2100 Copenhagen, Denmark.
| | - Pernille Lühdorf
- Department of Neurology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Zorana J Andersen
- Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Centre, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Raaschou-Nielsen
- Diet, Genes and Environment, Danish Cancer Society Research Centre, Strandboulevarden 49, 2100 Copenhagen, Denmark
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Maheswaran R, Pearson T, Beevers SD, Campbell MJ, Wolfe CD. Outdoor air pollution, subtypes and severity of ischemic stroke--a small-area level ecological study. Int J Health Geogr 2014; 13:23. [PMID: 24939673 PMCID: PMC4070355 DOI: 10.1186/1476-072x-13-23] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/08/2014] [Indexed: 12/24/2022] Open
Abstract
Background Evidence linking outdoor air pollution and incidence of ischemic stroke subtypes and severity is limited. We examined associations between outdoor PM10 and NO2 concentrations modeled at a fine spatial resolution and etiological and clinical ischemic stroke subtypes and severity of ischemic stroke. Methods We used a small-area level ecological study design and a stroke register set up to capture all incident cases of first ever stroke (1995–2007) occurring in a defined geographical area in South London (948 census output areas; population of 267839). Modeled PM10 and NO2 concentrations were available at a very fine spatial scale (20 meter by 20 meter grid point resolution) and were aggregated to output area level using postcode population weighted averages. Ischemic stroke was classified using the Oxford clinical classification, the Trial of Org 10172 in Acute Stroke Treatment (TOAST) etiological classification, National Institutes of Health Stroke Scale (NIHSS) score and a pragmatic clinical severity classification based on Glasgow coma score, ability to swallow, urinary continence and death <2 days of stroke onset. Results Mean (SD) concentrations were 25.1 (1.2) ug/m3 (range 23.3-36.4) for PM10 and 41.4 (3.0) ug/m3 (range 35.4-68.0) for NO2. There were 2492 incident cases of ischemic stroke. We found no evidence of association between these pollutants and the incidence of ischemic stroke subtypes classified using the Oxford and TOAST classifications. We found no significant association with stroke severity using NIHSS severity categories. However, we found that outdoor concentrations of both PM10 and NO2 appeared to be associated with increased incidence of mild but not severe ischemic stroke, classified using the pragmatic clinical severity classification. For mild ischemic stroke, the rate ratio in the highest PM10 category by tertile was 1.20 (1.05-1.38) relative to the lowest category. The rate ratio in the highest NO2 category was 1.22 (1.06-1.40) relative to the lowest category. Conclusions We found no evidence of association between outdoor PM10 and NO2 concentrations and ischemic stroke subtypes but there was a suggestion that living in areas with elevated outdoor PM10 and NO2 concentrations might be associated with increased incidence of mild, but not severe, ischemic stroke.
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Affiliation(s)
- Ravi Maheswaran
- Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
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Wolfe CDA, Rudd AG, McKevitt C. Modelling, evaluating and implementing cost-effective services to reduce the impact of stroke. PROGRAMME GRANTS FOR APPLIED RESEARCH 2014. [DOI: 10.3310/pgfar02020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BackgroundStroke is a leading cause of death and disability but there is little information on the longer-term needs of patients and those of different ethnic groups.ObjectivesTo estimate risk of stroke, longer-term needs and outcomes, risk of recurrence, trends and predictors of effective care, to model cost-effective configurations of care, to understand stakeholders’ perspectives of services and to develop proposals to underpin policy.DesignPopulation-based stroke register, univariate and multivariate analyses, Markov and discrete event simulation, and qualitative methods for stakeholder perspectives of care and outcome.SettingSouth London, UK, with modelling for estimates of cost-effectiveness.ParticipantsInner-city population of 271,817 with first stroke in lifetime between 1995 and 2012.Outcome measuresStroke incidence rates and trends, recurrence, survival, activities of daily living, anxiety, depression, quality of life, appropriateness and cost-effectiveness of care, and qualitative narratives of perspectives.Data sourcesSouth London Stroke Register (SLSR), qualitative data, group discussions.ResultsStroke incidence has decreased since 1995, particularly in the white population, but with a higher stroke risk in black groups. There are variations in risk factors and types of stroke between ethnic groups and a large number of strokes occurred in people with untreated risk factors with no improvement in detection observed over time. A total of 30% of survivors have a poor range of outcomes up to 10 years after stroke with differences in outcomes by sociodemographic group. Depression affects over half of all stroke patients and the prevalence of cognitive impairment remains 22%. Survival has improved significantly, particularly in the older black groups, and the cumulative risk of recurrence at 10 years is 24.5%. The proportion of patients receiving effective acute stroke care has significantly improved, yet inequalities of provision remain. Using register data, the National Audit Office (NAO) compared the levels of stroke care in the UK in 2010 with previous provision levels and demonstrated that improvements have been cost-effective. The treatment of, and productivity loss arising from, stroke results in total societal costs of £8.9B a year and 5% of UK NHS costs. Stroke unit care followed by early supported discharge is a cost-effective strategy, with the main gain being years of life saved. Half of stroke survivors report unmet long-term needs. Needs change over time, but may not be stroke specific. Analysis of patient journeys suggests that provision of care is also influenced by structural, social and personal characteristics.Conclusions/recommendationsThe SLSR has been a platform for a range of health services research activities of international relevance. The programme has produced data to inform policy and practice with estimates of need for stroke prevention and care services, identification of persistent sociodemographic inequalities in risk and care despite a reduction in stroke risk, quantification of the effectiveness and cost-effectiveness of care and development of models to simulate configurations of care. Stroke is a long-term condition with significant social impact and the data on need and economic modelling have been utilised by the Department of Health, the NAO and Healthcare for London to assess need and model cost-effective options for stroke care. Novel approaches are now required to ensure that such information is used effectively to improve population and patient outcomes.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and the Department of Health via the National Institute for Health Research Biomedical Research Centre award to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London.
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Affiliation(s)
- Charles DA Wolfe
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, School of Medicine, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK
| | - Anthony G Rudd
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, School of Medicine, King’s College London, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Christopher McKevitt
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, School of Medicine, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK
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Short-term effects of particulate matter on stroke attack: meta-regression and meta-analyses. PLoS One 2014; 9:e95682. [PMID: 24802512 PMCID: PMC4011734 DOI: 10.1371/journal.pone.0095682] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 03/31/2014] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose Currently there are more and more studies on the association between short-term effects of exposure to particulate matter (PM) and the morbidity of stroke attack, but few have focused on stroke subtypes. The objective of this study is to assess the relationship between PM and stroke subtypes attack, which is uncertain now. Methods Meta-analyses, meta-regression and subgroup analyses were conducted to investigate the association between short-term effects of exposure to PM and the morbidity of different stroke subtypes from a number of epidemiologic studies (from 1997 to 2012). Results Nineteen articles were identified. Odds ratio (OR) of stroke attack associated with particular matter (“thoracic particles” [PM10]<10 µm in aerodynamic diameter, “fine particles” [PM2.5]<2.5 µm in aerodynamic diameter) increment of 10 µg/m3 was as effect size. PM10 exposure was related to an increase in risk of stroke attack (OR per 10 µg/m3 = 1.004, 95%CI: 1.001∼1.008) and PM2.5 exposure was not significantly associated with stroke attack (OR per 10 µg/m3 = 0.999, 95%CI: 0.994∼1.003). But when focused on stroke subtypes, PM2.5 (OR per 10 µg/m3 = 1.025; 95%CI, 1.001∼1.049) and PM10 (OR per 10 µg/m3 = 1.013; 95%CI, 1.001∼1.025) exposure were statistically significantly associated with an increased risk of ischemic stroke attack, while PM2.5 (all the studies showed no significant association) and PM10 (OR per 10 µg/m3 = 1.007; 95%CI, 0.992∼1.022) exposure were not associated with an increased risk of hemorrhagic stroke attack. Meta-regression found study design and area were two effective covariates. Conclusion PM2.5 and PM10 had different effects on different stroke subtypes. In the future, it's worthwhile to study the effects of PM to ischemic stroke and hemorrhagic stroke, respectively.
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Yorifuji T, Suzuki E, Kashima S. Cardiovascular Emergency Hospital Visits and Hourly Changes in Air Pollution. Stroke 2014; 45:1264-8. [DOI: 10.1161/strokeaha.114.005227] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Takashi Yorifuji
- From the Department of Human Ecology, Graduate School of Environmental and Life Science (T.Y.), and Department of Epidemiology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences (E.S.), Okayama University, Okayama, Japan; and Department of Public Health and Health Policy, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan (S.K.)
| | - Etsuji Suzuki
- From the Department of Human Ecology, Graduate School of Environmental and Life Science (T.Y.), and Department of Epidemiology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences (E.S.), Okayama University, Okayama, Japan; and Department of Public Health and Health Policy, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan (S.K.)
| | - Saori Kashima
- From the Department of Human Ecology, Graduate School of Environmental and Life Science (T.Y.), and Department of Epidemiology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences (E.S.), Okayama University, Okayama, Japan; and Department of Public Health and Health Policy, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan (S.K.)
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Impact of particulate matter exposition on the risk of ischemic stroke: epidemiologic evidence and putative mechanisms. J Cereb Blood Flow Metab 2014; 34:215-20. [PMID: 24301290 PMCID: PMC3915219 DOI: 10.1038/jcbfm.2013.212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 10/22/2013] [Accepted: 11/05/2013] [Indexed: 11/08/2022]
Abstract
Ambient particulate matter (PM) pollution is estimated to be responsible for 3.2 million deaths annually worldwide. Although many studies have demonstrated PM as a serious risk factor for cardiovascular diseases, less is known on its association with cerebrovascular events. Over the last decade, however, an increasing number of studies have provided data showing a relationship between PM exposure and ischemic stroke (IS). In this article, we will report on existing epidemiologic findings for an association between PM exposure and IS based on a systemic literature search. Thus, despite inconsistencies in the results, currently available data suggest that PM exposure is a risk factor for IS, especially in patients with preexisting illnesses. With regards to the mechanisms leading to PM-dependent vascular damage, in particular proinflammatory, prooxidative, as well as proatherogenic pathways have been suggested to be involved. Notably, to date there is only one study published, which demonstrates the influence of PM exposure on cerebrovascular function. We will discuss reasonable approaches for future neurovascular research in this field.
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Affiliation(s)
- George Howard
- From the Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.); and Neurologische Klinik, Klinikum Ludwigshafen aRh, Ludwigshafen aRh, Germany (A.G.)
| | - Armin Grau
- From the Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.); and Neurologische Klinik, Klinikum Ludwigshafen aRh, Ludwigshafen aRh, Germany (A.G.)
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Suissa L, Fortier M, Lachaud S, Staccini P, Mahagne MH. Ozone air pollution and ischaemic stroke occurrence: a case-crossover study in Nice, France. BMJ Open 2013; 3:e004060. [PMID: 24319276 PMCID: PMC3855570 DOI: 10.1136/bmjopen-2013-004060] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Relationship between low-level air pollution and stroke is conflicting. This study was conducted to document the relationship between outdoor air pollution and ischaemic stroke occurrence. DESIGN Time-stratified case-crossover analysis. SETTING University Hospital of Nice, France. PARTICIPANTS All consecutive patients with ischaemic stroke living in Nice admitted in the University Hospital of Nice (France) between January 2007 and December 2011. MAIN OUTCOME MEASURE Association (adjusted OR) between daily levels of outdoor pollutants (ozone (O3), nitrogen dioxide (NO2), particulate matter (PM10) and sulfur dioxide (SO2)) and ischaemic stroke occurrence. RESULTS 1729 patients with ischaemic stroke (mean age: 76.1±14.0 years; men: 46.7%) were enrolled. No significant association was found between stroke occurrence and short-term effects of all pollutants tested. In stratified analysis, we observed significant associations only between recurrent (n=280) and large artery ischaemic stroke (n=578) onset and short-term effect of O3 exposure. For an increase of 10 µg/m(3) of O3 level, recurrent stroke risk (mean D-1, D-2 and D-3 lag) was increased by 12.1% (95% CI 1.5% to 23.9%) and large artery stroke risk (mean D-3 and D-4 lag) was increased by 8% (95% CI 2.0% to 16.6%). Linear dose-response relationship for both subgroups was found. CONCLUSIONS Our results confirm the relationship between low-level O3 exposure and ischaemic stroke in high vascular risk subgroup with linear exposure-response relation, independently of other pollutants and meteorological parameters. The physiopathological processes underlying this association between ischaemic stroke and O3 exposure remain to be investigated.
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Affiliation(s)
- Laurent Suissa
- Stroke Center, University Hospital of Nice, Nice, France
| | - Mikael Fortier
- Department of Emergency Medicine, University Hospital of Nice, Nice, France
| | | | - Pascal Staccini
- Department of Medical Information, University Hospital of Nice, Nice, France
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Koton S, Molshatzki N, Yuval, Myers V, Broday DM, Drory Y, Steinberg DM, Gerber Y. Cumulative exposure to particulate matter air pollution and long-term post-myocardial infarction outcomes. Prev Med 2013; 57:339-44. [PMID: 23777671 DOI: 10.1016/j.ypmed.2013.06.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/03/2013] [Accepted: 06/06/2013] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Chronic environmental exposure to particulate matter <2.5μm in diameter (PM2.5) has been associated with cardiovascular disease; however, the effect of air pollution on myocardial infarction (MI) survivors is not clear. We studied the association of chronic exposure to PM2.5 with death and recurrent cardiovascular events in MI survivors. METHODS Consecutive patients aged ≤65years admitted to all medical centers in central Israel after first-MI in 1992-1993 were followed through 2005 for cardiovascular events and 2011 for survival. Data on sociodemographic and prognostic factors were collected at baseline and during follow-up. Residential exposure to PM2.5 was estimated for each patient based on data recorded at air quality monitoring stations. Cox and Andersen-Gill proportional hazards models were used to study the pollution-outcome association. RESULTS Among the 1120 patients, 469 (41.9%) died and 541 (48.3%) experienced one or more recurrent cardiovascular event. The adjusted hazard ratios associated with a 10μg/m(3) increase in PM2.5 exposure were 1.3 (95% CI 0.8-2.1) for death and 1.5 (95% CI 1.1-1.9) for multiple recurrences of cardiovascular events (MI, heart failure and stroke). CONCLUSION When adjustment for socio-demographic factors is performed, cumulative chronic exposure to PM2.5 is positively associated with recurrence of cardiovascular events in patients after a first MI.
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Affiliation(s)
- Silvia Koton
- School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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