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Li W, Li N, Liang Z, Hou X, Si Y, Wang X, Feng X, Tai B, Hu D, Lin H, Wang B, Wang C, Zheng S, Liu X, Rong W, Wang W, Sun S, Meng H, Zhang Z. Long-term exposure to ambient fine particulate matter and periodontitis: An observational study using nationally representative survey data. J Clin Periodontol 2024; 51:596-609. [PMID: 38268133 DOI: 10.1111/jcpe.13950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/10/2023] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
AIM The rising prevalence of periodontitis imposes substantial burdens on individuals and society. Identifying environmental risk factors for periodontitis may contribute to tackling the global public health burden of it. This study aimed to assess the association between long-term exposure to PM2.5 and periodontitis in a nationally representative population from China. MATERIALS AND METHODS In this multi-centre cross-sectional study of 372 communities in 31 provinces of Mainland China, we used data from the Fourth National Oral Health Survey of China in 2015-2016, in combination with high-resolution gridded concentrations of fine particulate matter (PM2.5). Logistic regression was applied to assess the relationship between long-term PM2.5 exposure and the risk of periodontitis. In addition, we examined whether the association varied by individual characteristics, and estimated the exposure-response relationship and the risk of damaged tooth in each tooth quadrant. RESULTS A total of 8391 participants from 96 cities were diagnosed with periodontitis, accounting for 60.04% (8391/13,459) of the participants. For each 10 μg/m3 increment in 1-, 3- and 5-year average concentrations of PM2.5, the risk of total periodontitis increased by 9.0% (95% confidence interval: 6.0%, 12.0%), 8.0% (6.0, 11·0) and 7.0% (5.0, 10.0), respectively. Mild periodontitis was more strongly associated with PM2.5 exposure than moderate and severe periodontitis. The teeth in the lower anterior, lower posterior or upper anterior are more susceptible to the effect of PM2.5 on the periodontal pocket, calculus and bleeding gums. CONCLUSIONS Long-term exposure to PM2.5 is significantly associated with an increased risk of periodontitis in the nationally representative Chinese population. Considering the rising prevalence of periodontitis, considerable costs of treatment, and substantially adverse effects on individuals and society, these findings suggest that stricter air quality regulations may help ease the burden of periodontal disease.
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Affiliation(s)
- Wenjing Li
- Beijing Laboratory of Biomedical Materials, Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
| | - Na Li
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Zhisheng Liang
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Xingduo Hou
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Yan Si
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xing Wang
- Chinese Stomatological Association, Beijing, China
| | - Xiping Feng
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Baojun Tai
- School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Deyu Hu
- Department of Preventive Dentistry, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Huancai Lin
- Department of Preventive Dentistry, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yet-sen University, Guangzhou, China
| | - Bo Wang
- Chinese Stomatological Association, Beijing, China
| | - Chunxiao Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shuguo Zheng
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xuenan Liu
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wensheng Rong
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Weijian Wang
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Shengzhi Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Huanxing Meng
- Department of Periodontology, Peking University School of Stomatology, Beijing, China
| | - Zhenyu Zhang
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
- Institute of Carbon Neutrality, Peking University, Beijing, China
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2
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Tian W, Zhu G, Xiao W, Gao B, Lu W, Wang Y. Stroke burden and attributable risk factors in China, 1990-2019. Front Neurol 2023; 14:1193056. [PMID: 37292127 PMCID: PMC10245554 DOI: 10.3389/fneur.2023.1193056] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/03/2023] [Indexed: 06/10/2023] Open
Abstract
Background and purpose Understanding the temporal trends of stroke burden and its attributable risk factors are essential for targeted prevention strategies. We aimed to describe the temporal trends and attributable risk factors of stroke in China. Methods Data on the stroke burden [incidence, prevalence, mortality, and disability-adjusted life years (DALYs)] and the population-attributable fraction for stroke risk factors from 1990 to 2019 were obtained from the Global Burden of Disease Study 2019 (GBD 2019). We analyzed trends in the burden of stroke and its attributable risk factors from 1990 to 2019, and the characteristics of stroke-attributable risk factors by sex, age group, and stroke subtype. Results From 1990 to 2019, the age-standardized incidence, mortality, and DALY rates for total stroke decreased by 9.3% (3.3, 15.5), 39.8% (28.6, 50.7), and 41.6% (30.7, 50.9) respectively. The corresponding indicators all decreased for intracerebral hemorrhage and subarachnoid hemorrhage. The age-standardized incidence rate of ischemic stroke increased by 39.5% (33.5 to 46.2) for male patients and by 31.4% (24.7 to 37.7) for female patients, and the age-standardized mortality and DALY rates remained almost unchanged. The three leading stroke risk factors were high systolic blood pressure, ambient particulate matter pollution, and smoking. High systolic blood pressure has remained the leading risk factor since 1990. The attributable risk of ambient particulate matter pollution shows a clear upward trend. Smoking and alcohol consumption were important risk factors for men. Conclusion This study reinforced the findings of an increased stroke burden in China. Precise stroke prevention strategies are needed to reduce the disease burden of stroke.
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Affiliation(s)
- Wenxin Tian
- School of Public Health, Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
| | - Guanghan Zhu
- School of Public Health, Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
| | - Wenbo Xiao
- School of Public Health, Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
| | - Bei Gao
- School of Public Health, Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
| | - Wenli Lu
- School of Public Health, Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
| | - Yuan Wang
- School of Public Health, Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
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3
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Hasegawa K, Tsukahara T, Nomiyama T. Short-term associations of low-level fine particulate matter (PM 2.5) with cardiorespiratory hospitalizations in 139 Japanese cities. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 258:114961. [PMID: 37137261 DOI: 10.1016/j.ecoenv.2023.114961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/09/2023] [Accepted: 04/24/2023] [Indexed: 05/05/2023]
Abstract
There have been few studies in non-western countries on the relationship between low levels of daily fine particulate matter (PM2.5) exposure and morbidity or mortality, and the impact of PM2.5 concentrations below 15 μg/m3, which is the latest World Health Organization Air Quality Guideline (WHO AQG) value for the 24-h mean, is not yet clear. We assessed the associations between low-level PM2.5 exposure and cardiorespiratory admissions in Japan. We collected the daily hospital admission count data, air pollutant data, and meteorological condition data recorded from April 2016 to March 2019 in 139 Japanese cities. City-specific estimates were obtained from conditional logistic regression models in a time-stratified case-crossover design and pooled by random-effect models. We estimated that every 10-μg/m3 increase in the concurrent-day PM2.5 concentration was related to a 0.52% increase in cardiovascular admissions (95% CI: 0.13-0.92%) and a 1.74% increase in respiratory admissions (95% CI: 1.41-2.07%). These values were nearly the same when the datasets were filtered to contain only daily PM2.5 concentrations <15 μg/m3. The exposure-response curves showed approximately sublinear-to-linear curves with no indication of thresholds. These associations with cardiovascular diseases weakened after adjusting for nitrogen dioxide or sulfur dioxide, but associations with respiratory diseases were almost unchanged when additionally adjusted for other pollutants. This study demonstrated that associations between daily PM2.5 and daily cardiorespiratory hospitalizations might persist at low concentrations, including those below the latest WHO AQG value. Our findings suggest that the updated guideline value may still be insufficient from the perspective of public health.
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Affiliation(s)
- Kohei Hasegawa
- Department of Preventive Medicine and Public Health, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
| | - Teruomi Tsukahara
- Department of Preventive Medicine and Public Health, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan; Department of Occupational Medicine, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Tetsuo Nomiyama
- Department of Preventive Medicine and Public Health, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan; Department of Occupational Medicine, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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Wang M, Han Y, Wang CJ, Xue T, Gu HQ, Yang KX, Liu HY, Cao M, Meng X, Jiang Y, Yang X, Zhang J, Xiong YY, Zhao XQ, Liu LP, Wang YL, Guan TJ, Li ZX, Wang YJ. Short-term effect of PM2.5 on stroke in susceptible populations: A case-crossover study. Int J Stroke 2023; 18:312-321. [PMID: 35722790 DOI: 10.1177/17474930221110024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fine particulate matter (PM2.5) is a risk factor for stroke, and patients with pre-existing diseases appear to be particularly susceptible. We conducted a case-crossover study to examine the association between short-term exposure to fine particulate matter (PM2.5) and hospital admission for stroke in individuals with atrial fibrillation (AF), hypertension, diabetes, or hyperlipidemia. METHODS Patients diagnosed with acute ischemic stroke (AIS) were recruited from 2015 to 2017 in Chinese Stroke Center Alliances. We estimated daily PM2.5 average exposures with a spatial resolution of 0.1° using a data assimilation approach combining satellite measurements, air model simulations, and monitoring values. Conditional logistic regression was used to assess PM2.5-related stroke risk in patients with pre-existing medical co-morbidities. RESULTS A total of 155,616 patients diagnosed with AIS were admitted. Patients with a history of AF (n = 15,430), hypertension (n = 138,220), diabetes (n = 43,737), or hyperlipidemia (n = 16,855) were assessed separately. A 10 µg/m3 increase in daily PM2.5 was associated with a significant increase in AIS for individuals with AF at lag 4 (odds ratio (OR), 1.008; 95% confidence interval (CI), 1.002-1.014), and with hypertension (OR, 1.008; 95% CI, 1.006-1.010), diabetes (OR, 1.006; 95% CI, 1.003-1.010), and hyperlipidemia (OR, 1.007; 95% CI, 1.001-1.012) at lags 0-7. Elderly (⩾ 65 years old) and female patients with AF had significantly higher associations at lag 5 (OR, 1.009; 95% CI, 1.002-1.015) and lag 5 (OR, 1.010; 95% CI, 1.002-1.018), respectively. CONCLUSION Short-term exposure to PM2.5 is significantly associated with hospital admission for stroke in individuals with pre-existing medical histories, especially in older or female patients with AF. Preventive measures to reduce PM2.5 concentrations are particularly important in individuals with other medical co-morbidities.
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Affiliation(s)
- Meng Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Ying Han
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Tao Xue
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Kai-Xuan Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Heng-Yi Liu
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Man Cao
- Department of Health Policy and Management, School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xia Meng
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Jing Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Yun-Yun Xiong
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Liu
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Long Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tian-Jia Guan
- Department of Health Policy and Management, School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zi-Xiao Li
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.,Chinese Institute for Brain Research, Beijing, China
| | - Yong-Jun Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.,Chinese Institute for Brain Research, Beijing, China.,Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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5
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Tanaka M, Okuda T, Itoh K, Ishihara N, Oguro A, Fujii-Kuriyama Y, Nabetani Y, Yamamoto M, Vogel CFA, Ishihara Y. Polycyclic aromatic hydrocarbons in urban particle matter exacerbate movement disorder after ischemic stroke via potentiation of neuroinflammation. Part Fibre Toxicol 2023; 20:6. [PMID: 36797786 PMCID: PMC9933276 DOI: 10.1186/s12989-023-00517-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND A recent epidemiological study showed that air pollution is closely involved in the prognosis of ischemic stroke. We and others have reported that microglial activation in ischemic stroke plays an important role in neuronal damage. In this study, we investigated the effects of urban aerosol exposure on neuroinflammation and the prognosis of ischemic stroke using a mouse photothrombotic model. RESULTS When mice were intranasally exposed to CRM28, urban aerosols collected in Beijing, China, for 7 days, microglial activation was observed in the olfactory bulb and cerebral cortex. Mice exposed to CRM28 showed increased microglial activity and exacerbation of movement disorder after ischemic stroke induction. Administration of core particles stripped of attached chemicals from CRM28 by washing showed less microglial activation and suppression of movement disorder compared with CRM28-treated groups. CRM28 exposure did not affect the prognosis of ischemic stroke in null mice for aryl hydrocarbon receptor, a polycyclic aromatic hydrocarbon (PAH) receptor. Exposure to PM2.5 collected at Yokohama, Japan also exacerbated movement disorder after ischemic stroke. CONCLUSION Particle matter in the air is involved in neuroinflammation and aggravation of the prognosis of ischemic stroke; furthermore, PAHs in the particle matter could be responsible for the prognosis exacerbation.
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Affiliation(s)
- Miki Tanaka
- Program of Biomedical Science, Graduate School of Integrated Sciences for Life, Hiroshima University, 1-7-1, Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8521, Japan
- Laboratory for Pharmacotherapy and Experimental Neurology, Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, Sanuki, Kagawa, 769-2101, Japan
| | - Tomoaki Okuda
- Faculty of Science and Technology, Keio University, Yokohama, Kanagawa, 223-8522, Japan
| | - Kouichi Itoh
- Laboratory for Pharmacotherapy and Experimental Neurology, Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, Sanuki, Kagawa, 769-2101, Japan
| | - Nami Ishihara
- Program of Biomedical Science, Graduate School of Integrated Sciences for Life, Hiroshima University, 1-7-1, Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8521, Japan
| | - Ami Oguro
- Program of Biomedical Science, Graduate School of Integrated Sciences for Life, Hiroshima University, 1-7-1, Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8521, Japan
| | - Yoshiaki Fujii-Kuriyama
- Medical Research Institute, Molecular Epidemiology, Tokyo Medical and Dental University, Bunkyo, Tokyo, 113-8510, Japan
| | - Yu Nabetani
- Department of Applied Chemistry, Faculty of Engineering, University of Miyazaki, Miyazaki, 889-2192, Japan
| | - Megumi Yamamoto
- Department of Environment and Public Health, National Institute for Minamata Disease, Minamata, Kumamoto, 867-0008, Japan
| | - Christoph F A Vogel
- Department of Environmental Toxicology, University of California, Davis, Davis, CA, 95616, USA
- Center for Health and the Environment, University of California, Davis, Davis, CA, 95616, USA
| | - Yasuhiro Ishihara
- Program of Biomedical Science, Graduate School of Integrated Sciences for Life, Hiroshima University, 1-7-1, Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8521, Japan.
- Center for Health and the Environment, University of California, Davis, Davis, CA, 95616, USA.
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Chen H, Zhou Z, Li Z, Liang S, Zhou J, Zou G, Zhou S. Time trends in the burden of stroke and subtypes attributable to PM2.5 in China from 1990 to 2019. Front Public Health 2022; 10:1026870. [PMID: 36311576 PMCID: PMC9605206 DOI: 10.3389/fpubh.2022.1026870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/26/2022] [Indexed: 01/29/2023] Open
Abstract
Background Increasing studies have found that PM2.5 has large adverse effects on stroke mortality. We want to investigate the long-term trends in the mortality of stroke attributable to ambient particulate matter pollution and household air pollution to provide evidence facilitating the design of policy. Methods The deaths data of stroke and its subtypes attributable to PM2.5 were obtained from the Global Burden of Disease (GBD) 2019, analyzed by Joinpoint regression software and the age-period-cohort (APC) method to assess the magnitude of the trends in mortality and the temporal trends in the mortality rate by age, period, and cohort. Results From 1990 to 2019, the age-standardized mortality rate (ASMR) attributable to PM2.5 exposure trended downwards, but the trends of ambient particulate matter pollution and household air pollution were opposite. The trends varied among subtypes, the AAPC of intracerebral hemorrhage, ischemic stroke, and subarachnoid hemorrhage attributable to PM2.5 were 0.7, 2.5, and-3.3%, respectively. The longitudinal age curve of the APC model showed that the mortality rates due to PM2.5 exposure increased with age. The period RRs of ischemic stroke due to ambient particulate matter pollution increased significantly. The cohort RRs of ambient particulate matter pollution increased among those born from 1905 to 1990. The net drifts of all subtypes attributable to PM2.5 were below 0, but owing to the increase of ambient particulate matter pollution, the range of the decline was small. Males had higher net drift values, compared with females. Conclusions Ambient particulate matter pollution has become the main type of PM2.5 leading to stroke in China. PM2.5 exposure is more harmful to ischemic stroke, males, and elderly. Chinese government should pay attention to the long-term impact of ambient air pollution on stroke and take effective public health policies and interventions.
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7
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Pan W, Chen X, Duan X, Xue Y, Jia L. Particulate matter exposure at urban traffic intersection during haze episodes: A case study in Changsha. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 838:156006. [PMID: 35595146 DOI: 10.1016/j.scitotenv.2022.156006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
Urban intersection has been identified as a major contributor to the total personal exposure and short-term high exposure of particulate matter (PM) in modern cities. The main aim of this study was to get a better understanding of the determinants of traffic-related PM temporal variations and personal exposure to PMs at a viaduct-covered intersection controlled by traffic signals during the winter haze episodes. A two-day field sampling campaign was conducted with a portable device during evening rush hour and measured the PMs in the 0.3-10 μm size range both on the surface crosswalk and underground passage. PM variations and related cumulative respiratory deposition dose (RDD) along two routes with six road crossing scenarios were estimated on a severe pollution day and a typical day for both adults and children, respectively. The PM concentration on the severe pollution day ranged 59.2-67.9 μg/m3 for PM1, 163.8-257.0 μg/m3 for PM2, and 258.2-469.1 μg/m3 for PM10, respectively, as compared to 47.9-57.9 μg/m3for PM1, 112.7-199.8 μg/m3 for PM2, and 151.0-301.0 μg/m3 for PM10 on the typical day, respectively. The variability could be explained largely by the built-up environment, traffic component, signal setting, and ventilation condition. Our data suggest that an appropriate setting of the traffic signal would help reduce the personal exposure dose on the surface crosswalk at urban intersections and the ventilation condition had a significant influence on local PM distributions inside the underground passage. Results here provide possible suggestions for the future design of a walkable city.
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Affiliation(s)
- Wei Pan
- College of Liberal Arts and Science, National University of Defense Technology, Changsha, Hunan 410073, PR China; School of Basic Medical Sciences, Guangxi Medical University, Nanning 530021, PR China; School of Information and Management, Guangxi Medical University, Nanning 530021, PR China.
| | - Xiaolu Chen
- School of Information and Management, Guangxi Medical University, Nanning 530021, PR China
| | - Xiaojun Duan
- College of Liberal Arts and Science, National University of Defense Technology, Changsha, Hunan 410073, PR China
| | - Yu Xue
- School of Physical Science and Technology, Guangxi University, Nanning 530004, PR China
| | - Lisi Jia
- Department of Information and Electromechanical Engineering, Guangxi Agricultural Vocational University, Nanning 530007, PR China
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8
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Wu H, Zhang B, Wei J, Lu Z, Zhao M, Liu W, Bovet P, Guo X, Xi B. Short-term effects of exposure to ambient PM 1, PM 2.5, and PM 10 on ischemic and hemorrhagic stroke incidence in Shandong Province, China. ENVIRONMENTAL RESEARCH 2022; 212:113350. [PMID: 35487259 DOI: 10.1016/j.envres.2022.113350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Short-term exposure to ambient PM2.5 and PM10 is associated with increased risk of mortality and hospital admissions for stroke. However, there is less evidence regarding the effect of exposure to PM1 on stroke incidence. We estimated the incidence risk of stroke and the attributable fractions related to short-term exposure to ambient PM1, PM2.5 and PM10 in China. METHODS County-specific incidence of stroke was obtained from health statistics in years 2014-2019. We linked county-level mean daily concentrations of PM1, PM2.5 and PM10 with stroke incidence. We used the time stratified case-crossover design to estimate the associations between stroke incidence and exposure to PM1, PM2.5 and PM10. We also estimated the disease burden fractions attributable to PM1, PM2.5, and PM10. RESULTS The study included a total of 2,193,954 stroke, from which 1,861,331 were ischemic and 332,623 were hemorrhagic stroke. PM1, PM2.5, and PM10 levels were associated with increased risks of total stroke and ischemic stroke at when assessing the associations in exposure at lag0-4 days. The increase of 10 μg/m3 in PM1, PM2.5, and PM10 was associated with total stroke, and the relative risks were 1.012 (95% confidence interval: 1.008, 1.015), 1.006 (1.004, 1.007) and 1.003 (1.002, 1.004), while the associations with ischemic stroke were 1.013 (1.010, 1.017), 1.006 (1.005, 1.008) and 1.003 (1.002, 1.004), respectively. There was no significant association between PM and risk of hemorrhagic stroke. The attributable fractions of total stroke were 6.9% (5.1%, 8.5%), 5.6% (4.2%, 6.8%) and 5.6% (3.9%, 7.1%) for PM1, PM2.5, and PM10, respectively. CONCLUSIONS PM1 showed a stronger association with stroke, with a larger attributable fraction of outcomes, than PM2.5 and PM10. Clean air policies should target the whole scope of PM, including PM1.
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Affiliation(s)
- Han Wu
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
| | - Bingyin Zhang
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, Shandong, China.
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, USA.
| | - Zilong Lu
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, Shandong, China.
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
| | - Wenhui Liu
- Information and Data Analysis Lab, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
| | - Pascal Bovet
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
| | - Xiaolei Guo
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, Shandong, China.
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
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Li W, Wang J, Zhou K, Tian Y, Wei F, Zhang M, Wang X. Association of PM 2.5 and its components with lengths of hospital stay for hand foot and mouth disease in children. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:50598-50607. [PMID: 35237913 DOI: 10.1007/s11356-022-19448-9] [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: 11/18/2021] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
Hand foot and mouth disease (HFMD) is a widespread public health concern but the studies on air pollution and the lengths of hospital stay (LOS) of HFMD are scarce nevertheless. Clinic demographic features among 5135 hospitalized HFMD cases in Nanjing, China, had been characterized from 2012 to 2017. Then, we had analyzed the association between PM2.5 short-term exposure as well as its components (OM, BC, SO42-, NH4+, NIT, SOIL, and SS) and the LOS of HFMD. Among these cases that were involved in our study, 98.62% were aged 0-6 years old, and 3772 (73.46%) were hospitalized within 1 week or less. The LOS of HFMD patients was different in various age ranges, illness onset years, and illness onset seasons (P < 0.01). For per IQR increase in PM2.5 concentrations, LOS of HFMD increased by 0.52 (0.33, 0.71), 0.50 (95% CI, 0.31-0.69) and 0.46 (95% CI, 0.28-0.65) day in adjusted models at lag 3 days, lag 7 days, and lag 14 days, respectively. In addition, per IQR increase of BC, SO42-, NH4+, NIT, and SOIL was also significantly associated with the LOS of HFMD. Our findings corroborated that short-term PM2.5 exposure was associated with the increased LOS of HFMD, and its components (BC, SO42-, NH4+, NIT, and SOIL) of PM2.5 might play a key role in prolonged LOS of HFMD.
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Affiliation(s)
- Wei Li
- Department of Quality Management, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Jieguo Wang
- Department of Emergency, Pediatric Intensive Care Unit, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Kai Zhou
- Department of Infection, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Ye Tian
- Department of Infection, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Feiran Wei
- Division of Rheumatology, Zhongda Hospital Southeast University, Nanjing, 210008, China
| | - Mingzhi Zhang
- Institute of Toxicology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
| | - Xu Wang
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
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10
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Liu T, Jiang Y, Hu J, Li Z, Guo Y, Li X, Xiao J, Yuan L, He G, Zeng W, Kan H, Rong Z, Chen G, Yang J, Wang Y, Ma W. Association of ambient PM 1 with hospital admission and recurrence of stroke in China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 828:154131. [PMID: 35219663 DOI: 10.1016/j.scitotenv.2022.154131] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/10/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Particulate matter (PM) pollution is a well-known risk factor of stroke. However, little is known about the association between PM1 (aerodynamic diameter ≤ 1.0 μm) and stroke. We estimated the associations of short-term exposure to PM1 with hospital admission and recurrence of stoke in China. METHODS Stroke data were derived from the Chinese Stroke Center Alliance (CASA) program conducted in 1458 hospitals in 292 Chinese cities from 2015 to 2019. Daily air pollution and meteorological data were collected in the cities where studied hospitals were located. Daily PM1 concentration was estimated by a generalized additive model (GAM) using PM2.5 and meteorological variables. A time-stratified case-crossover design was applied to estimate the associations of short-term exposure to PM1 with hospital admission of stroke. A GAM model was used to estimate the association between average PM1 exposure during hospitalization and the recurrence of stroke. RESULTS A total of 989,591 stroke cases were included in the study. Each 10 μg/m3 increase in PM1 (lag06-day) was associated with a 0.53% (95%CI, 0.39%, 0.67%) increment in hospital admission for stroke. The adverse effects of PM1 on ischemic stroke was stronger than on intracerebral hemorrhage. We found the associations were significant in Northeast (0.94%, 95%CI, 0.51%, 1.38%), North (0.47%, 95%CI, 0.20%, 0.75%), Central (0.57%, 95%CI, 0.30%, 0.85%), and East China (0.63%, 95%CI, 0.27%, 0.99%). Of all stroke cases, 62,988 (6.4%) had recurrent stoke attack during their hospitalization. Each 10 μg/m3 increase in PM1 was associated with a 1.64% (95%CI, 1.28%, 2.01%) increment in recurrence of stroke during hospitalization. CONCLUSIONS Short-term exposure to PM1 may increase the risk of incidence and recurrence of stroke in China, and the effects varied across different types of stroke and regions. Geographically targeted strategies and measures are needed to control air pollution for reducing the burden of stroke from PM1.
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Affiliation(s)
- Tao Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 510632 Guangzhou, China; Disease Control and Prevention Institute of Jinan University, Jinan University, Guangzhou 510632, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Jianxiong Hu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Zixiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing 100070, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 100070, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3800, Australia
| | - Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Lixia Yuan
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Guanhao He
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China; Children's Hospital of Fudan University, National Center for Children's Health, Shanghai 200032, China
| | - Zuhua Rong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Gongbo Chen
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Jun Yang
- Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing 100070, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 100070, China.
| | - Wenjun Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 510632 Guangzhou, China; Disease Control and Prevention Institute of Jinan University, Jinan University, Guangzhou 510632, China.
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11
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Ohlsson L, Isaxon C, Wrighton S, El Ouahidi W, Fornell L, Uller L, Ansar S, Voss U. Short-term exposure to urban PM 2.5 particles induces histopathological and inflammatory changes in the rat small intestine. Physiol Rep 2022; 10:e15249. [PMID: 35416410 PMCID: PMC9006536 DOI: 10.14814/phy2.15249] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/08/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023] Open
Abstract
Air pollution and exposure to fine airborne particles with aerodynamic diameter <2.5 μm (PM2.5 ) negatively impacts human health. Airways constitute a primary route of exposure but PM2.5 -contaminated food, drinks as well as mucociliary and hepatobiliary clearance all constitute potential entry points into the intestine. This study evaluated intestinal histopathological and inflammatory changes as well as enteric neuronal numbers after short- or long-term exposure to urban PM2.5 . Using a nebulizer, male rats were exposed to a mist with a concentration of 5.3mg PM2.5 /m3 for 8 h (short term) or 1.8 mg PM2.5 /m3 for 3 h/day, 5 days/week for 8 weeks (long-term) with controls run in parallel. Samples were taken from three regions of the small intestine as well as the colon. Results showed that short-term exposure to PM2.5 induces mucosal lesions and reduces IL1β levels in the small intestine but not colon. No significant changes were observed after long-term exposure, suggesting the presence of intestinal adaptation to environmental stressors in the PM2.5 . To our knowledge, this is the first study to systematically characterize regional effects along the intestine.
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Affiliation(s)
- Lena Ohlsson
- Unit of Experimental Vascular ResearchDepartment of Clinical SciencesLund UniversityLundSweden
| | - Christina Isaxon
- Division of Ergonomics and Aerosol TechnologyDepartment of Design SciencesLund UniversityLundSweden
| | - Sebastian Wrighton
- Division of Infection MedicineDepartment of Clinical SciencesLund UniversityLundSweden
| | - Wissal El Ouahidi
- Unit of Applied Neurovascular ResearchDepartment of Clinical SciencesLund UniversityLundSweden
| | - Lisa Fornell
- Unit of Applied Neurovascular ResearchDepartment of Clinical SciencesLund UniversityLundSweden
| | - Lena Uller
- Unit of Respiratory ImmunopharmacologyDepartment of Experimental Medical SciencesLund UniversityLundSweden
| | - Saema Ansar
- Unit of Applied Neurovascular ResearchDepartment of Clinical SciencesLund UniversityLundSweden
| | - Ulrikke Voss
- Unit of Applied Neurovascular ResearchDepartment of Clinical SciencesLund UniversityLundSweden
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12
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Zhang Y, He Q, Zhang Y, Xue X, Kan H, Wang X. Differential associations of particle size ranges and constituents with stroke emergency-room visits in Shanghai, China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 232:113237. [PMID: 35104777 DOI: 10.1016/j.ecoenv.2022.113237] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND PURPOSE Fine particulate matter (PM2.5) has been associated with increased risks of stroke, but it remains unclear which specific size ranges and chemical constituents dominate the effects of PM2.5 on stroke. We aimed to evaluate the associations of size-segregated particles and various constituents of PM2.5 with daily emergency-room visits for stroke. METHODS We conducted a time-series study to investigate the associations of 5 particle size ranges from 0.01 to 2.5 µm and 35 constituents of PM2.5 with the daily emergency-room visits for stroke in Shanghai, from 2014 to 2019. Over-dispersed generalized additive models were used to estimate the associations. The robustness of these associations was evaluated by additionally controlling for PM2.5 mass. RESULTS For size ranges from 0.01 to 0.3 µm, there were significant positive associations between particle number concentrations and daily emergency-room visits for stroke with the strongest associations occurring for the size range 0.05-0.1 µm. The size-dependent pattern was not changed by adjusting for PM2.5 and gaseous pollutants. The associations of daily emergency-room visits for stroke also varied considerably by various PM2.5 constituents. After controlling for the simultaneous exposure to PM2.5 and gaseous pollutants in two-pollutant models, we identified 11 out of 35 constituents that had robust associations, these being organic carbon, elemental carbon, chlorine, magnesium, ammonium, nitrate, sulfate, copper, manganese, lead and zinc. CONCLUSION Ultra-fine particles and some PM2.5 constituents (i.e., carbonaceous fractions, inorganic ions and some elements) may be mainly responsible for the excess risk of stroke induced by PM2.5.
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Affiliation(s)
- Yuhao Zhang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Shanghai 200032, China; Shanghai Clinical Research Center for Interventional Medicine, Shanghai 200032, China.
| | - Qinglin He
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Yaping Zhang
- Department of Emergency, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiaowei Xue
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Shanghai 200032, China; Shanghai Clinical Research Center for Interventional Medicine, Shanghai 200032, China.
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13
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Association of short-term exposure to air pollution with recurrent ischemic cerebrovascular events in older adults. Int J Hyg Environ Health 2022; 240:113925. [PMID: 35045384 DOI: 10.1016/j.ijheh.2022.113925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 11/22/2022]
Abstract
The acute effects of ambient air pollution on recurrence of ischemic cerebrovascular events (ICEs) remains largely unknown. We therefore conducted a time-stratified case-crossover study of 43,896 patients who were 60 years or older and were admitted to hospital for recurrent ICEs including ischemic stroke and transient ischemic attack in Guangzhou, China during 2016-2019. Based on each patient's home address and pollutant data from its neighboring air quality monitoring stations, we used an inverse distance weighting method to assess exposures to particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5), particulate matter with an aerodynamic diameter ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and ozone (O3). Conditional logistic regression models were used to quantify exposure-response associations. During the study period, there were 43,896 case days and 149,131 control days. In single-pollutant models, each 10 μg/m3 increase in exposure to PM10, NO2 and CO (mean exposure on date of admission and 1 day prior) was significantly associated with a 0.74% (95% confidence interval [CI]: 0.13-1.36%), 2.15% (1.38-2.93%) and 0.14% (0.07-0.21%) increase in odds of hospital admissions for recurrent ICEs, respectively, and no significant departures from linearity were detected. The association for NO2 exposure remained consistent in 2-pollutant models, while the associations for PM10 and CO disappeared or changed materially with adjustment for other pollutants. Stronger association for NO2 exposure was observed in cool season than that in warm season. We found that short-term exposure to ambient air pollutants, especially NO2, was associated with increased risk of hospital admissions for recurrent ICEs in older adults.
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14
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Weng L, Li N, Feng T, Zhu R, Zheng ZJ. Short-Term Association of Air Pollutant Levels and Hospital Admissions for Stroke and Effect Modification by Apparent Temperature: Evidence From Shanghai, China. Front Public Health 2021; 9:716153. [PMID: 34646803 PMCID: PMC8503471 DOI: 10.3389/fpubh.2021.716153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/23/2021] [Indexed: 11/19/2022] Open
Abstract
The epidemiological evidence on relationships between air pollution, temperature, and stroke remains inconclusive. Limited evidence is available for the effect modification by apparent temperature, an indicator reflecting reactions to the thermal environment, on short-term associations between air pollution and hospital admissions for stroke. We used a generalized additive model with Poisson regression to estimate the relative risk (RR) of stroke admissions in Shanghai, China, between 2014 and 2016 associated with air pollutants, with subgroup analyses by age, sex, apparent temperature, and season. During the study period, changes in the daily number of stroke admissions per 10 μg/m3 increase in nitrogen dioxide (at lags 0, 1, 0–1, and 0–2) ranged from 1.05 (95% CI: 0.82%, 2.88%) to 2.24% (95% CI: 0.84%, 3.65%). For each 10 μg/m3 increase in sulfur dioxide concentrations at lags 1, 2, 0–1, and 0–2, the RR of daily stroke admissions increased by 3.34 (95% CI: 0.955%, 5.79%), 0.32 (95% CI: −1.97%, 2.67%), 3.33 (95% CI: 0.38%, 6.37%), and 2.86% (95% CI: −0.45%, 6.28%), respectively. The associations of same-day exposure to nitrogen dioxide with stroke admissions remained significant after adjustment for ozone levels. These associations were not modified by sex, age, apparent temperature, or season. More research is warranted to determine whether apparent temperature modifies the associations between air pollution and stroke admissions.
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Affiliation(s)
- Lvkan Weng
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Chest Hospital, Shanghai, China
| | - Na Li
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Tienan Feng
- Clinic Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongjia Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University, Shanghai, China.,Clinic Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
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15
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Wang X, Leng M, Liu Y, Qian ZM, Zhang J, Li Z, Sun L, Qin L, Wang C, Howard SW, Vaughn MG, Yan Y, Lin H. Different sized particles associated with all-cause and cause-specific emergency ambulance calls: A multicity time-series analysis in China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 783:147060. [PMID: 34088160 DOI: 10.1016/j.scitotenv.2021.147060] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Compared with mortality and hospital admission, emergency ambulance calls (EACs) could be a more accurate outcome indicator to reflect the health effects of short-term air pollution exposure. However, such studies have been scarce, especially on a multicity scale in China. METHODS We estimated the associations of different diameter particles [i.e., inhalable particulate matter (PM10), coarse particulate matter (PMc), and fine particulate matter (PM2.5)] with EACs for all-cause, cardiovascular, and respiratory diseases in seven Chinese cities. We collected data on EACs and air pollution from 2014 to 2019. We used generalized additive models and random-effects meta-analysis to examine the city-specific and overall associations. Stratified analyses were conducted to examine the effect modifications of gender, age, and season. RESULTS Significant associations of PM10 and PM2.5 with EACs were observed, while the PMc associations were positive but not statistically significant in most analyses. Specifically, each 10 μg/m3 increase in 2-day moving average concentration of PM10 was associated with a 0.25% [95% confidence interval (CI): 0.04%, 0.47%] increase in all-cause EACs, 0.13% (95% CI: -0.01%, 0.26%) in cardiovascular EACs, and 0.35% (95% CI: 0.04%, 0.66%) in respiratory EACs. The corresponding increases in daily EACs for PM2.5 were 0.30% (95% CI, 0.03%, 0.57%), 0.13% (95% CI, -0.07%, 0.33%), and 0.46% (95% CI, 0.01%, 0.92%). Season of the year also modifies the association between particulate matter pollution and EACs. CONCLUSIONS Short-term exposure to PM10 and PM2.5 were positively associated with daily all-cause and respiratory-related EACs. The associations were stronger during warm season than cold season. Our findings suggest that the most harmful fraction of particulate matter pollution is PM2.5, which has important implications for current air quality guidelines and regulations in China.
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Affiliation(s)
- Xiaojie Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Meifang Leng
- Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yixuan Liu
- Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Zhengmin Min Qian
- College for Public Health & Social Justice, Saint Louis University, USA
| | - Junguo Zhang
- Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Ziyi Li
- Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Liwen Sun
- Huairou District Center for Disease Control and Prevention, Beijing, China
| | - Lijie Qin
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Steven W Howard
- College for Public Health & Social Justice, Saint Louis University, USA
| | - Michael G Vaughn
- College for Public Health & Social Justice, Saint Louis University, USA
| | - Yue Yan
- Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China..
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
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Leão MLP, Penteado JO, Ulguim SM, Gabriel RR, Dos Santos M, Brum AN, Zhang L, da Silva Júnior FMR. Health impact assessment of air pollutants during the COVID-19 pandemic in a Brazilian metropolis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:41843-41850. [PMID: 33788092 PMCID: PMC8010497 DOI: 10.1007/s11356-021-13650-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/22/2021] [Indexed: 05/13/2023]
Abstract
Studies around the world have revealed reduced levels of atmospheric particulate matter in periods of greatest human mobility restriction to contain the spread of SARS-CoV-2 during the COVID-19 pandemic. The present study aimed to carry out a health impact assessment in Recife, Brazil, hypothesizing a scenario in which the levels of PM10 and PM2.5 remained, throughout the year, as in the most restrictive period of human mobility. Particular material data (PM10 and PM2.5) were measured during the pandemic and population and health (mortality, hospital admissions for heart and respiratory problems) data from 2018 were used. We observed a reduction in the concentration of PM2.5 in up to 43.7% and PM10 up to 29.5% during the period of social isolation in the city of Recife. The reduction in PM2.5 would avoid 106 annual deaths from non-external causes and 58 annual deaths from cardiovascular diseases. In this scenario, $ 294.88 million would be saved ($ 114.88 million from heart problems and $ 180 million from non-external causes). When considering hospitalizations avoided by the decrease in PM10, we observed 57 fewer hospitalizations for respiratory diseases, 42 for heart diseases and a reduction of 37 deaths due to non-external causes. The reduction in spending on respiratory and cardiovascular hospitalizations would exceed $ 330,000. Therefore, the reduction of particulate matter could prevent hospital admissions, deaths and consequently there would be a reduction in disease burden in developing countries where economic resources are scarce. In this sense, governments should seek to reduce levels of pollution in order to improve the life quality and health of the population.
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Affiliation(s)
- Marcos Lorran Paranhos Leão
- Faculdade de Ciências Médicas (FCM) e Hospital Universitário Oswaldo Cruz (HUOC) da Universidade de Pernambuco (UPE) Campus Santo Amaro, Recife. Rua Arnóbio Marques, 310 - Santo Amaro, Recife, PE, CEP: 50100-130, Brazil
| | - Julia Oliveira Penteado
- Laboratório de Ensaios Farmacológicos e Toxicológicos, Instituto de Ciências Biológicas, Universidade Federal Do Rio Grande, Avenida Itália, km 8, Campus Carreiros, Rio Grande, RS, CEP: 96203-900, Brazil
- Programa de Pós-Graduação em Ciências Da Saúde, Faculdade de Medicina, Rua Visconde de Paranaguá 102 Centro, Rio Grande, RS, Brasil, CEP: 96203-900
| | - Sabrina Morales Ulguim
- Laboratório de Ensaios Farmacológicos e Toxicológicos, Instituto de Ciências Biológicas, Universidade Federal Do Rio Grande, Avenida Itália, km 8, Campus Carreiros, Rio Grande, RS, CEP: 96203-900, Brazil
| | - Rômulo Reginato Gabriel
- Laboratório de Ensaios Farmacológicos e Toxicológicos, Instituto de Ciências Biológicas, Universidade Federal Do Rio Grande, Avenida Itália, km 8, Campus Carreiros, Rio Grande, RS, CEP: 96203-900, Brazil
| | - Marina Dos Santos
- Laboratório de Ensaios Farmacológicos e Toxicológicos, Instituto de Ciências Biológicas, Universidade Federal Do Rio Grande, Avenida Itália, km 8, Campus Carreiros, Rio Grande, RS, CEP: 96203-900, Brazil
- Programa de Pós-Graduação em Ciências Da Saúde, Faculdade de Medicina, Rua Visconde de Paranaguá 102 Centro, Rio Grande, RS, Brasil, CEP: 96203-900
| | - Aline Neutzling Brum
- Programa de Pós-Graduação em Ciências Da Saúde, Faculdade de Medicina, Rua Visconde de Paranaguá 102 Centro, Rio Grande, RS, Brasil, CEP: 96203-900
| | - Linjie Zhang
- Programa de Pós-Graduação em Ciências Da Saúde, Faculdade de Medicina, Rua Visconde de Paranaguá 102 Centro, Rio Grande, RS, Brasil, CEP: 96203-900
| | - Flavio Manoel Rodrigues da Silva Júnior
- Laboratório de Ensaios Farmacológicos e Toxicológicos, Instituto de Ciências Biológicas, Universidade Federal Do Rio Grande, Avenida Itália, km 8, Campus Carreiros, Rio Grande, RS, CEP: 96203-900, Brazil.
- Programa de Pós-Graduação em Ciências Da Saúde, Faculdade de Medicina, Rua Visconde de Paranaguá 102 Centro, Rio Grande, RS, Brasil, CEP: 96203-900.
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Verhoeven JI, Allach Y, Vaartjes ICH, Klijn CJM, de Leeuw FE. Ambient air pollution and the risk of ischaemic and haemorrhagic stroke. Lancet Planet Health 2021; 5:e542-e552. [PMID: 34390672 DOI: 10.1016/s2542-5196(21)00145-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 03/30/2021] [Accepted: 05/14/2021] [Indexed: 05/26/2023]
Abstract
Stroke is a leading cause of disability and the second most common cause of death worldwide. Increasing evidence suggests that air pollution is an emerging risk factor for stroke. Over the past decades, air pollution levels have continuously increased and are now estimated to be responsible for 14% of all stroke-associated deaths. Interpretation of previous literature is difficult because stroke was usually not distinguished as ischaemic or haemorrhagic, nor by cause. This Review summarises the evidence on the association between air pollution and the different causes of ischaemic stroke and haemorrhagic stroke, to clarify which people are most at risk. The risk for ischaemic stroke is increased after short-term or long-term exposure to air pollution. This effect is most pronounced in people with cardiovascular burden and stroke due to large artery disease or small vessel disease. Short-term exposure to air pollution increases the risk of intracerebral haemorrhage, a subtype of haemorrhagic stroke, whereas the effects of long-term exposure are less clear. Limitations of the current evidence are that studies are prone to misclassification of exposure, often rely on administrative data, and have insufficient clinical detail. In this Review, we provide an outlook on new research opportunities, such as those provided by the decreased levels of air pollution due to the current COVID-19 pandemic.
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Affiliation(s)
- Jamie I Verhoeven
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Youssra Allach
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ilonca C H Vaartjes
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.
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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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Zhang R, Jiang Y, Zhang G, Yu M, Wang Y, Liu G. Association between short-term exposure to ambient air pollution and hospital admissions for transient ischemic attacks in Beijing, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:6877-6885. [PMID: 33010014 PMCID: PMC7840640 DOI: 10.1007/s11356-020-10963-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/21/2020] [Indexed: 05/02/2023]
Abstract
Numerous studies have examined the associations between air pollution and stroke. However, little is known about the associations between air pollution and transient ischemic attack (TIA). In this study, we aimed to conduct a time-series study to systematically examine the associations between hospital admissions for TIA and air pollutants. Admissions for TIA (ICD-10: G45) from 1 January 2014 to 31 December 2016 were identified based on the primary diagnosis from 134 hospitals in Beijing, China. Hourly measurements of air pollutants were obtained from the National Air Pollution Monitoring System. Generalized additive models with quasi-Poisson regression were used to determine the associations for each pollutant. Additionally, stratified analysis was implemented to examine whether age, gender, temperature, and season were the potential effect modifiers. Restricted cubic spline was applied to investigate the exposure-response curve. In total, 109,975 hospital admissions for TIA were included. The positive associations were detected between PM2.5, PM10, SO2, NO2, and CO and hospital admissions for TIA. The effects of PM2.5 and PM10 in men are stronger than in women. Additionally, the effects of PM2.5, PM10, SO2, and O3 are more pronounced on warm days than cool days. From exposure-response curves, we observe a nearly linear relationship for PM2.5, PM10, CO, and NO2. Further studies are needed to verify the association. This research contributes evidence on the association between air pollution and admissions for TIA in the low- and middle-income countries and may promote related public health policy development.
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Affiliation(s)
- Runhua Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China
| | - Guitao Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China
| | - Miaoxin Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China.
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China.
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Association between exposure to ambient air pollution and hospital admission, incidence, and mortality of stroke: an updated systematic review and meta-analysis of more than 23 million participants. Environ Health Prev Med 2021; 26:15. [PMID: 33499804 PMCID: PMC7839211 DOI: 10.1186/s12199-021-00937-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/10/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Previous studies have suggested that exposure to air pollution may increase stroke risk, but the results remain inconsistent. Evidence of more recent studies is highly warranted, especially gas air pollutants. METHODS We searched PubMed, Embase, and Web of Science to identify studies till February 2020 and conducted a meta-analysis on the association between air pollution (PM2.5, particulate matter with aerodynamic diameter less than 2.5 μm; PM10, particulate matter with aerodynamic diameter less than 10 μm; NO2, nitrogen dioxide; SO2, sulfur dioxide; CO, carbon monoxide; O3, ozone) and stroke (hospital admission, incidence, and mortality). Fixed- or random-effects model was used to calculate pooled odds ratios (OR)/hazard ratio (HR) and their 95% confidence intervals (CI) for a 10 μg/m3 increase in air pollutant concentration. RESULTS A total of 68 studies conducted from more than 23 million participants were included in our meta-analysis. Meta-analyses showed significant associations of all six air pollutants and stroke hospital admission (e.g., PM2.5: OR = 1.008 (95% CI 1.005, 1.011); NO2: OR = 1.023 (95% CI 1.015, 1.030), per 10 μg/m3 increases in air pollutant concentration). Exposure to PM2.5, SO2, and NO2 was associated with increased risks of stroke incidence (PM2.5: HR = 1.048 (95% CI 1.020, 1.076); SO2: HR = 1.002 (95% CI 1.000, 1.003); NO2: HR = 1.002 (95% CI 1.000, 1.003), respectively). However, no significant differences were found in associations of PM10, CO, O3, and stroke incidence. Except for CO and O3, we found that higher level of air pollution (PM2.5, PM10, SO2, and NO2) exposure was associated with higher stroke mortality (e.g., PM10: OR = 1.006 (95% CI 1.003, 1.010), SO2: OR = 1.006 (95% CI 1.005, 1.008). CONCLUSIONS Exposure to air pollution was positively associated with an increased risk of stroke hospital admission (PM2.5, PM10, SO2, NO2, CO, and O3), incidence (PM2.5, SO2, and NO2), and mortality (PM2.5, PM10, SO2, and NO2). Our study would provide a more comprehensive evidence of air pollution and stroke, especially SO2 and NO2.
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21
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Hu W, Chen Y, Chen J. Short-term effect of fine particular matter on daily hospitalizations for ischemic stroke: A time-series study in Yancheng, China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 208:111518. [PMID: 33120271 DOI: 10.1016/j.ecoenv.2020.111518] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To investigate the associations between short-term exposure to fine particular matter (PM2.5) and ischemic stroke (IS) in Yancheng, China, from 2017 to 2019. METHODS We designed a time-series study based on generalized additive models to explore the association of PM2.5 and IS admitted in two major hospitals in Yancheng. We built different lag patterns and conducted stratification analyses by age, gender, and season. Moreover, we examined the robustness of the associations adopting two-pollutant models and fitted the concentration-response curves. RESULT We observed positive and significant associations at lag 0 day. Every 10 μg/m3 increase in PM2.5 (lag0) was associated with 1.06% (95% CI: 0.21%-1.91%) increases in hospitalizations for IS. The association remained stable and statistically significant to the adjustment of carbon monoxide and ozone. We observed that the associations were stronger in females and during cold seasons. The overall concentration-response relationship curve was linear positive and increased slowly but rose sharply at higher concentrations in the cold season. CONCLUSION Our study added to the evidence that short-term exposure to PM2.5 may induce IS, and the government should take action to address the air pollution issues and protect susceptible populations.
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Affiliation(s)
- Wei Hu
- Department of Orthopedic Surgery, The First Affiliated Hospital of China Medical University, Liaoning, China
| | - Yutong Chen
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jinhua Chen
- Department of Neurosurgery, The People's Hospital of Dafeng, Yancheng, China.
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22
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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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Ruan Z, Qi J, Yin P, Qian Z(M, Liu J, Liu Y, Yang Y, Li H, Zhang S, Howard SW, Lin H, Wang L. Prolonged Life Expectancy for Those Dying of Stroke by Achieving the Daily PM 2.5 Targets. GLOBAL CHALLENGES (HOBOKEN, NJ) 2020; 4:2000048. [PMID: 33304609 PMCID: PMC7713556 DOI: 10.1002/gch2.202000048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Indexed: 05/11/2023]
Abstract
This time-series study collects data on stroke-related mortality, years of life lost (YLL), air pollution, and meteorological conditions in 96 Chinese cities from 2013 to 2016 and proposes a three-stage strategy to generate the national and regional estimations of avoidable YLL, gains in life expectancy and stroke-related population attributable fraction by postulating that the daily fine particulate matter (PM2.5) has been kept under certain standards. A total of 1 318 911 stroke deaths are analyzed. Each 10 µg m-3 increment in PM2.5 at lag03 is associated with a city-mean increase of 0.31 (95% CI: 0.19, 0.44) years of life lost from stroke. A number of 914.11 (95% CI: 538.28, 1288.94) years of city-mean life lost from stoke could be avoided by attaining the WHO's Air Quality Guidelines (AQG) (25 µg m-3). Moreover, by applying the AQG standard, 0.11 (0.08, 0.15) years of life lost might be prevented for each death, and about 0.91% (95% CI: 0.62%, 1.19%) of the total years of life lost from stroke might be explained by the daily excess PM2.5 exposure. This study indicates that stroke patients can have a longer life expectancy if stricter PM2.5 standards are put in place, especially ischemic stroke patients.
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Affiliation(s)
- Zengliang Ruan
- Department of EpidemiologySchool of Public HealthSun Yat‐Sen UniversityGuangzhou510080China
| | - Jinlei Qi
- National Center for Chronic and Noncommunicable Disease Control and PreventionChinese Center for Disease Control and PreventionBeijing100050China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and PreventionChinese Center for Disease Control and PreventionBeijing100050China
| | - Zhengmin (Min) Qian
- Department of Epidemiology and BiostatisticsCollege for Public Health & Social JusticeSaint Louis UniversitySaint LouisMO63104USA
| | - Jiangmei Liu
- National Center for Chronic and Noncommunicable Disease Control and PreventionChinese Center for Disease Control and PreventionBeijing100050China
| | - Yunning Liu
- National Center for Chronic and Noncommunicable Disease Control and PreventionChinese Center for Disease Control and PreventionBeijing100050China
| | - Yin Yang
- Department of EpidemiologySchool of Public HealthSun Yat‐Sen UniversityGuangzhou510080China
| | - Huan Li
- Department of EpidemiologySchool of Public HealthSun Yat‐Sen UniversityGuangzhou510080China
| | - Shiyu Zhang
- Department of EpidemiologySchool of Public HealthSun Yat‐Sen UniversityGuangzhou510080China
| | - Steven W. Howard
- Department of Health Management & PolicyCollege for Public Health & Social JusticeSaint Louis UniversitySaint LouisMO63104USA
| | - Hualiang Lin
- Department of EpidemiologySchool of Public HealthSun Yat‐Sen UniversityGuangzhou510080China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and PreventionChinese Center for Disease Control and PreventionBeijing100050China
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Zhang S, Routledge MN. The contribution of PM 2.5 to cardiovascular disease in China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:37502-37513. [PMID: 32691311 PMCID: PMC7496016 DOI: 10.1007/s11356-020-09996-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/01/2020] [Indexed: 05/02/2023]
Abstract
China is experiencing rapid urbanization and industrialization with correspondingly high levels of air pollution. Although the harm of PM2.5 has been long reported, it is only quite recently that there is increasing concern in China for its possible adverse health effects on cardiovascular disease. We reviewed the epidemiologic evidence of potential health effects of PM2.5 on cardiovascular disease reported from recent studies in China (2013 onwards). There is clear evidence for the contribution of PM2.5 to cardiovascular outcomes, including mortality, ischemic heart disease, and stroke from studies based in various regions in China. This evidence adds to the global evidence that PM2.5 contributes to adverse cardiovascular health risk and highlights the need for improved air quality in China.
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Affiliation(s)
- Shuqi Zhang
- School of Public Health, Fudan University, Shanghai, 200032 China
| | - Michael N. Routledge
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang, China
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25
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Cheng FJ, Wu KH, Hung SC, Lee KH, Lee CW, Liu KY, Hsu PC. Association between ambient air pollution and out-of-hospital cardiac arrest: are there potentially susceptible groups? JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2020; 30:641-649. [PMID: 31578416 DOI: 10.1038/s41370-019-0140-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/08/2019] [Accepted: 03/18/2019] [Indexed: 06/10/2023]
Abstract
This study aimed to examine the association between air pollution and out-of-hospital cardiac arrest (OHCA), and the effects of underlying diseases. Between January 2015 and December 2016, data on particulate matter (PM)2.5 and other air pollutants in Kaohsiung City were collected, and an emergency medical service database was used for information on patients who experienced OHCA. Overall, 3566 patients were analyzed and subgroup analyses by sex, age, and preexisting morbidities were performed. Interquartile increments in PM2.5, PM10, and O3 levels on lag 1 and NO2 level on lag 3 were associated with increments of 10.8%, 11.3%, 6.2%, and 1.7% in OHCA incidence, respectively. Subgroup analyses showed that patients with diabetes (1.363; interaction p = 0.009), heart disease (1.612; interaction p = 0.001), and advanced age (≥70 years, 1.297; interaction p = 0.003) were more susceptible to NO2 on lag 3. Moreover, patients were more susceptible to O3 during the cold season (1.194; interaction p = 0.001). We found that PM2.5, PM10, NO2, and O3 may play an important role in OHCA events, and the effects vary by underlying condition, age and season.
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Affiliation(s)
- Fu-Jen Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
- Department of Safety, Health and Environmental Engineering, National Kaohsiung University of Science and Technology, Kaohsiung City, Taiwan
| | - Kuan-Han Wu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Shih-Chiang Hung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Kuo-Hsin Lee
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Chia-Wei Lee
- Department of Safety, Health and Environmental Engineering, National Kaohsiung University of Science and Technology, Kaohsiung City, Taiwan
| | - Kun-Ying Liu
- Fire Bureau, Kaohsiung City Government, Kaohsiung City, Taiwan
| | - Ping-Chi Hsu
- Department of Safety, Health and Environmental Engineering, National Kaohsiung University of Science and Technology, Kaohsiung City, Taiwan.
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Gu J, Shi Y, Chen N, Wang H, Chen T. Ambient fine particulate matter and hospital admissions for ischemic and hemorrhagic strokes and transient ischemic attack in 248 Chinese cities. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 715:136896. [PMID: 32007884 DOI: 10.1016/j.scitotenv.2020.136896] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/11/2020] [Accepted: 01/22/2020] [Indexed: 05/18/2023]
Abstract
Few studies have investigated the acute effects of fine particulate matter (PM2.5) on the risk of stroke subtypes and transient ischemic attack (TIA) in low- and middle-income countries. The primary aim of this study was to assess the associations between short-term exposure to PM2.5 and daily hospital admissions for total cerebrovascular disease, ischemic and hemorrhagic strokes, and TIA in China. A total of 8,359,162 hospital admissions in 248 Chinese cities from 2013 to 2017 were identified from the Hospital Quality Monitoring System of China. Generalized additive models with quasi-Poisson regression were used to estimate the associations in each city, and random-effect meta-analyses were conducted to combine the city-specific estimates. We found that a 10 μg/m3 increase in PM2.5 concentration was significantly associated with a 0.19% (95% CI, 0.13% to 0.25%), 0.26% (95% CI, 0.17% to 0.35%), and 0.26% (95% CI, 0.13% to 0.38%) increase in same-day hospital admissions for total cerebrovascular disease, ischemic stroke, and TIA, respectively. In contrast, a non-significant negative association with PM2.5 was observed for hemorrhagic stroke in the main analyses (lag 0 day), which became statistically significant when using other single-day exposures (lag 1 or 2 days) or moving average exposures (lag 0-1, 0-2, or 0-3 days) as exposure metric. These associations were robust to adjustment for other criteria air pollutants in two-pollutant models. For ischemic stroke, the effect estimates were significantly larger in people aged 65-74 years, in cool season, and in cities with lower annual average PM2.5 concentrations. The exposure-response curves were nonlinear with a leveling off at high concentrations. These results contribute to the relatively limited literature on the PM2.5-related risks of cerebrovascular events in low- and middle-income countries.
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Affiliation(s)
- Jiangshao Gu
- Center for Big Data Research in Health and Medicine, Institute for Data Sciences, Tsinghua University, Beijing 100084, China; Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing 100084, China; Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Department of Computer Science and Technology, Tsinghua University, Beijing 100084, China
| | - Ying Shi
- China Standard Medical Information Research Center, Shenzhen 518054, China
| | - Ning Chen
- Center for Big Data Research in Health and Medicine, Institute for Data Sciences, Tsinghua University, Beijing 100084, China; Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing 100084, China; Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Department of Computer Science and Technology, Tsinghua University, Beijing 100084, China
| | - Haibo Wang
- China Standard Medical Information Research Center, Shenzhen 518054, China; Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Ting Chen
- Center for Big Data Research in Health and Medicine, Institute for Data Sciences, Tsinghua University, Beijing 100084, China; Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing 100084, China; Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Department of Computer Science and Technology, Tsinghua University, Beijing 100084, China.
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Rocha II, Narasimhalu K, De Silva DA. Impact of Air Pollution and Seasonal Haze on Neurological Conditions: A Review. ANNALS ACADEMY OF MEDICINE SINGAPORE 2020. [DOI: 10.47102/annals-acadmedsg.18087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Air pollution is a global problem and seasonal haze from forest clearing
and peat land burning in Indonesia is an annual phenomenon in Southeast Asia. As
neurological disorders comprise 6.3% of the burden of disease globally, we reviewed
evidence of the association between common neurological conditions and air pollution
exposure, and summarised existing data on the impact of the haze phenomenon in
Southeast Asia. Materials and Methods: A PubMed search for relevant studies on air
pollution, Alzheimer’s disease (AD), dementia, epilepsy, haze, headache, migraine, stroke, Parkinson’s disease (PD) and neuromuscular conditions was performed. There were 52 articles which were relevant and were reviewed. Results: There were associations between short-term air pollution exposure with AD, epilepsy, ischaemic stroke and migraine. Long-term air pollution exposure was associated with AD, amyotrophic lateral sclerosis, dementia and ischaemic stroke. Evidence on the link between air pollution and PD was inconsistent. Currently, there is no specific data on the effects haze has on neurological conditions in Southeast Asia. Conclusion: Air pollution is associated with increased risk of certain common neurological disorders. More specific studies are needed to investigate the impact of seasonal haze on neurological conditions in Southeast Asia.
Key words: Alzheimer’s disease, Epilepsy, Migraine, Parkinson’s disease, Stroke
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Affiliation(s)
| | - Kaavya Narasimhalu
- National Neuroscience Institute (Singapore General Hospital campus), Singapore
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28
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Yue JL, Liu H, Li H, Liu JJ, Hu YH, Wang J, Lu L, Wang F. Association between ambient particulate matter and hospitalization for anxiety in China: A multicity case-crossover study. Int J Hyg Environ Health 2020; 223:171-178. [DOI: 10.1016/j.ijheh.2019.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/16/2019] [Accepted: 09/12/2019] [Indexed: 12/18/2022]
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29
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Tian Y, Liu H, Wu Y, Si Y, Song J, Cao Y, Li M, Wu Y, Wang X, Chen L, Wei C, Gao P, Hu Y. Association between ambient fine particulate pollution and hospital admissions for cause specific cardiovascular disease: time series study in 184 major Chinese cities. BMJ 2019; 367:l6572. [PMID: 31888884 PMCID: PMC7190041 DOI: 10.1136/bmj.l6572] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To estimate the risks of daily hospital admissions for cause specific major cardiovascular diseases associated with short term exposure to ambient fine particulate matter (aerodynamic diameter ≤2.5 μm; PM2.5) pollution in China. DESIGN National time series study. SETTING 184 major cities in China. POPULATION 8 834 533 hospital admissions for cardiovascular causes in 184 Chinese cities recorded by the national database of Urban Employee Basic Medical Insurance from 1 January 2014 to 31 December 2017. MAIN OUTCOME MEASURES Daily counts of city specific hospital admissions for primary diagnoses of ischaemic heart disease, heart failure, heart rhythm disturbances, ischaemic stroke, and haemorrhagic stroke among different demographic groups were used to estimate the associations between PM2.5 and morbidity. An overdispersed generalised additive model was used to estimate city specific associations between PM2.5 and cardiovascular admissions, and random effects meta-analysis used to combine the city specific estimates. RESULTS Over the study period, a mean of 47 hospital admissions per day (standard deviation 74) occurred for cardiovascular disease, 26 (53) for ischaemic heart disease, one (five) for heart failure, two (four) for heart rhythm disturbances, 14 (28) for ischaemic stroke, and two (four) for haemorrhagic stroke. At the national average level, an increase of 10 μg/m3 in PM2.5 was associated with a 0.26% (95% confidence interval 0.17% to 0.35%) increase in hospital admissions on the same day for cardiovascular disease, 0.31% (0.22% to 0.40%) for ischaemic heart disease, 0.27% (0.04% to 0.51%) for heart failure, 0.29% (0.12% to 0.46%) for heart rhythm disturbances, and 0.29% (0.18% to 0.40%) for ischaemic stroke, but not with haemorrhagic stroke (-0.02% (-0.23% to 0.19%)). The national average association of PM2.5 with cardiovascular disease was slightly non-linear, with a sharp slope at PM2.5 levels below 50 μg/m3, a moderate slope at 50-250 μg/m3, and a plateau at concentrations higher than 250 μg/m3. Compared with days with PM2.5 up to 15 μg/m3, days with PM2.5 of 15-25, 25-35, 35-75, and 75 μg/m3 or more were significantly associated with increases in cardiovascular admissions of 1.1% (0 to 2.2%), 1.9% (0.6% to 3.2%), 2.6% (1.3% to 3.9%), and 3.8% (2.1% to 5.5%), respectively.According to projections, achieving the Chinese grade 2 (35 μg/m3), Chinese grade 1 (15 μg/m3), and World Health Organization (10 μg/m3) regulatory limits for annual mean PM2.5 concentrations would reduce the annual number of admissions for cardiovascular disease in China. Assuming causality, which should be done with caution, this reduction would translate into an estimated 36 448 (95% confidence interval 24 441 to 48 471), 85 270 (57 129 to 113 494), and 97 516 (65 320 to 129 820), respectively. CONCLUSIONS These data suggest that in China, short term exposure to PM2.5 is associated with increased hospital admissions for all major cardiovascular diseases except for haemorrhagic stroke, even for exposure levels not exceeding the current regulatory limits.
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Affiliation(s)
- Yaohua Tian
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, 100191 Beijing, China
| | - Hui Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, 100191 Beijing, China
- Medical Informatics Centre, Peking University, Beijing, China
| | - Yiqun Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, 100191 Beijing, China
| | - Yaqin Si
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, 100191 Beijing, China
- Beijing HealthCom Data Technology, Beijing, China
| | - Jing Song
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, 100191 Beijing, China
| | - Yaying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, 100191 Beijing, China
| | - Man Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, 100191 Beijing, China
| | - Yao Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, 100191 Beijing, China
| | - Xiaowen Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, 100191 Beijing, China
| | - Libo Chen
- Beijing HealthCom Data Technology, Beijing, China
| | - Chen Wei
- Beijing HealthCom Data Technology, Beijing, China
| | - Pei Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, 100191 Beijing, China
- Key Laboratory of Molecular Cardiovascular (Peking University), Ministry of Education, Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, 100191 Beijing, China
- Medical Informatics Centre, Peking University, Beijing, China
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30
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Machine Learning-Based Forecast of Hemorrhagic Stroke Healthcare Service Demand considering Air Pollution. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:7463242. [PMID: 31781360 PMCID: PMC6875383 DOI: 10.1155/2019/7463242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/13/2019] [Accepted: 09/25/2019] [Indexed: 02/05/2023]
Abstract
This study aimed to forecast the pattern of the demand for hemorrhagic stroke healthcare services based on air quality and machine learning. Hemorrhagic stroke, air quality, and meteorological data for 2016-2017 were obtained from the Longquanyi District of China, and the study included 1932 cases. Six machine learning methods were used to forecast the demand for hemorrhagic stroke healthcare services considering seasonality and a lag effect, and the average area under the curve was as high as 0.7971. Our results indicate that (1) the performance of forecasting during the warm season is significantly better than that in the cold season, (2) considering air pollution would improve the performance of forecasting the demand for hemorrhagic stroke healthcare services using machine learning, (3) the association between the demand for hemorrhagic stroke healthcare services and air pollutants is linear to some extent, and (4) it is feasible to use short-term concentrations of air pollutants to forecast the demand for hemorrhagic stroke healthcare services. This practical forecast model could provide an advance warning regarding the potentially high numbers of hemorrhagic stroke admissions to medical institutions, thus allowing time to implement an appropriate response to the increase in patient volumes.
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31
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Luo L, Dai Y, Zhang F, Chen M, Chen F, Qing F. Time series analysis of ambient air pollution effects on dynamic stroke mortality. Int J Health Plann Manage 2019; 35:79-103. [PMID: 31149758 DOI: 10.1002/hpm.2821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 12/11/2022] Open
Abstract
This study aims to examine the correlations between air pollution and dynamic stroke mortality, which is defined as the daily real-time number of deaths from stroke. Death data were obtained from daily medical records of 7230 incidents from the Center for Disease Control and Prevention in the Longquanyi District of China from 2016 to 2017. Air pollution data were obtained from environmental monitoring stations in the Longquanyi District. Time series analysis using generalized additive Poisson regression models was applied, and single-pollutant and two-pollutant adjusted models were utilized. Furthermore, categories based on gender, age, and meteorological factors were considered in the analysis. The results indicated that PM2.5, PM10, O3 , and CO had significant effects on dynamic stroke mortality, which were stronger for older people and during the cold season. This study helps hospital managers, patients, and governments seeking to prevent and control the effects of air pollution on the risks of stroke.
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Affiliation(s)
- Li Luo
- Business School, Sichuan University, Chengdu, China
| | - Yuting Dai
- Business School, Sichuan University, Chengdu, China
| | - Fengyi Zhang
- Business School, Sichuan University, Chengdu, China
| | - Mei Chen
- The First People's Hospital of Longquanyi District, Chengdu, China
| | - Fang Chen
- The First People's Hospital of Longquanyi District, Chengdu, China
| | - Fang Qing
- Business School, Sichuan University, Chengdu, China
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32
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Ji Y, Stone C, Guan L, Peng C, Han W. Is air pollution a potential cause of neuronal injury? Neurol Res 2019; 41:742-748. [DOI: 10.1080/01616412.2019.1609170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Yu Ji
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Christopher Stone
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Longfei Guan
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Research & Development Center, John D. Dingell VA Medical Center, Detroit, MI, USA
| | - Changya Peng
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Research & Development Center, John D. Dingell VA Medical Center, Detroit, MI, USA
| | - Wei Han
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
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33
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Tian Y, Liu H, Xiang X, Zhao Z, Juan J, Li M, Song J, Cao Y, Wu Y, Wang X, Chen L, Wei C, Gao P, Hu Y. Ambient Coarse Particulate Matter and Hospital Admissions for Ischemic Stroke. Stroke 2019; 50:813-819. [DOI: 10.1161/strokeaha.118.022687] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background and Purpose—
Evidence on the effects of coarse particulate matter (PM
10–2.5
) on ischemic stroke is limited and inconsistent. We evaluated the acute effects of PM
10–2.5
exposure on hospital admissions for ischemic stroke in China.
Methods—
We conducted a national time-series analysis of associations between daily PM
10–2.5
concentrations and daily hospital admissions for ischemic stroke in China between January 2014 and December 2016. Hospital admissions for ischemic stroke were identified from the database of Urban Employee Basic Medical Insurance, which contains data from 0.28 billion beneficiaries. We applied a city-specific Poisson regression to examine the associations of PM
10–2.5
and daily ischemic stroke admissions. We combined the city-specific effect estimates with a random effects meta-analysis, and further evaluated the exposure-response relationship curve and potential effect modifiers.
Results—
We identified >2 million hospital admissions for ischemic stroke in 172 Chinese cities. A 10 μg/m
3
increase in PM
10–2.5
concentrations (lag day 0) was associated with a 0.91% (95% CI, 0.73–1.10) increase in hospital admissions for ischemic stroke. The association remained significant after adjusting for PM
2.5
(percentage change, 0.96%; 95% CI, 0.75–1.18). The exposure-response relationship was approximately linear, with a moderate response at lower levels (<200 μg/m
3
) and a steeper response at higher levels. The association was stronger in cities with lower PM
10–2.5
concentrations, higher temperatures, or higher relative humidity.
Conclusions—
This nationwide study provides robust evidence of the short-term association between exposure to PM
10–2.5
and increased hospital admissions for ischemic stroke and supports the hypothesis that the association differs by city characteristics.
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Affiliation(s)
- Yaohua Tian
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Hui Liu
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
- Medical Informatics Center (H.L.), Peking University, Beijing, China
| | - Xiao Xiang
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Zuolin Zhao
- Beijing HealthCom Data Technology Co, Ltd, Beijing, China (Z.Z., L.C., C.W.)
| | - Juan Juan
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Man Li
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Jing Song
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Yaying Cao
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Yao Wu
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Xiaowen Wang
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Libo Chen
- Beijing HealthCom Data Technology Co, Ltd, Beijing, China (Z.Z., L.C., C.W.)
| | - Chen Wei
- Beijing HealthCom Data Technology Co, Ltd, Beijing, China (Z.Z., L.C., C.W.)
| | - Pei Gao
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
| | - Yonghua Hu
- From the Department of Epidemiology and Biostatistics, School of Public Health (Y.T., H.L., X.X., J.J., M.L., J.S., Y.C., Y.W., X.W., P.G., Y.H.), Peking University, Beijing, China
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Guan L, Geng X, Stone C, Cosky EEP, Ji Y, Du H, Zhang K, Sun Q, Ding Y. PM 2.5 exposure induces systemic inflammation and oxidative stress in an intracranial atherosclerosis rat model. ENVIRONMENTAL TOXICOLOGY 2019; 34:530-538. [PMID: 30672636 DOI: 10.1002/tox.22707] [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: 10/11/2018] [Revised: 12/22/2018] [Accepted: 12/26/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Exposure to airborne particle (PM2.5 ) is a risk factor for intracranial atherosclerosis (ICA). Because of the established role of systemic inflammation and oxidative stress by PM2.5 , we determined whether these processes account for PM2.5 -mediated ICA, and also whether omega-3 fatty acid (O3FA) dietary supplementation could attenuate them. METHODS Adult Sprague-Dawley rats were exposed to filtered air (FA) or PM2.5 and fed either a normal chow diet (NCD) or a high-cholesterol diet (HCD), administered with or without O3FA (5 mg/kg/day by gavage) for 12 weeks. The lumen and thickness of the middle cerebral artery (MCA) were assessed. Serum tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), interleukin-1β (IL-1β), and interferon gamma (IFN-γ) were detected by ELISA. Reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase (SOD) activity, nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) activity, mRNA levels of Nrf2, HO-1, NQO-1, and protein level of NOX subunit gp91 were quantified to determine the oxidative profile of brain vessels. RESULTS PM2.5 increased (P < .05) ICA, especially in the HCD group; elevated serum TNF-α, IL-6, IL-1β, and IFN-γ; increased cerebrovascular ROS, MDA, NOX activity, and gp91 protein levels; and decreased cerebrovascular SOD activity. Nrf2, HO-1, and NQO-1 mRNA levels were upregulated (P < .05) by PM2.5 exposure, especially in the HCD group. O3FA attenuated (P < .05) PM2.5 -induced systemic inflammation, vascular oxidative injury, and ICA. CONCLUSIONS PM2.5 exposure induced systemic inflammation, cerebrovascular oxidative injury, and ICA in rats with HCD. O3FA prevented ICA development, and may therefore exert a protective effect against the atherogenic potential of PM2.5 .
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Affiliation(s)
- Longfei Guan
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Xiaokun Geng
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Christopher Stone
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Eric E P Cosky
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Yu Ji
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Huishan Du
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Kezhong Zhang
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan
| | - Qinghua Sun
- Division of Environmental Health Sciences, College of Public Health, Ohio State University, Columbus, Ohio
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
- Department of Research & Development Center, John D. Dingell VA Medical Center, Detroit, Michigan
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Zhu X, Qiu H, Wang L, Duan Z, Yu H, Deng R, Zhang Y, Zhou L. Risks of hospital admissions from a spectrum of causes associated with particulate matter pollution. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 656:90-100. [PMID: 30502738 DOI: 10.1016/j.scitotenv.2018.11.240] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 05/04/2023]
Abstract
Ambient particulate matter (PM) pollution has been linked to elevated hospital admissions (HAs), especially from respiratory and cardiovascular diseases. However, few studies have estimated the associations between PM pollution and HAs for a wider range of broad disease categories. This study aimed to evaluate the effects of PM with aerodynamic diameter ≤ 2.5 μm (PM2.5) and ≤10 μm (PM10) on a range of broad and specific causes of HAs in Chengdu, China during 2015-2016, using a generalized additive model (GAM). Age-, gender- and season-specific analyses were also performed on the broad categories. We further calculated the corresponding morbidity burden due to PM exposure. During the study period, the daily mean level for PM2.5 and PM10 was 57.3 μg/m3 and 94.7 μg/m3, respectively. For broad disease categories, each 10 μg/m3 increase in PM10 at lag06 was associated with increments of 0.65% (95% CI: 0.32%-0.99%) in HAs from respiratory, 0.49% (95% CI: 0.04%-0.95%) from circulatory and 0.91% (95% CI: 0.15%-1.69%) from skin and subcutaneous tissue diseases. By contrast, only respiratory HAs showed a significant positive association with elevated PM2.5 at lag06 (1.03% increase per 10 μg/m3, 95% CI: 0.50%-1.56%, p < 0.001). Increased HAs risks for several more refined specific causes within respiratory, circulatory, skin and subcutaneous tissue, nervous and genitourinary diseases were also observed. Subgroup analyses indicated that effect estimates were modified by age, gender and season. Overall, the largest morbidity burden was observed in myocardial infarction, about 11.27% (95% CI: 3.45%-18.07%) and 11.11% (95% CI: 4.07%-17.27%) of HAs for myocardial infarction could be attributable to PM2.5 and PM10 levels exceeding the WHO's air quality guidelines (24-h mean: 25 μg/m3 for PM2.5 and 50 μg/m3 for PM10). Our study suggests that both PM2.5 and PM10 increase risks of morbidity from broad range of causes of HAs in Chengdu, and result in substantial morbidity burden.
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Affiliation(s)
- Xiaojuan Zhu
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China; Center for Artificial Intelligence and Smart Health, School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Hang Qiu
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China; Center for Artificial Intelligence and Smart Health, School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China.
| | - Liya Wang
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhanqi Duan
- Health and Family Planning Information Center of Sichuan Province, Chengdu, China
| | - Haiyan Yu
- School of Economics and Management, Chongqing University of Posts and Telecommunications, Chongqing, China; Department of Statistics, The Pennsylvania State University, University Park, PA, USA
| | - Ren Deng
- Health and Family Planning Information Center of Sichuan Province, Chengdu, China
| | - Yanlong Zhang
- Chengdu Shulianyikang Technology Co., Ltd, Chengdu, China
| | - Li Zhou
- Health and Family Planning Information Center of Sichuan Province, Chengdu, China.
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Bao X, Tian X, Yang C, Li Y, Hu Y. Association between ambient air pollution and hospital admission for epilepsy in Eastern China. Epilepsy Res 2019; 152:52-58. [PMID: 30909052 DOI: 10.1016/j.eplepsyres.2019.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 01/26/2019] [Accepted: 02/24/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND We aimed to study the short-term association between air pollutants and hospitalization for epilepsy in 47 hospitals from 10 cities in eastern China. METHOD We identified hospital epilepsy admissions in 2014 and 2015. A conditional Poisson regression model was used to examine the association between air pollutants and hospital admission, with temperature and relative humidity adjusted using the natural spline (ns) function. Pollutants included sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and particulate matter (PM). The association was stratified by sex, age, and geographic region in single-pollutant and two-pollutant models. RESULTS An interquartile (IQR) increase of NO2 and CO on the concurrent day is correlated with an increased admission of 2.0% (0.5%, 3.6%) and 1.1% (0.1%, 2.1%), respectively. The association is stronger in children (≤18 years) and in northern China, but did not vary with sex. A positive association was also observed on the previous day for CO [1.5%, 95% confidence interval (CI): 0.3%, 2.6%], NO2 (2.5%, 95% CI: 0.6%, 4.3%), and PM2.5 (1.32%, 95% CI: 0.16%, 2.48%). Moving average concentration of 7 days for all pollutants was associated with decreased admission (CO: -1.29%, NO2: -0.4.69%, SO2:-2.12%, PM2.5:-0.98%, PM10:-1.70%). CONCLUSION Exposures to NO2 and CO on concurrent days, and PM2.5 on the previous day, are associated with increased epilepsy hospitalization, whereas cumulative exposure appeared protective.
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Affiliation(s)
- Xiaoyuan Bao
- Medical Informatics Center, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China.
| | - Xin Tian
- Department of Health Policy and Administration, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China.
| | - Chao Yang
- Renal Division, Peking University First Hospital, Peking Uni versity Institute of Nephrology, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Yan Li
- Department of Hospital Management, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China.
| | - Yonghua Hu
- Medical Informatics Center, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China; Department of Epidemiology and Biostatistics, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China.
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Zhu Z, Chen X, Sun J, Li Q, Lian X, Li S, Wang Y, Tian L. Inhibition of nuclear thioredoxin aggregation attenuates PM 2.5-induced NF-κB activation and pro-inflammatory responses. Free Radic Biol Med 2019; 130:206-214. [PMID: 30420332 DOI: 10.1016/j.freeradbiomed.2018.10.438] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 11/17/2022]
Abstract
Exposure to fine particulate matter (PM2.5) can induce oxidative stress and proinflammatory cytokine production, which are central for the induction of PM2.5-mediated adverse effects on public health. Nuclear factor kappa B (NF-κB) signaling is essential for inflammation. The subcellular distribution of thioredoxin (Trx) is related to the activation of NF-κB, but the mechanism involved is unclear. In the current study, we focused on the relationship between the antioxidant Trx and NF-κB in human bronchial epithelial cells (BEAS-2B) after PM2.5 exposure. We inhibited the nuclear translocation of Trx by cHCEU (4-cyclohexyl-[3-(2-chloroethyl)ureido]benzene) and subsequently increased the transcriptional activity of Nrf2 to upregulate the expression of Trx by t-BHQ. Our data suggest that PM2.5 exposure induces the activation of NF-κB and the expression of the downstream proinflammatory cytokines IL-1, IL-6, IL-8 and TNF-α in BEAS-2B cells. CHCEU alleviates inflammatory cytokines by blocking Trx nuclear translocation and inhibits the DNA binding activity of NF-κB. T-BHQ could promote the transcriptional activity of Nrf2 but failed to alleviate the production of inflammatory cytokines. Furthermore, the synergistic effect of t-BHQ and cHCEU on alleviating PM2.5-induced inflammation is more effective than the use of cHCEU alone. Our findings characterize the underlying molecular mechanisms of proinflammatory responses induced by PM2.5 and show that the nuclear translocation and accumulation of Trx in nuclei play important roles in PM2.5-induced NF-κB activation and proinflammatory responses.
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Affiliation(s)
- Zhonghui Zhu
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Xiaowei Chen
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Jingping Sun
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Qiuyue Li
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Ximeng Lian
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Siling Li
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Yan Wang
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Lin Tian
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China.
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Tian Y, Liu H, Zhao Z, Xiang X, Li M, Juan J, Song J, Cao Y, Wang X, Chen L, Wei C, Hu Y, Gao P. Association between ambient air pollution and daily hospital admissions for ischemic stroke: A nationwide time-series analysis. PLoS Med 2018; 15:e1002668. [PMID: 30286080 PMCID: PMC6171821 DOI: 10.1371/journal.pmed.1002668] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 09/07/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Evidence of the short-term effects of ambient air pollution on the risk of ischemic stroke in low- and middle-income countries is limited and inconsistent. We aimed to examine the associations between air pollution and daily hospital admissions for ischemic stroke in China. METHODS AND FINDINGS We identified hospital admissions for ischemic stroke in 2014-2016 from the national database covering up to 0.28 billion people who received Urban Employee Basic Medical Insurance (UEBMI) in China. We examined the associations between air pollution and daily ischemic stroke admission using a two-stage method. Poisson time-series regression models were firstly fitted to estimate the effects of air pollution in each city. Random-effects meta-analyses were then conducted to combine the estimates. Meta-regression models were applied to explore potential effect modifiers. More than 2 million hospital admissions for ischemic stroke were identified in 172 cities in China. In single-pollutant models, increases of 10 μg/m3 in particulate matter with aerodynamic diameter <2.5 μm (PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3) and 1 mg/m3 in carbon monoxide (CO) concentrations were associated with 0.34% (95% confidence interval [CI], 0.20%-0.48%), 1.37% (1.05%-1.70%), 1.82% (1.45%-2.19%), 0.01% (-0.14%-0.16%), and 3.24% (2.05%-4.43%) increases in hospital admissions for ischemic stroke on the same day, respectively. SO2 and NO2 associations remained significant in two-pollutant models, but not PM2.5 and CO associations. The effect estimates were greater in cities with lower air pollutant levels and higher air temperatures, as well as in elderly subgroups. The main limitation of the present study was the unavailability of data on individual exposure to ambient air pollution. CONCLUSIONS As the first national study in China to systematically examine the associations between short-term exposure to ambient air pollution and ischemic stroke, our findings indicate that transient increase in air pollution levels may increase the risk of ischemic stroke, which may have significant public health implications for the reduction of ischemic stroke burden in China.
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Affiliation(s)
- Yaohua Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Hui Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Medical Informatics Center, Peking University, Beijing, China
| | - Zuolin Zhao
- Beijing HealthCom Data Technology Co. Ltd, Beijing, China
| | - Xiao Xiang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Man Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Juan Juan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jing Song
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yaying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Xiaowen Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Libo Chen
- Beijing HealthCom Data Technology Co. Ltd, Beijing, China
| | - Chen Wei
- Beijing HealthCom Data Technology Co. Ltd, Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- * E-mail: (YH); (PG)
| | - Pei Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- * E-mail: (YH); (PG)
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Liu H, Tian Y, Xiang X, Li M, Wu Y, Cao Y, Juan J, Song J, Wu T, Hu Y. Association of short-term exposure to ambient carbon monoxide with hospital admissions in China. Sci Rep 2018; 8:13336. [PMID: 30190544 PMCID: PMC6127141 DOI: 10.1038/s41598-018-31434-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/20/2018] [Indexed: 12/20/2022] Open
Abstract
Evidence on the acute effects of ambient carbon monoxide (CO) pollution on morbidity risk in developing countries is scarce and inconsistent. We conducted a multicity case-crossover study in 26 largest cities in China from January, 2014 to December, 2015 to examine the association between short-term exposure to CO and daily hospital admission. We fitted conditional logistic regression to obtain effect estimates of the associations. We also performed subset analyses to explore the health effects of CO at low levels. During the study period, a total of 14,569,622, 2,008,786 and 916,388 all-cause, cardiovascular and respiratory admissions were identified, respectively. A 1 mg/m3 increase in the CO concentrations corresponded to a 3.75% (95% CI, 3.63–3.87%), 4.39% (95% CI, 4.07–4.70%), and 4.44% (95% CI, 3.97–4.92%) increase in all-cause, cardiovascular, and respiratory admissions on the same day, respectively. The associations were robust to controlling for criteria co-pollutants. In subset analyses, negative effects of short-term CO exposure on hospital admission were observed at lower concentrations (<1 mg/m3), while positive effects were observed at higher concentrations (>2 mg/m3). In conclusion, current CO levels in China were significantly associated with increased daily hospital admissions.
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Affiliation(s)
- Hui Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China.,Medical Informatics Center, Peking University, No.38 Xueyuan Road, 100191, Beijing, China
| | - Yaohua Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China
| | - Xiao Xiang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China
| | - Man Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China
| | - Yao Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China
| | - Yaying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China
| | - Juan Juan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China
| | - Jing Song
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China
| | - Tao Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China.
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China.
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Ambient Particulate Matter Concentrations and Hospital Admissions in 26 of China’s Largest Cities. Epidemiology 2018; 29:649-657. [DOI: 10.1097/ede.0000000000000869] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zheng Q, Liu H, Zhang J, Chen D. The effect of ambient particle matters on hospital admissions for cardiac arrhythmia: a multi-city case-crossover study in China. Environ Health 2018; 17:60. [PMID: 30012150 PMCID: PMC6048711 DOI: 10.1186/s12940-018-0404-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 06/29/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND The relationship between particle matters (PMs) and cardiac arrhythmia has been investigated in numerous studies. However, evidence from developing countries is limited. The aim of this study was to evaluate the association between ambient PMs and hospital admissions for cardiac arrhythmia in China and to examine the potential effect modifiers. METHODS A time-stratified case-crossover analysis was conducted in 26 large Chinese cities. In total, we identified 175,265 hospital admissions for cardiac arrhythmia between January 2014 and December 2015 from electronic hospitalization summary reports. Conditional logistic regression was performed to estimate the percentage changes in cardiac arrhythmia admissions in relation to interquartile range increases in air pollutants. Age, gender and prespecified comorbid health conditions including hypertension, diabetes, congestive heart failure and hyperlipidemia were stratified to evaluate susceptibility factors. RESULTS PMs levels were positively associated with the number of hospital admissions for cardiac arrhythmia. Both PM2.5 and PM10 had the strongest impact on lag 2 days. An interquartile range increase in PM2.5 (47.5 μg/m3) and PM10 (76.9 μg/m3) concentrations on lag 2 days was associated with increments of 2.09% (95%CI, 1.58-2.60%) and 2.33% (95%CI, 1.68-2.97%) in hospital admission for cardiac arrhythmia, respectively. Evidence of effect modification by age and comorbid diabetes was observed. The elderly (> 65 years) and patients with comorbid diabetes were more likely to be hospitalized for cardiac arrhythmia following exposure to high levels of PMs. CONCLUSIONS This study found an increased risk of arrhythmia admissions associated with PM2.5 and PM10 levels among 26 Chinese cities. The associations of PMs with arrhythmia admissions were stronger in aged population and people with diabetes.
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Affiliation(s)
- Qiwen Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Hui Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
- Medical Informatics Center, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Jun Zhang
- Department of Neurology, Peking University People's Hospital, No.11 South Xizhimen Street, Xicheng District, Beijing, 100044, China.
| | - Dafang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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Nakao M, Ishihara Y, Kim CH, Hyun IG. The Impact of Air Pollution, Including Asian Sand Dust, on Respiratory Symptoms and Health-related Quality of Life in Outpatients With Chronic Respiratory Disease in Korea: A Panel Study. J Prev Med Public Health 2018; 51:130-139. [PMID: 29886708 PMCID: PMC5996190 DOI: 10.3961/jpmph.18.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/17/2018] [Indexed: 11/09/2022] Open
Abstract
Objectives Air pollution is a growing concern in Korea because of transboundary air pollution from mainland China. A panel study was conducted to clarify the effects of air pollution on respiratory symptoms and health-related quality of life (HR-QoL) in outpatients with and without chronic obstructive pulmonary disease (COPD) in Korea. Methods Patients filled out a questionnaire including self-reported HR-QoL in February and were followed up in May and July. The study was conducted from 2013 to 2015, with different participants each year. Air quality parameters were applied in a generalized estimating equation as independent variables to predict factors affecting HR-QoL. Results Lower physical fitness scores were associated with Asian sand dust events. Daily activity scores were worse when there were high concentrations of particulate matter (PM) less than 10 μm in diameter (PM10). Lower social functioning scores were associated with high PM less than 2.5 μm in diameter and nitrogen dioxide (NO2) concentrations. High NO2 concentrations also showed a significant association with mental health scores. Weather-related cough was prevalent when PM10, NO2, or ozone (O3) concentrations were high, regardless of COPD severity. High PM10 concentrations were associated with worsened wheezing, particularly in COPD patients. Conclusions The results suggest that PM, NO2, and O3 cause respiratory symptoms leading to HR-QoL deterioration. While some adverse effects of air pollution appeared to occur regardless of COPD, others occurred more often and more intensely in COPD patients. The public sector, therefore, needs to consider tailoring air pollution countermeasures to people with different conditions to minimize adverse health effects.
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Affiliation(s)
- Motoyuki Nakao
- Department of Public Health, Kurume University School of Medicine, Kurume, Japan
| | - Yoko Ishihara
- Department of Public Health, Kurume University School of Medicine, Kurume, Japan
| | - Cheol-Hong Kim
- Department of Internal Medicine, Respiratory Health Center, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - In-Gyu Hyun
- Department of Internal Medicine, Respiratory Health Center, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
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Wang F, Liu H, Li H, Liu J, Guo X, Yuan J, Hu Y, Wang J, Lu L. Ambient concentrations of particulate matter and hospitalization for depression in 26 Chinese cities: A case-crossover study. ENVIRONMENT INTERNATIONAL 2018; 114:115-122. [PMID: 29500987 DOI: 10.1016/j.envint.2018.02.012] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Air pollution with high ambient concentrations of particulate matter (PM) has been frequently reported in China. However, no Chinese study has looked into the short-term effect of PM on hospitalization for depression. We used a time-stratified case-crossover design to identify possible links between ambient PM levels and hospital admissions for depression in 26 Chinese cities. METHODS Electronic hospitalization summary reports (January 1, 2014-December 31, 2015) were used to identify hospital admissions related to depression. Conditional logistic regression was applied to determine the association between PM levels and hospitalizations for depression, with stratification by sex, age, and comorbidities. RESULTS Both PM2.5 and PM10 levels were positively associated with the number of hospital admissions for depression. The strongest effect was observed on the day of exposure (lag day 0) for PM10, with an interquartile range increase in PM10 associated with a 3.55% (95% confidence interval: 1.69-5.45) increase in admissions for depression. For PM2.5, the risks of hospitalization peaked on lag day 0 (2.92; 1.37-4.50) and lag day 5 (3.65; 2.09-5.24). The elderly (>65) were more sensitive to PM2.5 exposure (9.23; 5.09-13.53) and PM10 exposure (6.35; 3.31-9.49) on lag day 0, and patients with cardiovascular disease were likely to be hospitalized for depression following exposure to high levels of PM10 (4.47; 2.13-6.85). CONCLUSIONS Short-term elevations in PM may increase the risk of hospitalization for depression, particularly in the elderly and in patients with cardiovascular disease.
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Affiliation(s)
- Feng Wang
- Peking University Sixth Hospital/Institute of Mental Health, 100191 Beijing, China; National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), 100191 Beijing, China; Key Laboratory of Mental Health, Ministry of Health, Peking University, 100191 Beijing, China.
| | - Hui Liu
- Peking University Medical Informatics Center, Peking University, 100191 Beijing, China.
| | - Hui Li
- Peking University Sixth Hospital/Institute of Mental Health, 100191 Beijing, China; National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), 100191 Beijing, China; Key Laboratory of Mental Health, Ministry of Health, Peking University, 100191 Beijing, China.
| | - Jiajia Liu
- Peking University Sixth Hospital/Institute of Mental Health, 100191 Beijing, China; National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), 100191 Beijing, China; Key Laboratory of Mental Health, Ministry of Health, Peking University, 100191 Beijing, China.
| | - Xiaojie Guo
- Peking University Sixth Hospital/Institute of Mental Health, 100191 Beijing, China; National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), 100191 Beijing, China; Key Laboratory of Mental Health, Ministry of Health, Peking University, 100191 Beijing, China.
| | - Jie Yuan
- North China University of Science and Technology, 063000, Hebei Province, China.
| | - Yonghua Hu
- Peking University Medical Informatics Center, Peking University, 100191 Beijing, China.
| | - Jing Wang
- Peking University Medical Informatics Center, Peking University, 100191 Beijing, China.
| | - Lin Lu
- Peking University Sixth Hospital/Institute of Mental Health, 100191 Beijing, China; National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), 100191 Beijing, China; Key Laboratory of Mental Health, Ministry of Health, Peking University, 100191 Beijing, China.
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Yu Y, Dong H, Yao S, Ji M, Yao X, Zhang Z. Protective Effects of Ambient Ozone on Incidence and Outcomes of Ischemic Stroke in Changzhou, China: A Time-Series Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121610. [PMID: 29261153 PMCID: PMC5751026 DOI: 10.3390/ijerph14121610] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/22/2017] [Accepted: 12/19/2017] [Indexed: 12/16/2022]
Abstract
The potential beneficial effect of ozone (O3) on stroke had been identified experimentally and clinically, but these effects remain controversial in population-based studies. This study aimed to explore the epidemiological association between O3 and risk of ischemic stroke. Ischemic stroke related health data and air pollution data were obtained from the Center for Disease Control and Prevention and Environmental Monitoring Center in Changzhou between 2015 and 2016, respectively. The associations between the short-term exposure to O3 and daily ischemic stroke onsets and deaths were examined based on time-series generalized additive Poisson model. During the study period, daily ischemic stroke onsets and deaths decreased 0.340% (95% confidence interval (CI) −0.559% to −0.120%) and 0.697% (95% CI −1.103% to −0.290%) with an interquartile range (IQR) (41.1 µg/m3) increase in levels of ambient O3, respectively. The protective effects of O3 were more significant in men and elders and in the cool season than those in women and young people and in the warm season, respectively. The negative association was independent of PM2.5, PM10, SO2, NO2 or CO exposure. Acute O3 exposure was associated with decreased risk of ischemic stroke. These findings will help provide new insights into the relationship between ischemic stroke and ambient O3 concentrations.
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Affiliation(s)
- Yongquan Yu
- Department of Occupational Medicine and Environmental Health, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China.
| | - Huibin Dong
- Department of Chronic Disease Control and Prevention, Changzhou Center for Disease Control and Prevention, 203 Taishan Road, Changzhou 213022, China.
| | - Shen Yao
- Department of Occupational Medicine and Environmental Health, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China.
| | - Minghui Ji
- Department of Occupational Medicine and Environmental Health, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China.
| | - Xingjuan Yao
- Department of Chronic Disease Control and Prevention, Changzhou Center for Disease Control and Prevention, 203 Taishan Road, Changzhou 213022, China.
| | - Zhan Zhang
- Department of Hygiene Analysis and Detection, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China.
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Effect of short-term exposure to ambient air particulate matter on incidence of delirium in a surgical population. Sci Rep 2017; 7:15461. [PMID: 29133855 PMCID: PMC5684401 DOI: 10.1038/s41598-017-15280-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/09/2017] [Indexed: 02/06/2023] Open
Abstract
Delirium remains an independent risk factor for morbidity and mortality among older surgical adults. Recent research has shed light on the relationship between pollution and dementia, yet little is known about the health impacts of particulate matter (PM) on delirium. Therefore, we aim to further explore association of PM and delirium among surgical population. We conducted a time-stratified case-crossover study. Electronic hospitalization summary reports derived from 26 major cities in China between 1 January 2014 and 31 December 2015 were used. Conditional logistic regression were applied to explore the association between perioperative PM exposure and delirium. A total of 559 surgical patients with delirium were identified. Both PM2.5 and SO2 on the day of surgery had a negative impact, with an interquartile range (IQR) increase in PM2.5 (47.5 μg/m3) and SO2 (22.2 μg/m3) significantly associated with an 8.79% (95% confidence interval [CI], 0.01–18.47%, P < 0.05) and 16.83% (95% CI, 0.10–36.35%, P < 0.05) increase in incidence of delirium, respectively. PM on other days during the perioperative period showed no significant impact. The present study showed that short-term exposure to ambient air PM on the day of surgery increased the incidence of delirium in a surgical population during hospitalization.
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