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Guo Y, Luo C, Cao F, Liu J, Yan J. Short-term environmental triggers of hemorrhagic stroke. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 265:115508. [PMID: 37774546 DOI: 10.1016/j.ecoenv.2023.115508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Abstract
Hemorrhagic stroke (HS) is associated with severe morbidity and high mortality. Identifying the trigger factors for HS is critical for disease prevention. This study aimed to assess the associations between short-term environmental triggers (STETs) and HS risk. We systematically searched six databases for articles published up to September 9, 2022. Pooled odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using random-effect models to evaluate the associations between STETs and the risk of HS. Heterogeneity was assessed using Cochran Q and I2 tests. A total of 63 studies were included for analysis. Of these, 40 focused on air pollutants and 23 on meteorological factors. Pooling results showed that exposure to particulate matter 2.5 (PM2.5; OR, 1.003 per 10 μg/m3; 95% CI, 1.001-1.007), sulfur dioxide (SO2; OR, 1.022 per 10 ppb; 95% CI, 1.005-1.040), and nitrogen dioxide (NO2; OR, 1.026 per 10 ppb; 95% CI, 1.004-1.047) was associated with an increase in HS risk. Moreover, exposure to PM2.5 (OR, 1.018 per 10 μg/m3; 95% CI, 1.009-1.027) and SO2 (OR, 1.102 per 10 ppb; 95% CI, 1.010-1.204) was positively associated with the risk of intracerebral hemorrhage. In addition, extreme temperature, high pressures, high and low relative humidity were potentially associated with HS risk. Targeted preventive measures to limit the effect of these air pollutants and extreme meteorological factors should be taken to reduce the HS disease burden. Further studies are warranted to verify these findings.
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Affiliation(s)
- Yuxin Guo
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, Hunan 410078, China
| | - Chun Luo
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, Hunan 410078, China
| | - Fang Cao
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, Hunan 410078, China
| | - Junyu Liu
- Department of Neurosurgery, XiangYa Hospital, Central South University, Changsha 410008, China; Department of Pharmacology, Kyoto University Graduate School of Medicine, Kyoto 606-8501, Japan.
| | - Junxia Yan
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, Hunan 410078, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, XiangYa School of Public Health, Central South University, Changsha 410078, China.
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Oktay MM, Al B, Boğan M, Kul S, Gümüşboğa H, Bayram H. Impact of desert dust storms, PM 10 levels and daily temperature on mortality and emergency department visits due to stroke. Front Public Health 2023; 11:1218942. [PMID: 37780446 PMCID: PMC10540066 DOI: 10.3389/fpubh.2023.1218942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023] Open
Abstract
Objective It is known that the inhalation of air pollutants adversely affects human health. These air pollutants originated from natural sources such as desert storms or human activities including traffic, power generating, domestic heating, etc. This study aimed to investigate the impacts of desert dust storms, particulate matter ≤10 μm (PM10) and daily maximum temperature (MT) on mortality and emergency department (ED) visits due to stroke in the city of Gaziantep, Southeast Turkey. Method The data on mortality and ED visits due to stroke were retrospectively recruited from January 1, 2009, to March 31, 2014, in Gaziantep City Centre. Results PM10 levels did not affect ED visits or mortality due to stroke; however, MT increased both ED visits [adjusted odds ratio (OR) = 1.002, 95% confidence interval (CI) = 1.001-1.003] and mortality (OR = 1.006, 95% CI = 0.997-1.014) due to stroke in women. The presence of desert storms increased ED visits due to stroke in the total population (OR = 1.219, 95% CI = 1.199-1.240), and all subgroups. It was observed that desert dust storms did not have an increasing effect on mortality. Conclusion Our findings suggest that MT and desert dust storms can induce morbidity and mortality due to stroke.
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Affiliation(s)
- M. Murat Oktay
- Emergency Department, School of Medicine, Gaziantep Islam Science and Technology University, Gaziantep, Türkiye
- Department of Emergency Medicine, School of Medicine, Gaziantep University, Gaziantep, Türkiye
| | - Behcet Al
- Department of Emergency Medicine, School of Medicine, Gaziantep University, Gaziantep, Türkiye
- Emergency Department, School of Medicine, Istanbul Medeniyet University, Istanbul, Türkiye
| | - Mustafa Boğan
- Department of Emergency Medicine, School of Medicine, Gaziantep University, Gaziantep, Türkiye
- Emergency Department, School of Medicine, Düzce University, Düzce, Türkiye
| | - Seval Kul
- Biostatistics Department, School of Medicine, Gaziantep University, Gaziantep, Türkiye
| | - Hasan Gümüşboğa
- Department of Emergency Medicine, School of Medicine, Gaziantep University, Gaziantep, Türkiye
- Emergency Department, Şehitkamil State Hospital, Gaziantep, Türkiye
| | - Hasan Bayram
- Department of Pulmonary Medicine, School of Medicine, Koç University, Istanbul, Türkiye
- Department of Pulmonary Medicine, School of Medicine, Gaziantep University, Gaziantep, Türkiye
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Koo GPY, Zheng H, Aik JCL, Tan BYQ, Sharma VK, Sia CH, Ong MEH, Ho AFW. Clustering of Environmental Parameters and the Risk of Acute Ischaemic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4979. [PMID: 36981888 PMCID: PMC10049712 DOI: 10.3390/ijerph20064979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/05/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
Acute ischaemic stroke (AIS) risk on days with similar environmental profiles remains unknown. We investigated the association between clusters of days with similar environmental parameters and AIS incidence in Singapore. We grouped calendar days from 2010 to 2015 with similar rainfall, temperature, wind speed, and Pollutant Standards Index (PSI) using k-means clustering. Three distinct clusters were formed 'Cluster 1' containing high wind speed, 'Cluster 2' having high rainfall, and 'Cluster 3' having high temperatures and PSI. We aggregated the number of AIS episodes over the same period with the clusters and analysed their association using a conditional Poisson regression in a time-stratified case-crossover design. Comparing the three clusters, Cluster 3 had the highest AIS occurrence (IRR 1.09; 95% confidence interval (CI) 1.05-1.13), with no significant difference between Clusters 1 and 2. Subgroup analyses in Cluster 3 showed that AIS risk was amplified in the elderly (≥65 years old), non-smokers, and those without a history of ischaemic heart disease/atrial fibrillation/vascular heart disease/peripheral vascular disease. In conclusion, we found that AIS incidence may be higher on days with higher temperatures and PSI. These findings have important public health implications for AIS prevention and health services delivery during at-risk days, such as during the seasonal transboundary haze.
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Affiliation(s)
| | - Huili Zheng
- National Registry of Diseases Officer, Health Promotion Board, Singapore 168937, Singapore
| | - Joel C. L. Aik
- Environmental Epidemiology and Toxicology Division, Environmental Health Institute, National Environment Agency, Singapore 228231, Singapore
- Pre-Hospital & Emergency Research Center, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Benjamin Y. Q. Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Vijay K. Sharma
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Ching Hui Sia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
| | - Marcus E. H. Ong
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Andrew F. W. Ho
- Pre-Hospital & Emergency Research Center, Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
- Centre of Population Health Research and Implementation, SingHealth Regional Health System, Singapore 168753, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
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Liu T, Jiang Y, Hu J, Li Z, Li X, Xiao J, Yuan L, He G, Zeng W, Rong Z, Zhu S, Ma W, Wang Y. Joint Associations of Short-Term Exposure to Ambient Air Pollutants with Hospital Admission of Ischemic Stroke. Epidemiology 2023; 34:282-292. [PMID: 36722811 DOI: 10.1097/ede.0000000000001581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studies have estimated the associations of short-term exposure to ambient air pollution with ischemic stroke. However, the joint associations of ischemic stroke with air pollution as a mixture remain unknown. METHODS We employed a time-stratified case-crossover study to investigate 824,808 ischemic stroke patients across China. We calculated daily mean concentrations of particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5), maximum 8-h average for O3 (MDA8 O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide (CO) across all monitoring stations in the city where the IS patients resided. We conducted conditional logistic regression models to estimate the exposure-response associations. RESULTS Results from single-pollutant models showed positive associations of hospital admission for ischemic stroke with PM2.5 (excess risk [ER] = 0.38%, 95% confidence interval [CI]: 0.29% to 0.47%, for 10 μg/m3), MDA8 O3 (ER = 0.29%, 95% CI: 0.18% to 0.40%, for 10 μg/m3), NO2 (ER = 1.15%, 95% CI: 0.92% to 1.39%, for 10 μg/m3), SO2 (ER = 0.82%, 95% CI: 0.53% to 1.11%, for 10 μg/m3) and CO (ER = 3.47%, 95% CI: 2.70% to 4.26%, for 1 mg/m3). The joint associations (ER) with all air pollutants (for interquartile range width increases in each pollutant) estimated by the single-pollutant model was 8.73% and was 4.27% by the multipollutant model. The joint attributable fraction of ischemic stroke attributable to air pollutants based on the multipollutant model was 7%. CONCLUSIONS Short-term exposures to PM2.5, MDA8 O3, NO2, SO2, and CO were positively associated with increased risks of hospital admission for ischemic stroke. The joint associations of air pollutants with ischemic stroke might be overestimated using single-pollutant models. See video abstract at, http://links.lww.com/EDE/C8.
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Affiliation(s)
- Tao Liu
- From the Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, 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 Tiantan Hospital, Capital Medical University, 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 Tiantan Hospital, Capital Medical University, 100070, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 100070, China
| | - 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
| | - Zuhua Rong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430; China
| | - Sui Zhu
- From the Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
- Disease Control and Prevention Institute of Jinan University, Jinan University, Guangzhou 510632, China
| | - Wenjun Ma
- From the Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
- Disease Control and Prevention Institute of Jinan University, Jinan University, Guangzhou 510632, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, 100070, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 100070, China
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Sîrbu CA, Stefan I, Dumitru R, Mitrica M, Manole AM, Vasile TM, Stefani C, Ranetti AE. Air Pollution and Its Devastating Effects on the Central Nervous System. Healthcare (Basel) 2022; 10:1170. [PMID: 35885697 PMCID: PMC9324939 DOI: 10.3390/healthcare10071170] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Air pollution is a real public health problem, it being one of the five most common causes of mortality in developing countries. However, pollution studies have focused on the cardiovascular and pulmonary systems in recent decades. Recently, researchers have moved towards a new direction, tracing a direct link between pollution and stroke. Stroke has many known risk factors such as smoking, a sedentary lifestyle, and hypertension. Pollution is universally widespread, already a matter of public interest, so that, although intuitive, it is difficult to connect the two. The particles found in the air that we breathe, regardless of their origin, can attack the body in different ways, causing inflammation, and triggering a true cascade of phenomena that end up attacking the central nervous system and other organs. This article tries to explain the series of phenomena that determine the harmful effect of particles present in the air, with an increased focus on the central nervous system and especially on strokes. A deeper understanding of these phenomena helps in guiding future studies and finding viable solutions to protect people at risk.
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Affiliation(s)
- Carmen Adella Sîrbu
- Department of Neurology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010242 Bucharest, Romania; (C.A.S.); (R.D.)
| | - Ion Stefan
- Department of Infectious Diseases, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010242 Bucharest, Romania
- Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 031593 Bucharest, Romania
| | - Rodica Dumitru
- Department of Neurology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010242 Bucharest, Romania; (C.A.S.); (R.D.)
| | - Marian Mitrica
- Clinical Neurosciences Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania;
| | - Aida Mihaela Manole
- Department of Neurology, Clinical Ambulatory, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010242 Bucharest, Romania;
| | - Titus Mihai Vasile
- Clinical Neurosciences Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania;
| | - Constantin Stefani
- Department of Family Medicine and Clinical Base, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010242 Bucharest, Romania;
- Department No. 5, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Aurelian Emil Ranetti
- Department No. 2, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania;
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Short-Term Effects of Low-Level Ambient Air NO 2 on the Risk of Incident Stroke in Enshi City, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116683. [PMID: 35682266 PMCID: PMC9180296 DOI: 10.3390/ijerph19116683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/19/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022]
Abstract
Previous studies found that exposure to ambient nitrogen dioxide (NO2) was associated with an increased risk of incident stroke, but few studies have been conducted for relatively low NO2 pollution areas. In this study, the short-term effects of NO2 on the risk of incident stroke in a relatively low-pollution area, Enshi city of Hubei Province, China, were investigated through time-series analysis. Daily air-pollution data, meteorological data, and stroke incidence data of residents in Enshi city from 1 January 2015 to 31 December 2018 were collected. A time-series analysis using a generalised additive model (GAM) based on Poisson distribution was applied to explore the short-term effects of low-level NO2 exposure on the risk of incident stroke and stroke subtypes, as well as possible age, sex, and seasonal differences behind the effects. In the GAM model, potential confounding factors, such as public holidays, day of the week, long-term trends, and meteorological factors (temperature and relative humidity), were controlled. A total of 9122 stroke incident cases were included during the study period. We found that NO2 had statistically significant effects on the incidence of stroke and ischemic stroke, estimated by excess risk (ER) of 0.37% (95% CI: 0.04–0.70%) and 0.58% (95% CI: 0.18–0.98%), respectively. For the cumulative lag effects, the NO2 still had a statistically significant effect on incident ischemic stroke, estimated by ER of 0.61% (95% CI: 0.01–1.21%). The two-pollutant model showed that the effects of NO2 on incident total stroke were still statistically significant after adjusting for other air pollutants (PM2.5, PM10, SO2, CO, and O3). In addition, the effects of NO2 exposure on incident stroke were statistically significant in elderly (ER = 0.75%; 95% CI: 0.11–1.40%), males (ER = 0.47%; 95% CI: 0.05–0.89%) and cold season (ER = 0.83%; 95% CI: 0.15–1.51%) subgroups. Our study showed that, as commonly observed in high-pollution areas, short-term exposure to low-level NO2 was associated with an increased risk of incident stroke, including ischemic stroke. Males and elderly people were more vulnerable to the effects of NO2, and the adverse effects might be promoted in the cold season.
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Elser H, Chen KT, Arteaga D, Reimer R, Picciotto S, Costello S, Eisen EA. Metalworking Fluid Exposure and Stroke Mortality Among US Autoworkers. Am J Epidemiol 2022; 191:1040-1049. [PMID: 35029630 PMCID: PMC9393063 DOI: 10.1093/aje/kwac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/26/2021] [Accepted: 01/05/2022] [Indexed: 01/16/2023] Open
Abstract
Although air pollution is an important risk factor for stroke, few studies have considered the impact of workplace exposure to particulate matter (PM). We examined implications of exposure to PM composed of metalworking fluids (MWFs) for stroke mortality in the United Autoworkers-General Motors cohort. Cox proportional hazards models with age as the timescale were used to estimate the association of cumulative straight, soluble, and synthetic MWF exposure with stroke mortality, controlling for sex, race, plant, calendar year, and hire year. Among 38,553 autoworkers followed during 1941-1995, we identified 114 ischemic stroke deaths and 113 hemorrhagic stroke deaths. Overall stroke mortality risk was increased among workers in the middle exposure category for straight MWF (hazard ratio (HR) = 1.31, 95% confidence interval (CI): 0.87, 1.98) and workers in the highest exposure category for synthetic MWF (HR = 1.94, 95% CI: 1.13, 3.16) compared with workers who had no direct exposure. Ischemic stroke mortality risk was increased among workers in the highest exposure categories for straight MWF (HR = 1.45, 95% CI: 0.83, 2.52) and synthetic MWF (HR = 2.39, 95% CI: 1.39, 4.50). We observed no clear relationship between MWF exposure and hemorrhagic stroke mortality. Our results support a potentially important role for occupational PM exposures in stroke mortality and indicate the need for further studies of PM exposure and stroke in varied occupational settings.
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Affiliation(s)
- Holly Elser
- Correspondence to Dr. Holly Elser, Department of Neurology, 3 Gates, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (e-mail: )
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Weng L, Li N, Feng T, Zhu R, Zheng ZJ. Short-Term Association of Air Pollutant Levels and Hospital Admissions for Stroke and Effect Modification by Apparent Temperature: Evidence From Shanghai, China. Front Public Health 2021; 9:716153. [PMID: 34646803 PMCID: PMC8503471 DOI: 10.3389/fpubh.2021.716153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/23/2021] [Indexed: 11/19/2022] Open
Abstract
The epidemiological evidence on relationships between air pollution, temperature, and stroke remains inconclusive. Limited evidence is available for the effect modification by apparent temperature, an indicator reflecting reactions to the thermal environment, on short-term associations between air pollution and hospital admissions for stroke. We used a generalized additive model with Poisson regression to estimate the relative risk (RR) of stroke admissions in Shanghai, China, between 2014 and 2016 associated with air pollutants, with subgroup analyses by age, sex, apparent temperature, and season. During the study period, changes in the daily number of stroke admissions per 10 μg/m3 increase in nitrogen dioxide (at lags 0, 1, 0–1, and 0–2) ranged from 1.05 (95% CI: 0.82%, 2.88%) to 2.24% (95% CI: 0.84%, 3.65%). For each 10 μg/m3 increase in sulfur dioxide concentrations at lags 1, 2, 0–1, and 0–2, the RR of daily stroke admissions increased by 3.34 (95% CI: 0.955%, 5.79%), 0.32 (95% CI: −1.97%, 2.67%), 3.33 (95% CI: 0.38%, 6.37%), and 2.86% (95% CI: −0.45%, 6.28%), respectively. The associations of same-day exposure to nitrogen dioxide with stroke admissions remained significant after adjustment for ozone levels. These associations were not modified by sex, age, apparent temperature, or season. More research is warranted to determine whether apparent temperature modifies the associations between air pollution and stroke admissions.
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Affiliation(s)
- Lvkan Weng
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Chest Hospital, Shanghai, China
| | - Na Li
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Tienan Feng
- Clinic Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongjia Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University, Shanghai, China.,Clinic Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
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Relationship between Air Pollution and Hospital Admissions for Chronic Obstructive Pulmonary Disease in Changchun, China: A Season-Stratified Case-Cross Study. Can Respir J 2021; 2021:3240785. [PMID: 34326908 PMCID: PMC8302390 DOI: 10.1155/2021/3240785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/16/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to explore the relationship between air pollution and hospital admissions for COPD in Changchun, a northeast city of China, in different seasons. Methods The data on a total of 1,733 hospitalized patients living in Changchun with acute exacerbation of COPD from September 2013 to April 2018 were collected from a comprehensive 3A hospital of Changchun. Daily average concentrations of PM2.5, PM10, SO2, NO2, CO, and O3 were collected from the Department of Ecology and Environment of Jilin Province. The conditional logistic regression model was adopted to analyze the effect of air pollutant concentration on the number of hospitalized patients with COPD in different seasons. Results The maximum OR value for most air pollutants emitted in spring was on lag day 4, in summer and autumn on lag day 3, and in winter on lag day 2. In spring, SO2 and NO2 were entered into the regression equation, and the OR (95%CI) was 0.992 (0.986-0.998) and 1.009 (1.002-1.017); in autumn, PM2.5, PM10, and SO2 were entered into the regression equation, and the OR (95%CI) was 1.005 (1.000-1.011), 0.995 (0.991-1.000), and 1.006 (1.001-1.011), respectively; and in winter, PM2.5 and PM10 were entered into the regression equation, and the OR (95%CI) was 1.008 (1.002-1.015) and 0.994 (0.988-0.999), respectively. Conclusion The relationship between air pollution and hospital admission for COPD in Northeast China varies with different seasons. In spring, NO2 is likely to be the major risk factor for hospital admissions for COPD; in autumn, PM2.5 and SO2 are the major risk factors; and in winter, PM2.5 is the major risk factor.
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Yan Y, Chen X, Guo Y, Wu C, Zhao Y, Yang N, Dai J, Gong J, Xiang H. Ambient air pollution and cerebrovascular disease mortality: an ecological time-series study based on 7-year death records in central China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:27299-27307. [PMID: 33511535 DOI: 10.1007/s11356-021-12474-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
Most studies of short-term exposure to ambient air pollution and cerebrovascular diseases focused on specific stroke-related outcomes, and results were inconsistent due to data unavailability and limited sample size. It is unclear yet how ambient air pollution contributes to the total cardiovascular mortality in central China. Daily deaths from cerebrovascular diseases were obtained from the Disease Surveillance Point System (DSPs) of Wuhan Center for Disease Control and Prevention during the period from 2013 to 2019. Air pollution data were obtained from Wuhan Ecology and Environment Institute from 10 national air quality monitoring stations, including average daily PM2.5, PM10, SO2, NO2, and O3. Average daily temperature and relative humidity were obtained from Wuhan Meteorological Bureau. We performed a Poisson regression in generalized additive models (GAM) to examine the association between ambient air pollution and cerebrovascular disease mortality. We observed a total of 84,811 deaths from cerebrovascular diseases from 1 January 2013 to 31 December 2019 in Wuhan. Short-term exposure to PM2.5, PM10, SO2, and NO2 was positively associated with daily deaths from cerebrovascular diseases, and no significant association was found for O3. The largest effect on cerebrovascular disease mortality was found at lag0 for PM2.5 (ERR: 0.927, 95% CI: 0.749-1.105 per 10 μg/m3) and lag1 for PM10 (ERR: 0.627, 95% CI: 0.493-0.761 per 10 μg/m3), SO2 (ERR: 2.518, 95% CI: 1.914, 3.122 per 10 μg/m3), and NO2 (ERR: 1.090, 95% CI: 0.822-1.358 per 10 μg/m3). The trends across lags were statistically significant. The stratified analysis demonstrated that females were more susceptible to SO2 and NO2, while elder individuals aged above 65 years old, compared with younger people, suffered more from air pollution, especially from SO2. Short-term exposure to PM2.5, PM10, SO2, and NO2 were significantly associated with a higher risk of cerebrovascular disease mortality, and elder females seemed to suffer more from air pollution. Further research is required to reveal the underlying mechanisms.
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Affiliation(s)
- Yaqiong Yan
- Wuhan Centers for Disease Control and Prevention, No.288 Machang Road, Wuhan, China
| | - Xi Chen
- Wuhan Centers for Disease Control and Prevention, No.288 Machang Road, Wuhan, China
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Yan Guo
- Wuhan Centers for Disease Control and Prevention, No.288 Machang Road, Wuhan, China
| | - Chuangxin Wu
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Yuanyuan Zhao
- Wuhan Centers for Disease Control and Prevention, No.288 Machang Road, Wuhan, China
| | - Niannian Yang
- Wuhan Centers for Disease Control and Prevention, No.288 Machang Road, Wuhan, China
| | - Juan Dai
- Wuhan Centers for Disease Control and Prevention, No.288 Machang Road, Wuhan, China
| | - Jie Gong
- Wuhan Centers for Disease Control and Prevention, No.288 Machang Road, Wuhan, China.
| | - Hao Xiang
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China.
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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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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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13
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Kim H, Kim WH, Kim YY, Park HY. Air Pollution and Central Nervous System Disease: A Review of the Impact of Fine Particulate Matter on Neurological Disorders. Front Public Health 2020; 8:575330. [PMID: 33392129 PMCID: PMC7772244 DOI: 10.3389/fpubh.2020.575330] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/20/2020] [Indexed: 12/19/2022] Open
Abstract
Background: It is widely known that the harmful effects of fine dust can cause various diseases. Research on the correlation between fine dust and health has been mainly focused on lung and cardiovascular diseases. By contrast, the effects of air pollution on the central nervous system (CNS) are not broadly recognized. Findings: Air pollution can cause diverse neurological disorders as the result of inflammation of the nervous system, oxidative stress, activation of microglial cells, protein condensation, and cerebral vascular-barrier disorders, but uncertainty remains concerning the biological mechanisms by which air pollution produces neurological disease. Neuronal cell damage caused by fine dust, especially in fetuses and infants, can cause permanent brain damage or lead to neurological disease in adulthood. Conclusion: It is necessary to study the air pollution–CNS disease connection with particular care and commitment. Moreover, the epidemiological and experimental study of the association between exposure to air pollution and CNS damage is critical to public health and quality of life. Here, we summarize the correlations between fine dust exposure and neurological disorders reported so far and make suggestions on the direction future research should take.
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Affiliation(s)
- Hyunyoung Kim
- Division of Allergy and Respiratory Disease Research, Department of Chronic Disease Convergence Research, Korea National Institute of Health, Cheongju-si, South Korea
| | - Won-Ho Kim
- Division of Cardiovascular Disease Research, Department of Chronic Disease Convergence Research, Korea National Institute of Health, Cheongju-si, South Korea
| | - Young-Youl Kim
- Division of Allergy and Respiratory Disease Research, Department of Chronic Disease Convergence Research, Korea National Institute of Health, Cheongju-si, South Korea
| | - Hyun-Young Park
- Department of Precision Medicine, Korea National Institute of Health, Cheongju-si, South Korea
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14
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Li C, Li G. Does environmental regulation reduce China's haze pollution? An empirical analysis based on panel quantile regression. PLoS One 2020; 15:e0240723. [PMID: 33112878 PMCID: PMC7592848 DOI: 10.1371/journal.pone.0240723] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/02/2020] [Indexed: 11/18/2022] Open
Abstract
Haze pollution in China is very serious and has become the source of mortality, affecting the health and lives of residents. The Chinese government adopts different policy measures to reduce haze pollution. The impact of different types of environmental regulations on haze pollution has become a hot topic for academics and government departments. Based on panel data from 2005–2017, this paper studies the effect of different types of environmental regulations on haze pollution in 30 provinces of China using a panel quantile model. The results show that when haze pollution changes from a low quantile to a high quantile, the marginal impact of command-and-control environmental regulation on haze pollution changes from 0.122 to -0.332. Command-and-control environmental regulation can reduce haze pollution, but its impact is not significant. The main reason for this finding is that environmental law enforcement is not strict. The marginal impact of economically restrained environmental regulation on haze pollution changes from -14.389 to 49.939. Economically restrained environmental regulation can reduce haze pollution in low quantiles, but not in high quantiles. The collection of sewage charges fees is far less than the total profit, which has no deterrent effect on enterprises. The marginal impact of public participation in environmental regulation on haze pollution changes from 0.154 to -0.002. Public participation in environmental regulation cannot reduce haze pollution in low quantiles, but can in high quantiles; however its impact becomes insignificant. This study reveals the quantile-based discrepancy in the effect of environmental regulation on haze pollution, and offers a new perspective for research on the effects of environmental regulation.
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Affiliation(s)
- Congxin Li
- School of Economics, Hebei GEO University, Shijiazhuang, Hebei Province, China
| | - Guozhu Li
- School of Economics, Hebei GEO University, Shijiazhuang, Hebei Province, China
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15
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Byrne CP, Bennett KE, Hickey A, Kavanagh P, Broderick B, O’Mahony M, Williams DJ. Short-Term Air Pollution as a Risk for Stroke Admission: A Time-Series Analysis. Cerebrovasc Dis 2020; 49:404-411. [DOI: 10.1159/000510080] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/12/2020] [Indexed: 11/19/2022] Open
Abstract
Background: The harmful effects of outdoor air pollution on stroke incidence are becoming increasingly recognised. We examined the impact of different air pollutants (PM2.5, PM10, NO2, ozone, and SO2) on admission for all strokes in two Irish urban centres from 2013 to 2017. Methods: Using an ecological time series design with Poisson regression models, we analysed daily hospitalisation for all strokes and ischaemic stroke by residence in Dublin or Cork, with air pollution level monitoring data with a lag of 0–2 days from exposure. Splines of temperature, relative humidity, day of the week, and time were included as confounders. Analysis was also performed across all four seasons. Data are presented as relative risks (RRs) and 95% confidence intervals (95% CI) per interquartile range (IQR) increase in each pollutant. Results: There was no significant association between all stroke admission and any individual air pollutant. On seasonal analysis, during winter in the larger urban centre (Dublin), we found an association between all stroke cases and an IQR increase in NO2 (RR 1.035, 95% CI: 1.003–1.069), PM10 (RR 1.032, 95% CI: 1.007–1.057), PM2.5 (RR 1.024, 95% CI: 1.011–1.039), and SO2 (RR 1.035, 95% CI: 1.001–1.071). There was no significant association found in the smaller urban area of Cork. On meta-analysis, there remained a significant association between NO2 (RR 1.013, 95% CI: 1.001–1.024) and PM2.5 (1.009, 95% CI 1.004–1.014) per IQR increase in each. Discussion: Short-term air pollution in winter was found to be associated with hospitalisation for all strokes in a large urban centre in Ireland. As Ireland has relatively low air pollution internationally, this highlights the need to introduce policy changes to reduce air pollution in all countries.
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16
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Wang X, Yu C, Zhang Y, Shi F, Meng R, Yu Y. Attributable Risk and Economic Cost of Cardiovascular Hospital Admissions Due to Ambient Particulate Matter in Wuhan, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5453. [PMID: 32751102 PMCID: PMC7432018 DOI: 10.3390/ijerph17155453] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 07/25/2020] [Accepted: 07/25/2020] [Indexed: 12/25/2022]
Abstract
Although the adverse effects of ambient particulate matter (PM) on cardiovascular disease (CVD) have been previously documented, information about their economic consequence was insufficient. This study aimed to evaluate the attributable risk and economic cost of cardiovascular hospitalizations due to ambient PM. Data of CVD hospitalizations and PM concentrations from 1 January 2015 to 31 December 2017 were collected in Wuhan, China. A generalized additive model was applied to quantify the PM-attributable CVD hospitalizations, and total attributable hospitalization costs were calculated via multiplying the total attributable cases by the case-average hospitalization costs. A total of 45,714 CVD hospitalizations were included in this study. The results showed that a 10 µg/m3 increase in PM2.5 and PM10 concentrations at lag7 day, respectively, contributed to a 1.01% (95% confidence interval: 0.67-1.34) and 0.48% (0.26-0.70) increase in CVD hospitalizations. During the study period, 1487 and 983 CVD hospitalizations were attributable to PM2.5 and PM10, equaling an economic cost of 29.27 and 19.34 million RMB (1 RMB = 0.1424 USD), respectively, and significant differences in PM-attributable hospitalizations and economic burden were found between gender and age groups. Our study added evidence in heavily polluted megacities regarding the increased health risk and economic cost of CVD hospitalizations associated with ambient particulate pollution.
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Affiliation(s)
- Xuyan Wang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, China; (X.W.); (F.S.)
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, China; (X.W.); (F.S.)
- Global Health Institute, Wuhan University, Wuhan 430072, China
| | - Yunquan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan 430065, China;
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Fang Shi
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, China; (X.W.); (F.S.)
| | - Runtang Meng
- Department of Preventive Medicine, School of Medicine, Hangzhou Normal University, Hangzhou 311121, China;
| | - Yong Yu
- School of Public Health and Management, Hubei University of Medicine, Shiyan 442000, China
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17
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Effect of ambient air pollutants and meteorological variables on COVID-19 incidence. Infect Control Hosp Epidemiol 2020; 41:1011-1015. [PMID: 32389157 PMCID: PMC7298083 DOI: 10.1017/ice.2020.222] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To determine whether ambient air pollutants and meteorological variables are associated with daily COVID-19 incidence. Design: A retrospective cohort from January 25 to February 29, 2020. Setting: Cities of Wuhan, Xiaogan, and Huanggang, China. Patients: The COVID-19 cases detected each day. Methods: We collected daily data of COVID-19 incidence, 8 ambient air pollutants (particulate matter of ≤2.5 µm [PM2.5], particulate matter ≤10 µm [PM10], sulfur dioxide [SO2], carbon monoxide [CO], nitrogen dioxide [NO2], and maximum 8-h moving average concentrations for ozone [O3-8h]) and 3 meteorological variables (temperature, relative humidity, and wind) in China’s 3 worst COVID-19–stricken cities during the study period. The multivariate Poisson regression was performed to understand their correlation. Results: Daily COVID-19 incidence was positively associated with PM2.5 and humidity in all cities. Specifically, the relative risk (RR) of PM2.5 for daily COVID-19 incidences were 1.036 (95% confidence interval [CI], 1.032–1.039) in Wuhan, 1.059 (95% CI, 1.046–1.072) in Xiaogan, and 1.144 (95% CI, 1.12–1.169) in Huanggang. The RR of humidity for daily COVID-19 incidence was consistently lower than that of PM2.5, and this difference ranged from 0.027 to 0.111. Moreover, PM10 and temperature also exhibited a notable correlation with daily COVID-19 incidence, but in a negative pattern The RR of PM10 for daily COVID-19 incidence ranged from 0.915 (95% CI, 0.896–0.934) to 0.961 (95% CI, 0.95–0.972, while that of temperature ranged from 0.738 (95% CI, 0.717–0.759) to 0.969 (95% CI, 0.966–0.973). Conclusions: Our data show that PM2.5 and humidity are substantially associated with an increased risk of COVID-19 and that PM10 and temperature are substantially associated with a decreased risk of COVID-19.
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18
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Bergmann S, Li B, Pilot E, Chen R, Wang B, Yang J. Effect modification of the short-term effects of air pollution on morbidity by season: A systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 716:136985. [PMID: 32044481 DOI: 10.1016/j.scitotenv.2020.136985] [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: 09/28/2019] [Revised: 01/15/2020] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
Studies of the health effects of air pollution have traditionally controlled for ambient temperature as a confounder, and vice versa. However, season might be an important factor contributing to adverse health effects of air pollution. Given the current inconsistencies in results of previous studies on the effect modification of air pollution on morbidity by season, a systematic review and meta-analysis was conducted to synthesize the current evidence on effects of season on air pollution and morbidity. The electronic databases including PubMed, Web of Science, Embase, CNKI, and Wanfang were used to identify papers published up to the 30st of November in 2019. We identified 4284 articles, after screening, eighty papers met the inclusion criteria. Significant effect modification of CO, O3, SO2 and NO2 on morbidity by season was observed, with corresponding ratio of relative risk of 1.0009 (95% CI: 1.0001-1.0018), 1.0080 (95% CI: 1.0021-1.0138), 0.9828 (95% CI: 0.9697-0.9962) and 0.9896 (95% CI: 0.9824-0.9968), respectively. Season significantly modified the effect of CO on pneumonia, the effect of SO2 on cardiovascular disease, the effect of PM10 on stroke, and the effect of O3 on stroke, asthma and pneumonia. The effect modifications of air pollution by season were similar among males and females, while the effect estimates seem to be higher among children under 18 years old and the elderly aged 75 or over. Further research is needed to better understand the mechanisms underlying the seasonal variance of the effect of air pollutants on morbidity.
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Affiliation(s)
- Stéphanie Bergmann
- Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China; Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Bixia Li
- Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China
| | - Eva Pilot
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Renchao Chen
- Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China
| | - Boguang Wang
- Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China; Guangdong-Hongkong-Macau Joint Laboratory of Collaborative Innovation for Environmental Quality, Guangzhou, 511443, China
| | - Jun Yang
- Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China; Guangdong-Hongkong-Macau Joint Laboratory of Collaborative Innovation for Environmental Quality, Guangzhou, 511443, China.
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19
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Guo Y, Xie X, Lei L, Zhou H, Deng S, Xu Y, Liu Z, Bao J, Peng J, Huang C. Short-term associations between ambient air pollution and stroke hospitalisations: time-series study in Shenzhen, China. BMJ Open 2020; 10:e032974. [PMID: 32198300 PMCID: PMC7103818 DOI: 10.1136/bmjopen-2019-032974] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the association between ambient air pollution and stroke morbidity in different subgroups and seasons. METHODS We performed a time-series analysis based on generalised linear models to study the short-term exposure-response relationships between air pollution and stroke hospitalisations, and conducted subgroup analyses to identify possible sensitive populations. RESULTS For every 10 µg/m3 increase in the concentration of air pollutants, across lag 0-3 days, the relative risk of stroke hospitalisation was 1.029 (95% CI 1.013 to 1.045) for PM2.5, 1.054 (95% CI 1.031 to 1.077) for NO2 and 1.012 (95% CI 1.002 to 1.022) for O3. Subgroup analyses showed that statistically significant associations were found in both men and women, middle-aged and older populations, and both cerebral infarction and intracerebral haemorrhage. The seasonal analyses showed that statistically significant associations were found only in the winter. CONCLUSIONS Our study indicates that short-term exposure to PM2.5, NO2 and O3 may induce stroke morbidity, and the government should take actions to mitigate air pollution and protect sensitive populations.
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Affiliation(s)
- Yanfang Guo
- Department of Non-Communicable Disease Control and Prevention, Bao'an District Hospital for Chronic Diseases Prevention and Cure, Shenzhen, China
| | - Xiufang Xie
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lin Lei
- Department of Non-Communicable Disease Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Haibin Zhou
- Department of Non-Communicable Disease Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Shizhou Deng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ying Xu
- Department of Non-Communicable Disease Control and Prevention, Bao'an District Hospital for Chronic Diseases Prevention and Cure, Shenzhen, China
| | - Zheng Liu
- Department of Non-Communicable Disease Control and Prevention, Bao'an District Hospital for Chronic Diseases Prevention and Cure, Shenzhen, China
| | - Junzhe Bao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Shanghai Typhoon Institute, China Meteorological Administration, Shanghai, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ji Peng
- Department of Non-Communicable Disease Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Cunrui Huang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Shanghai Typhoon Institute, China Meteorological Administration, Shanghai, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China
- School of Public Health, Zhengzhou University, Zhengzhou, China
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20
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Shen S, Li X, Yuan C, Huang Q, Liu D, Ma S, Hui J, Liu R, Wu T, Chen Q. Association of short-term exposure to sulfur dioxide and hospitalization for ischemic and hemorrhagic stroke in Guangzhou, China. BMC Public Health 2020; 20:263. [PMID: 32085727 PMCID: PMC7035656 DOI: 10.1186/s12889-020-8354-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/13/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In developing countries, ambient sulfur dioxide (SO2) is a serious air pollutant concern, but there is no enough and consistent epidemiological evidence about its health effects on stroke hospitalization. METHODS We collected the daily air pollution data, meteorological data and number of daily hospital admissions for ischemic and hemorrhagic stroke, in Guangzhou from January 1st 2009 to December 31st 2014. Then we applied generalized additive model with a quasi-Poisson link to assess the relationship between short-term SO2 exposure and the total number of hospital admissions for ischemic and hemorrhagic stroke. In addition, we evaluated the effect of ambient SO2 by age (< 65 years and ≥ 65 years). RESULTS During the study period, a 24-h mean concentration of ambient SO2 of 27.82 μg/m3, a total of 58,473 ischemic stroke and 9167 hemorrhagic stroke hospital admissions hospital were recorded. Ambient SO2 was found to increase the risk for both ischemic and hemorrhagic stroke hospital admission in single pollutant model. The maximum value of percentage changes for ischemic and hemorrhagic stroke occurred in lag 0 day and lag 1 day, per 10 μg/m3 increase in SO2 concentrations was corresponded to a 1.27% (95% confidence interval (CI), 0.42-2.12%) and 1.55% (95%CI, 0.02-3.11%) increased risk, respectively. The association between SO2 and ischemic stroke hospitalization was robust to two pollutant model, but for hemorrhagic stroke it's partially weakened after adjusting for co-pollutants. The effect of ambient SO2 on ischemic stroke appeared to be greater for people < 65 years old, but null effect on hemorrhagic stroke was identified for both age groups. CONCLUSIONS We found short-term exposure to ambient SO2 may significantly increase the risks of hospitalization for ischemic stroke. The findings may contribute to a better understanding of the health effects of low-levels of SO2.
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Affiliation(s)
- Shuqun Shen
- School of Public Health, Southern Medical University, 1838#Guangzhou North Avenue, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Chao Yuan
- Department of Neurology, Nanfang Hospital, Southern Medical University, 1838#Guangzhou North Avenue, Guangzhou, Guangdong, 510515, People's Republic of China.,Department of Cardiovascular Surgery & Center for Basic Medical Research, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences, & Nankai University, Tianjin, 300457, China
| | - Qin Huang
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, 1838#Guangzhou North Avenue, Guangzhou, Guangdong, 510515, People's Republic of China.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Dongyang Liu
- Department of Pain Management, The State Key Clinical Specialty for Pain Medicine, The Second Affiliated hospital, Guangzhou Medical University, Guangzhou, Guangdong, 510260, People's Republic of China
| | - Shuoyi Ma
- Department of Interventional Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No.1 Panfu Road, Guangzhou, 510180, Guangdong, People's Republic of China
| | - Jialiang Hui
- First Clinical Medicine College, Southern Medical University, 1838#Guangzhou North Avenue, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Ruiyu Liu
- First Clinical Medicine College, Southern Medical University, 1838#Guangzhou North Avenue, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Tongwei Wu
- First Clinical Medicine College, Southern Medical University, 1838#Guangzhou North Avenue, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Qing Chen
- School of Public Health, Southern Medical University, 1838#Guangzhou North Avenue, Guangzhou, Guangdong, 510515, People's Republic of China.
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Abstract
Ambient air pollution is a risk factor for both acute and chronic diseases and poses serious health threats to the world population. We aim to study the relationship between air pollution and all-cause mortality in the context of a city-state exposed to the Southeast Asian haze problem. The primary exposure was ambient air pollution, as measured by the Pollutants Standards Index (PSI). The outcome of interest was all-cause mortality from 2010–2015. A time-stratified case-crossover design was performed. A conditional Poisson regression model, including environmental variables such as PSI, temperature, wind speed, and rainfall, was fitted to the daily count of deaths to estimate the incidence rate ratio (IRR) of mortality per unit increase in PSI, accounting for overdispersion and autocorrelation. To account for intermediate exposure effects (maximum lag of 10 days), a distributed lag non-linear model was used. There were 105,504 deaths during the study period. Increment in PSI was significantly associated with an increased risk of mortality. The adjusted IRR of mortality per the 10-unit increase in PSI was 1.01 (95%CI = 1.00–1.01). The lag effect was stronger when PSI was in the unhealthy range compared to the good and moderate ranges. At lag = 7 days, PSI appeared to have an adverse effect on mortality, although the effect was not significant. These findings provide evidence on the general health hazard of exposure to air pollution and can potentially guide public health policies in the region.
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22
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Chen G, Wang A, Li S, Zhao X, Wang Y, Li H, Meng X, Knibbs LD, Bell ML, Abramson MJ, Wang Y, Guo Y. Long-Term Exposure to Air Pollution and Survival After Ischemic Stroke. Stroke 2019; 50:563-570. [PMID: 30741622 DOI: 10.1161/strokeaha.118.023264] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- China bears a heavy burden of stroke because of its large population of elderly people and the propensity for stroke. Previous studies have examined the association between air pollution and stroke mortality or hospital admission. However, the global evidence for adverse effects of air pollution on survival after stroke is scarce. Methods- We used the first national hospital-based prospective registry cohort of stroke in China, which included 12 291 ischemic stroke patients who visited hospitals during 2007 to 2008. All patients were followed for 1-year poststroke. Deaths during the follow-up period were recorded. Participants' 3-year prestroke exposures to ambient PM1, PM2.5, PM10 (particulate matter with aerodynamic diameters ≤1, ≤2.5, and ≤10 μm, respectively) and NO2 (nitrogen dioxide) were estimated by machine learning algorithms with satellite remote sensing, land use information, and meteorological data. Cox proportional hazards models were used to examine the association between air pollution and survival after ischemic stroke. Results- In total, 1649 deaths were identified during the 1-year follow-up period. After controlling for potential confounders, significant associations were observed between exposure to PM1 and PM2.5 and incident fatal ischemic stroke. The corresponding hazard ratios and 95% CIs associated with 10 µg/m3 increase in PM1 and PM2.5 were 1.05 (1.02-1.09) and 1.03 (1.00-1.06), respectively. No significant association was observed for PM10 or NO2 (hazard ratios and 95% CIs, 1.01 [1.00-1.03] and 1.03 [0.99-1.06], respectively). Higher hazard ratios (and 95% CIs) were observed for male, elderly and obese individuals. Conclusions- Prestroke exposure to PM1 and PM2.5 was associated with increased incident fatal ischemic stroke in the year following an ischemic stroke in China. Improved air quality may be beneficial for people to recover from stroke.
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Affiliation(s)
- Gongbo Chen
- From the Department of Global Health, School of Health Sciences, Wuhan University, China (G.C.).,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (G.C., S.L., M.J.A., Y.G.)
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (A.W., X.Z., Yilong Wang, H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing (A.W., X.Z., Y.-L.W., H.L., X.M., Y.-J.W.)
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (G.C., S.L., M.J.A., Y.G.)
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (A.W., X.Z., Yilong Wang, H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing (A.W., X.Z., Y.-L.W., H.L., X.M., Y.-J.W.)
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (A.W., X.Z., Yilong Wang, H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing (A.W., X.Z., Y.-L.W., H.L., X.M., Y.-J.W.)
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (A.W., X.Z., Yilong Wang, H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing (A.W., X.Z., Y.-L.W., H.L., X.M., Y.-J.W.)
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (A.W., X.Z., Yilong Wang, H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing (A.W., X.Z., Y.-L.W., H.L., X.M., Y.-J.W.)
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Brisbane, Australia (L.D.K.)
| | - Michelle L Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, CT (M.L.B.)
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (G.C., S.L., M.J.A., Y.G.)
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (A.W., X.Z., Yilong Wang, H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing (A.W., X.Z., Y.-L.W., H.L., X.M., Y.-J.W.)
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (G.C., S.L., M.J.A., Y.G.)
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23
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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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24
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Cheong KH, Ngiam NJ, Morgan GG, Pek PP, Tan BYQ, Lai JW, Koh JM, Ong MEH, Ho AFW. Acute Health Impacts of the Southeast Asian Transboundary Haze Problem-A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183286. [PMID: 31500215 PMCID: PMC6765769 DOI: 10.3390/ijerph16183286] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/29/2019] [Indexed: 11/23/2022]
Abstract
Air pollution has emerged as one of the world’s largest environmental health threats, with various studies demonstrating associations between exposure to air pollution and respiratory and cardiovascular diseases. Regional air quality in Southeast Asia has been seasonally affected by the transboundary haze problem, which has often been the result of forest fires from “slash-and-burn” farming methods. In light of growing public health concerns, recent studies have begun to examine the health effects of this seasonal haze problem in Southeast Asia. This review paper aims to synthesize current research efforts on the impact of the Southeast Asian transboundary haze on acute aspects of public health. Existing studies conducted in countries affected by transboundary haze indicate consistent links between haze exposure and acute psychological, respiratory, cardiovascular, and neurological morbidity and mortality. Future prospective and longitudinal studies are warranted to quantify the long-term health effects of recurrent, but intermittent, exposure to high levels of seasonal haze. The mechanism, toxicology and pathophysiology by which these toxic particles contribute to disease and mortality should be further investigated. Epidemiological studies on the disease burden and socioeconomic cost of haze exposure would also be useful to guide policy-making and international strategy in minimizing the impact of seasonal haze in Southeast Asia.
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Affiliation(s)
- Kang Hao Cheong
- Science and Math Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore.
| | - Nicholas Jinghao Ngiam
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119074, Singapore
| | - Geoffrey G Morgan
- School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119074, Singapore
| | - Joel Weijia Lai
- Science and Math Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore
| | - Jin Ming Koh
- Science and Math Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Andrew Fu Wah Ho
- SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore 169857, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore 169609, Singapore
- Cardiovascular & Metabolic Disorders Programme, Duke-NUS Medical School, Singapore 169857, Singapore
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25
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Cheong KH, Ngiam NJ, Morgan GG, Pek PP, Tan BYQ, Lai JW, Koh JM, Ong MEH, Ho AFW. Acute Health Impacts of the Southeast Asian Transboundary Haze Problem-A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019. [PMID: 31500215 DOI: 10.1007/s11270-007-9392-210.3390/ijerph16183286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Air pollution has emerged as one of the world's largest environmental health threats, with various studies demonstrating associations between exposure to air pollution and respiratory and cardiovascular diseases. Regional air quality in Southeast Asia has been seasonally affected by the transboundary haze problem, which has often been the result of forest fires from "slash-and-burn" farming methods. In light of growing public health concerns, recent studies have begun to examine the health effects of this seasonal haze problem in Southeast Asia. This review paper aims to synthesize current research efforts on the impact of the Southeast Asian transboundary haze on acute aspects of public health. Existing studies conducted in countries affected by transboundary haze indicate consistent links between haze exposure and acute psychological, respiratory, cardiovascular, and neurological morbidity and mortality. Future prospective and longitudinal studies are warranted to quantify the long-term health effects of recurrent, but intermittent, exposure to high levels of seasonal haze. The mechanism, toxicology and pathophysiology by which these toxic particles contribute to disease and mortality should be further investigated. Epidemiological studies on the disease burden and socioeconomic cost of haze exposure would also be useful to guide policy-making and international strategy in minimizing the impact of seasonal haze in Southeast Asia.
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Affiliation(s)
- Kang Hao Cheong
- Science and Math Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore.
| | - Nicholas Jinghao Ngiam
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119074, Singapore
| | - Geoffrey G Morgan
- School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119074, Singapore
| | - Joel Weijia Lai
- Science and Math Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore
| | - Jin Ming Koh
- Science and Math Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Andrew Fu Wah Ho
- SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore 169857, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore 169609, Singapore
- Cardiovascular & Metabolic Disorders Programme, Duke-NUS Medical School, Singapore 169857, Singapore
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26
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Wang X, Tian X, Ye B, Zhang Y, Li C, Liao J, Zou Y, Zhang S, Zhu Y, Yang J, Ma L. Gaseous pollutant exposure affects semen quality in central China: a cross-sectional study. Andrology 2019; 8:117-124. [PMID: 31169363 DOI: 10.1111/andr.12655] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/17/2019] [Accepted: 05/03/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Limited studies have explored the association between gaseous pollutant exposures and male reproductive outcomes, and findings remained inconsistent. OBJECTIVES To evaluate the potential association between gaseous pollutants and semen quality within different exposure windows. MATERIALS AND METHODS: We adopted semen quality data of 1852 subjects who attended the Reproductive Medicine Center of Renmin Hospital at Wuhan University during January 1st, 2013, to August 3rd, 2015. A generalized linear model was employed to assess the relationship between each exposure variable and sperm parameters in different exposure windows. RESULTS SO2 exposure with lag 0-90 days was significantly associated with decreased sperm concentration (β: -1.362; 95% CI: -1.844, -0.879), sperm count (β: -2.979; 95% CI: -4.267, -1.691), and PR (β: -0.551; 95% CI: -0.710, -0.393). Similar trends were observed for SO2 exposure with three other key periods (lag 0-9, 10-14, and 70-90 days). NO2 exposure with lag 0-90 days was also associated with decreased sperm concentration (β: -0.517; 95% CI: -1.006, -0.027), sperm count (β: -1.914; 95% CI: -3.214, -0.615), and PR (β: -0.264; 95% CI: -0.425, -0.102). No relationship between gaseous pollutant exposure and ejaculate volume was observed in any exposure window. DISCUSSION AND CONCLUSION Our study indicated a strong adverse effect of gaseous pollutants on semen quality outcomes during the sperm development. Gaseous pollution exposure appeared to be more detrimental in the initial phase of spermatogenesis.
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Affiliation(s)
- X Wang
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - X Tian
- Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan, China
| | - B Ye
- Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan, China
| | - Y Zhang
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - C Li
- Centre for Diseases Control and Prevention of the Lianyungang Economic and Technological Development Area, Lianyungang, China
| | - J Liao
- Department of Public Health, Wuhan University of Science and Technology School of Medicine, Wuhan, China
| | - Y Zou
- Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan, China.,Global Health Institute, Wuhan University, Wuhan, China
| | - S Zhang
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Y Zhu
- Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan, China
| | - J Yang
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - L Ma
- Department of Healthcare Management, School of Health Sciences, Wuhan University, Wuhan, China.,Global Health Institute, Wuhan University, Wuhan, China
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27
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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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28
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Abstract
The conference "Climate change, air pollution and health" was held at the Pontifical Academy of Sciences. The data presented highlighted that air pollution is a major, under-recognized and modifiable risk factor for stroke and heart disease. Air pollution causes 7.6% of all deaths making it the fifth cause of death globally, and this figure is expected to increase by 50% by 2050. Particulate matter causes endothelial dysfunction and induces thrombosis by altering reactive oxygen species, nitric oxide, insulin resistance, and lipid levels. Thirty-three articles published since 2002 were reviewed to assess the relation between air pollution and stroke with age, geographical location, particulate and gaseous matter type, duration of exposure, previous stroke, and comorbidities. It remains to be defined if air pollution has pathophysiological effects that preferentially predispose individuals to ischemic or hemorrhagic stroke. There is ample evidence showing an association between acute and chronic exposure to PM2.5 or gaseous pollutants with stroke. This potentially avoidable scenario and its dramatic consequences are heavily under-recognized by health professionals and the wider public. Preventive measures in people at high vascular risk are warranted. Procrastination in implementing efforts to stop the current worldwide course of worsening air pollution is the seed of a potential global health catastrophe.
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Affiliation(s)
- Conrado J Estol
- Stroke Unit, Sanatorio Guemes, Francisco Acuña de Figueroa 1240, C1180, CABA, Argentina
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29
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Ren Y, Yao X, Liu Y, Liu S, Li X, Huang Q, Liu F, Li N, Lu Y, Yuan Z, Li S, Xiang H. Outdoor air pollution pregnancy exposures are associated with behavioral problems in China's preschoolers. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:2397-2408. [PMID: 30467751 DOI: 10.1007/s11356-018-3715-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/07/2018] [Indexed: 05/22/2023]
Abstract
There are mounting evidences indicated that maternal exposure to outdoor air pollutants in pregnancy affects children's neural development, but the researches on children's behavioral difficulties are seldom. We explored the association between maternal exposure to outdoor air pollution during different trimesters of pregnancy and the prevalence of behavioral difficulties among 657 preschool children aged 3-4 from three kindergartens in Wuhan, China. This is a cross-sectional study. Children's behavioral difficulties were assessed by the Strengths and Difficulties Questionnaire (SDQ) (reported by parents). Maternal exposure to outdoor air pollutants during pregnancy were estimated based on the daily average measured concentration levels from ground monitoring stations. Potential confounding factors including children-related, maternal, and socio-economic status (SES) were adjusted in the study. We calculated the prevalence of each type of behavioral difficulties and used binary logistic regression method to estimate the crude odds ratio (cOR), adjusted odds ratio (aOR), and corresponding 95% confidence intervals (95% CIs) for 1 μg/m3 increase in each air pollutant during every exposure window in single- and two-pollutant models. The prevalence of participants' total behavioral difficulties was 9.6%. In single-pollutant models, during full gestation, positive associations were observed between exposure to NO2 (aOR = 1.204, 95% CI 1.042, 1.392), particle matter (PM)10 (aOR = 1.070, 95% CI 1.018, 1.125), PM2.5 (aOR = 1.095, 95% CI 1.021, 1.176) and total difficulties, exposure to PM10 (aOR = 1.040, 95% CI 1.001, 1.081), PM2.5 (aOR = 1.053, 95% CI 1.000, 1.109) and prosocial behavior, respectively. In the first trimester, exposure to SO2 (aOR = 1.047, 95% CI 1.009, 1.086), NO2 (aOR = 1.039, 95% CI 1.013, 1.066), PM10 (aOR = 1.013, 95% CI 1.004, 1.023), and PM2.5 (aOR = 1.016, 95% CI 1.004, 1.028) were all positively associated with total difficulties. The associations between second and third trimesters' exposure to all pollutants and outcomes were not statistically significant. However, in the two-pollutant models, second trimester exposure to PM2.5 (aOR = 1.078, 95%CI 1.023, 1.137) was positively associated with total behavioral difficulties after adjusting for PM10. Exposure to outdoor air pollutants SO2, NO2, PM10, and PM2.5 during pregnancy may be associated with behavioral difficulties, especially in the first trimester.
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Affiliation(s)
- Yunzhao Ren
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan, 430071, Hubei, China
| | - Xing Yao
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan, 430071, Hubei, China
| | - Yisi Liu
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Suyang Liu
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan, 430071, Hubei, China
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan, 430071, China
| | - Xiao Li
- Gilead Sciences Inc, 333 Lakeside Drive, Foster City, CA, 94404, USA
| | - Qing Huang
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan, 430071, Hubei, China
| | - Feifei Liu
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan, 430071, Hubei, China
| | - Na Li
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan, 430071, Hubei, China
| | - Yuanan Lu
- Environmental Health Laboratory, Department of Public Health Sciences, University of Hawaii at Manoa, 1960 East-West Rd, Biomed Bldg, D105, Honolulu, HI, 96822, USA
| | - Zhanpeng Yuan
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan, 430071, Hubei, China
| | - Shiyue Li
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan, 430071, Hubei, China.
| | - Hao Xiang
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan, 430071, Hubei, China.
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
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30
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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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31
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Effects of Dust Storms and Climatological Factors on Mortality and Morbidity of Cardiovascular Diseases Admitted to ED. Emerg Med Int 2018; 2018:3758506. [PMID: 30057816 PMCID: PMC6051083 DOI: 10.1155/2018/3758506] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 05/27/2018] [Accepted: 06/03/2018] [Indexed: 11/17/2022] Open
Abstract
Objective This study was designed to investigate the effects of Desert Dust Storms and Climatological Factors on Mortality and Morbidity of Cardiovascular Diseases admitted to emergency department in Gaziantep. Method Hospital records, obtained between September 01, 2009 and January 31, 2014, from four state hospitals in Gaziantep, Turkey, were compared to meteorological and climatological data. Statistical analysis was performed by Statistical Package for the Social Science (SPSS) for windows version 24.0. Results 168,467 patients were included in this study. 83% of the patients had chest pain and 17% of patients had cardiac failure (CF). An increase in inpatient hospitalization due to CF was observed and corresponded to the duration of dust storms measured by number of days. However, there was no significant increase in emergency department (ED) presentations. There was no significant association of cardiac related mortality and coinciding presence of a dust storm or higher recorded temperature. The association of increases in temperature levels and the presence of dust storms with “acute coronary syndrome- (ACS-) related emergency service presentations, inpatient hospitalization, and mortality” were statistically significant. The relationship between the increase in PM10 levels due to causes unrelated to dust storms and the outpatient application, admission, and mortality due to heart failure was not significant. The increase in particle matter 10 (PM) levels due to causes outside the dust storm caused a significant increase in outpatient application, hospitalization, and mortality originated from ACS. Conclusion Increased number of dust storms resulted in a higher prevalence of mortality due to ACS while mortality due to heart failure remained unchanged. Admission, hospitalization, and mortality due to chest pain both dependent and independent of ACS were increased by the presence of dust storms, PM10 elevation, and maximum temperature.
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Newell K, Kartsonaki C, Lam KBH, Kurmi O. Cardiorespiratory health effects of gaseous ambient air pollution exposure in low and middle income countries: a systematic review and meta-analysis. Environ Health 2018; 17:41. [PMID: 29669550 PMCID: PMC5907176 DOI: 10.1186/s12940-018-0380-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/29/2018] [Indexed: 05/16/2023]
Abstract
BACKGROUND Lack of research on the effects of gaseous pollutants (nitrogen oxides [NOx], sulfur dioxide [SO2], carbon monoxide [CO] and ozone [O3]) in the ambient environment on health outcomes from within low and middle income countries (LMICs) is leading to reliance on results from studies performed within high income countries (HICs). This systematic review and meta-analysis examines the cardiorespiratory health effects of gaseous pollutants in LMICs exclusively. METHODS Systematic searching was carried out and estimates pooled by pollutant, lag and outcome, and presented as excess relative risk per 10 μg/m3 (NOx, SO2, O3) or 1 ppm (CO) increase pollutant. Sub-group analysis was performed examining estimates by specific outcomes, city and co-pollutant adjustment. RESULTS Sixty studies met the inclusion criteria, most (44) from the East Asia and Pacific region. A 10 μg/m3 increase in same day NOx was associated with 0.92% (95% CI: 0.44, 1.39), and 0.70% (0.01, 1.40) increases in cardiovascular and respiratory mortality respectively, same day NOx was not associated with morbidity. Same day sulfur dioxide was associated with 0.73% (0.04, 1.42) and 0.50% (0.01, 1.00) increases in respiratory morbidity and in cardiovascular mortality respectively. CONCLUSIONS Acute exposure to gaseous ambient air pollution (AAP) is associated with increases in morbidity and mortality in LMICs, with greatest associations observed for cardiorespiratory mortality.
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Affiliation(s)
- Katherine Newell
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Christiana Kartsonaki
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kin Bong Hubert Lam
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Om Kurmi
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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A Multicity Analysis of the Short-Term Effects of Air Pollution on the Chronic Obstructive Pulmonary Disease Hospital Admissions in Shandong, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040774. [PMID: 29673181 PMCID: PMC5923816 DOI: 10.3390/ijerph15040774] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/08/2018] [Accepted: 04/12/2018] [Indexed: 11/17/2022]
Abstract
Although there is growing evidence linking chronic obstructive pulmonary disease (COPD) hospital admissions to the exposure to ambient air pollution, the effect can vary depending on the local geography, pollution type, and pollution level. The number of large-scale multicity studies remains limited in China. This study aims to assess the short-term effects of ambient air pollution (PM2.5, PM10, SO2, NO2) on chronic obstructive pulmonary disease hospital admissions from 2015 to 2016, with a total of 216,159 records collected from 207 hospitals in 17 cities all over the Shandong province, east China. Generalized additive models and penalized splines were applied to study the data whilst controlling for confounding meteorological factors and long-term trends. The air pollution was analyzed with 0–6 day lag effects and the percentage change of hospital admissions was assessed for a 10-μg/m3 increase in the air pollution levels. We also examined the percentage changes for different age groups and gender, respectively. The results showed that air pollution was significantly associated with adverse health outcomes and stronger effects were observed for females. The air pollution health effects were also impacted by geographical factors such that the air pollution had weaker health effects in coastal cities.
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Santurtún A, Ruiz PB, López-Delgado L, Sanchez-Lorenzo A, Riancho J, Zarrabeitia MT. Stroke: Temporal Trends and Association with Atmospheric Variables and Air Pollutants in Northern Spain. Cardiovasc Toxicol 2018; 17:360-367. [PMID: 27990617 DOI: 10.1007/s12012-016-9395-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Stroke, the second cause of death and the most frequent cause of severe disability among adults in developed countries, is related to a large variety of risk factors. This paper assesses the temporal patterns in stroke episodes in a city in Northern Spain during a 12-year period and analyzes the possible effects that atmospheric pollutants and meteorological variables may have on stroke on a daily scale. Our results show that there is an increase in stroke admissions (r = 0.818, p = 0.001) especially in patients over 85 years old. On a weekly scale, the number of hospital admissions due to stroke remains stable from Monday to Friday, whereas it abruptly decreases during the weekends, reaching its minimum values on Sunday (p < 0.005); however, mortality in patients admitted to the hospital is higher on Sundays than on other days of the week. Finally, a statistically significant positive correlation between the number of stroke hospital admissions and NO2 levels (p = 0.012) and an inverse correlation with relative humidity (p = 0.032) were found. The analysis of the relationship between ischemic strokes and atmospheric circulation shows a higher frequency of the former in Santander with enhanced negative air pressure anomalies over western Spain; the fact that under these conditions the region studied registers very low values of relative humidity is in line with the aforementioned inverse correlation, which has not been described elsewhere in the literature. This study could be a first step for implementing stroke alert protocols depending on air pollution levels and circulation patterns forecasts.
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Affiliation(s)
- Ana Santurtún
- Unit of Legal Medicine, Department of Physiology and Pharmacology, University of Cantabria, Av Cardenal Herrera Oria s/n, 39011, Santander, Spain.
| | - Patricia Bolivar Ruiz
- Unit of Legal Medicine, Department of Physiology and Pharmacology, University of Cantabria, Av Cardenal Herrera Oria s/n, 39011, Santander, Spain
| | - Laura López-Delgado
- Service of Internal Medicine, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Arturo Sanchez-Lorenzo
- Instituto Pirenaico de Ecología, Consejo Superior de Investigaciones Científicas (IPE-CSIC), Saragossa, Spain
| | - Javier Riancho
- Service of Neurology, University Hospital Marqués de Valdecilla - IDIVAL (CIBERNED), Santander, Spain
| | - María T Zarrabeitia
- Unit of Legal Medicine, Department of Physiology and Pharmacology, University of Cantabria, Av Cardenal Herrera Oria s/n, 39011, Santander, Spain
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Does the Short-Term Effect of Air Pollution Influence the Incidence of Spontaneous Intracerebral Hemorrhage in Different Patient Groups? Big Data Analysis in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121547. [PMID: 29232865 PMCID: PMC5750965 DOI: 10.3390/ijerph14121547] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 01/18/2023]
Abstract
Spontaneous intracerebral hemorrhage (sICH) has a high mortality rate. Research has demonstrated that the occurrence of sICH is related to air pollution. This study used big data analysis to explore the impact of air pollution on the risk of sICH in patients of differing age and geographic location. 39,053 cases were included in this study; 14,041 in the Taipei region (Taipei City and New Taipei City), 5537 in Taoyuan City, 7654 in Taichung City, 4739 in Tainan City, and 7082 in Kaohsiung City. The results of correlation analysis indicated that there were two pollutants groups, the CO and NO2 group and the PM2.5 and PM10 group. Furthermore, variations in the correlations of sICH with air pollutants were identified in different age groups. The co-factors of the influence of air pollutants in the different age groups were explored using regression analysis. This study integrated Taiwan National Health Insurance data and air pollution data to explore the risk factors of sICH using big data analytics. We found that PM2.5 and PM10 are very important risk factors for sICH, and age is an important modulating factor that allows air pollutants to influence the incidence of sICH.
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Newell K, Kartsonaki C, Lam KBH, Kurmi OP. Cardiorespiratory health effects of particulate ambient air pollution exposure in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Planet Health 2017; 1:e368-e380. [PMID: 29851649 DOI: 10.1016/s2542-5196(17)30166-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 10/17/2017] [Accepted: 11/20/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Most prospective studies on the health effects of particulate ambient air pollution exposure have focused on high-income countries, which have much lower pollutant concentrations than low-income and middle-income countries (LMICs) and different sources of pollution. We aimed to investigate the cardiorespiratory health effects of particulate ambient air pollution exposure in LMICs exclusively. METHODS For this systematic review and meta-analysis, we searched PubMed, Web of Science, Embase, LILACS, Global Health, and Proquest for studies published between database inception and Nov 28, 2016, investigating the cardiorespiratory health effects of particulate ambient air pollution exposure in LMICs. Data were extracted from published studies by one author, and then checked and verified by all authors independently. We pooled estimates by pollutant type (particulate matter with a diameter of <2·5 μm [PM2·5] or 2·5-10 μm [PM10]), lag, and outcome, and presented them as excess relative risk per 10 μg/m3 increase in particulate ambient air pollution. We used a random-effects model to derive overall excess risk. The study protocol is registered with PROSPERO, number CRD42016051733. FINDINGS Of 1553 studies identified, 91 met the full eligibility criteria. Only four long-term exposure studies from China were identified and not included in the meta-analysis. A 10 μg/m3 increase in same-day PM2·5 was associated with a 0·47% (95% CI 0·34-0·61) increase in cardiovascular mortality and a 0·57% (0·28-0·86) increase in respiratory mortality. A 10 μg/m3 increase in same-day PM10 was associated with a 0·27% (0·11-0·44) increase in cardiovascular mortality and a 0·56% (0·24-0·87) increase in respiratory mortality. INTERPRETATION Short-term exposure to particulate ambient air pollution is associated with increases in cardiorespiratory morbidity and mortality in LMIC's, with apparent regional-specific variations. FUNDING None.
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Affiliation(s)
- Katherine Newell
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Christiana Kartsonaki
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kin Bong Hubert Lam
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Om P Kurmi
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Liu H, Tian Y, Xu Y, Huang Z, Huang C, Hu Y, Zhang J. Association between ambient air pollution and hospitalization for ischemic and hemorrhagic stroke in China: A multicity case-crossover study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2017; 230:234-241. [PMID: 28654881 DOI: 10.1016/j.envpol.2017.06.057] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/15/2017] [Accepted: 06/17/2017] [Indexed: 05/19/2023]
Abstract
There is growing interest in the association between ambient air pollution and stroke, but few studies have investigated the association in developing countries. The primary objective of this study was to examine the association between levels of ambient air pollutants and hospital admission for stroke in China. A time-stratified case-crossover analysis was conducted between 2014 and 2015 in 14 large Chinese cities among 200,958 ischemic stroke and 41,746 hemorrhagic stroke hospitalizations. We used conditional logistic regression to estimate the percentage changes in stroke admissions in relation to interquartile range increases in air pollutants. Air pollution was positively associated with ischemic stroke. A difference of an interquartile range of the 6-day average for particulate matter less than 10 μm in aerodynamic diameter, sulfur dioxide, nitrogen dioxide, carbon monoxide, and ozone corresponded to 0.7% (95% CI: 0%, 1.4%), 1.6% (95% CI: 1.0%, 2.3%), 2.6% (95% CI: 1.8%, 3.5%), 0.5% (95% CI: -0.2%, 1.1%), and 1.3% (95% CI: 0.3%, 2.3%) increases in ischemic stroke admissions, respectively. For hemorrhagic stroke, we observed the only significant association in relation to nitrogen dioxide on the current day (percentage change: 1.6%; 95% CI: 0.3%, 2.9%). Our findings contribute to the limited scientific literature concerning the effect of ambient air pollution on stroke in developing countries. Our findings may have significant public health implications for primary prevention of stroke in China.
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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
| | - Yan Xu
- Department of Neurology, Peking University People's Hospital, No.11 South Xizhimen Street, 100044 Beijing, China
| | - Zhe Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191 Beijing, China
| | - Chao Huang
- 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.
| | - Jun Zhang
- Department of Neurology, Peking University People's Hospital, No.11 South Xizhimen Street, 100044 Beijing, China.
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Guo P, Wang Y, Feng W, Wu J, Fu C, Deng H, Huang J, Wang L, Zheng M, Liu H. Ambient Air Pollution and Risk for Ischemic Stroke: A Short-Term Exposure Assessment in South China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14091091. [PMID: 28930181 PMCID: PMC5615628 DOI: 10.3390/ijerph14091091] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/15/2017] [Accepted: 09/16/2017] [Indexed: 02/07/2023]
Abstract
Data on the association between air pollution and risk of ischemic stroke in China are still limited. This study aimed to investigate the association between short-term exposure to ambient air pollution and risk of ischemic strokes in Guangzhou, the most densely-populated city in south China, using a large-scale multicenter database of stroke hospital admissions. Daily counts of ischemic stroke admissions over the study years 2013-2015 were obtained from the Guangzhou Cardiovascular and Cerebrovascular Disease Event Surveillance System. Daily particulate matter <2.5 μm in diameter (PM2.5), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), and meteorological data were collected. The associations between air pollutants and hospital admissions for stroke were examined using relative risks (RRs) and their corresponding 95% confidence intervals (CIs) based on time-series Poisson regression models, adjusting for temperature, public holiday, day of week, and temporal trends in stroke. Ischemic stroke admissions increased from 27,532 to 35,279 through 2013 to 2015, increasing by 28.14%. Parameter estimates for NO₂ exposure were robust regardless of the model used. The association between same-day NO₂ (RR = 1.0509, 95% CI: 1.0353-1.0668) exposure and stroke risk was significant when accounting for other air pollutants, day of the week, public holidays, temperature, and temporal trends in stroke events. Overall, we observed a borderline significant association between NO₂ exposure modeled as an averaged lag effect and ischemic stroke risk. This study provides data on air pollution exposures and stroke risk, and contributes to better planning of clinical services and emergency contingency response for stroke.
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Affiliation(s)
- Pi Guo
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China.
| | - Yulin Wang
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China.
| | - Wenru Feng
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China.
| | - Jiagang Wu
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China.
| | - Chuanxi Fu
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China.
| | - Hai Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou 510100, China.
| | - Jun Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou 510100, China.
| | - Li Wang
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China.
| | - Murui Zheng
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China.
| | - Huazhang Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China.
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Babadjouni RM, Hodis DM, Radwanski R, Durazo R, Patel A, Liu Q, Mack WJ. Clinical effects of air pollution on the central nervous system; a review. J Clin Neurosci 2017; 43:16-24. [PMID: 28528896 PMCID: PMC5544553 DOI: 10.1016/j.jocn.2017.04.028] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/22/2017] [Indexed: 12/20/2022]
Abstract
The purpose of this review is to describe recent clinical and epidemiological studies examining the adverse effects of urban air pollution on the central nervous system (CNS). Air pollution and particulate matter (PM) are associated with neuroinflammation and reactive oxygen species (ROS). These processes affect multiple CNS pathways. The conceptual framework of this review focuses on adverse effects of air pollution with respect to neurocognition, white matter disease, stroke, and carotid artery disease. Both children and older individuals exposed to air pollution exhibit signs of cognitive dysfunction. However, evidence on middle-aged cohorts is lacking. White matter injury secondary to air pollution exposure is a putative mechanism for neurocognitive decline. Air pollution is associated with exacerbations of neurodegenerative conditions such as Alzheimer's and Parkinson's diseases. Increases in stroke incidences and mortalities are seen in the setting of air pollution exposure and CNS pathology is robust. Large populations living in highly polluted environments are at risk. This review aims to outline current knowledge of air pollution exposure effects on neurological health.
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Affiliation(s)
- Robin M Babadjouni
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Drew M Hodis
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Ryan Radwanski
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Ramon Durazo
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Arati Patel
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Qinghai Liu
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - William J Mack
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
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Gurung A, Son JY, Bell ML. Particulate Matter and Risk of Hospital Admission in the Kathmandu Valley, Nepal: A Case-Crossover Study. Am J Epidemiol 2017; 186:573-580. [PMID: 28911012 DOI: 10.1093/aje/kwx135] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 10/18/2016] [Indexed: 12/13/2022] Open
Abstract
Air pollution is known to lead to a substantial health burden, but the majority of evidence is based on data from North America and Europe. Despite rising pollution levels, very limited information is available for South Asia. We investigated the impact of particulate matter with an aerodynamic diameter less than or equal to 10 μm (PM10) on hospitalization, by cause and subpopulation, in the Kathmandu Valley, an understudied and rapidly urbanizing region in Nepal. Individual-level daily inpatient hospitalization data (2004-2007) were collected from each of 6 major hospitals, as Nepal has no central data collection system. Time-stratified case-crossover analysis was used with interaction terms for potential effect modifiers (e.g., age, sex, and socioeconomic status), with adjustment for day of the week and weather. Daily PM10 concentrations averaged 120 μg/m3, with the daily maximum reaching 403 μg/m3. A 10-μg/m3 increase in PM10 level was associated with increased risks of hospitalization of 1.00% (95% confidence interval (CI): 0.62, 1.38), 1.70% (95% CI: 0.18, 3.25), and 2.29% (95% CI: 0.18, 4.43) for total, respiratory, and cardiovascular admissions, respectively. We did not find strong evidence of effect modification by age, sex, or socioeconomic status. These results, in combination with the high levels of exposure, indicate a potentially serious human health burden from air pollution in the Kathmandu Valley.
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Huang F, Luo Y, Tan P, Xu Q, Tao L, Guo J, Zhang F, Xie X, Guo X. Gaseous Air Pollution and the Risk for Stroke Admissions: A Case-Crossover Study in Beijing, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14020189. [PMID: 28216595 PMCID: PMC5334743 DOI: 10.3390/ijerph14020189] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/15/2017] [Accepted: 01/27/2017] [Indexed: 01/11/2023]
Abstract
Background: Though increasing evidence supports association between gaseous air pollution and stroke, it remains unclear whether the effects differ in season, sex and age. The aim of this study was to examine the associations of gaseous air pollution with stroke admissions in Beijing, 2013–2014 in different subgroups. Methods: Case-crossover design and conditional logistic regression were used to perform the analyses. We examined the exposure-response relationship between air pollution and stroke. Stratified analyses were performed in different seasons, sex, and age groups. Results: There were 147,624 stroke admissions during the study period. In the whole study period, percent changes of stroke admissions were 0.82% (95% CI: 0.52% to 1.13%) and 0.73% (95% CI: 0.44% to 1.03%) per 10 μg/m3 increase in the same day conentration of nitrogen dioxide (NO2) and sulfur dioxide (SO2). The positive associations were higher in warm seasons and with patients >65 years (p < 0.05). Contrary effects of carbon monoxide (CO) and ozone on stroke admissions were observed in different seasons. Conclusions: NO2 and SO2 were positively associated with stroke admissions, with stronger effects in warm seasons and with patients >65 years. The associations of CO and ozone with stroke admissions differed across seasons.
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Affiliation(s)
- Fangfang Huang
- School of Public Health, Capital Medical University, Beijing 100069, China.
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Yanxia Luo
- School of Public Health, Capital Medical University, Beijing 100069, China.
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Peng Tan
- Beijing Public Health Information Center, Beijing 100050, China.
| | - Qin Xu
- 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.
| | - Jin Guo
- School of Public Health, Capital Medical University, Beijing 100069, China.
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Feng Zhang
- School of Public Health, Capital Medical University, Beijing 100069, China.
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Xueqin Xie
- Beijing Public Health Information Center, Beijing 100050, 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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Huang F, Luo Y, Guo Y, Tao L, Xu Q, Wang C, Wang A, Li X, Guo J, Yan A, Guo X. Particulate Matter and Hospital Admissions for Stroke in Beijing, China: Modification Effects by Ambient Temperature. J Am Heart Assoc 2016; 5:JAHA.116.003437. [PMID: 27413045 PMCID: PMC5015380 DOI: 10.1161/jaha.116.003437] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background The impact of particulate matter (PM) on stroke may vary by particle size, stroke subtype, and patient characteristics and temperature. We examined the association of stroke admissions with PM in different subgroups in Beijing, China, during 2013–2014. Methods and Results A time‐stratified case‐crossover design was used to assess the relation between PM of different particle sizes and hospital admissions for ischemic and hemorrhagic stroke. Stratified analyses were performed by age, sex, and temperature. In total, there were 147 624 stroke admissions during the study period. In the whole‐period analysis, both PM2.5 and PM10 were positively associated with ischemic stroke admissions on the day of hospital admission and negatively associated with ischemic stroke at lag2 and lag3 day. In warm days (>13.5°C), the odds ratios of ischemic stroke admissions were 2.071 (95% CI 1.959–2.190), 1.470 (95% CI 1.391–1.554), and 1.590 (95% CI 1.493–1.694) per IQR increase in the same‐day PM2.5 (82.0 μg/m3), PM2.5–10 (36.6 μg/m3), and PM10 (93.5 μg/m3), respectively. For hemorrhagic stroke, the corresponding values were 1.941 (95% CI 1.658–2.273), 1.590 (95% CI 1.366–1.851), and 1.527 (95% CI 1.278–1.826). The positive associations were also observed in the other lag structures and were higher than in cold days (≤13.5°C). Conclusions This study suggests that the associations of PM2.5, PM2.5–10, and PM10 with stroke admissions differed across levels of temperature. Short‐term exposure to PM2.5, PM2.5–10, and PM10 was positively associated with hospital admissions for ischemic and hemorrhagic stroke on warm days (>13.5°C).
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Affiliation(s)
- Fangfang Huang
- School of Public Health, Capital Medical University, Beijing, China Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yanxia Luo
- School of Public Health, Capital Medical University, Beijing, China Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yuming Guo
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Lixin Tao
- School of Public Health, Capital Medical University, Beijing, China Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Qin Xu
- School of Public Health, Capital Medical University, Beijing, China Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Chao Wang
- School of Public Health, Capital Medical University, Beijing, China Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Anxin Wang
- School of Public Health, Capital Medical University, Beijing, China Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xia Li
- Graduate Entry Medical School, University of Limerick, Ireland
| | - Jin Guo
- School of Public Health, Capital Medical University, Beijing, China Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Aoshuang Yan
- School of Public Health, Capital Medical University, Beijing, China Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China Beijing Municipal Science and Technology Commission, Beijing, China
| | - Xiuhua Guo
- School of Public Health, Capital Medical University, Beijing, China Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
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Li S, Williams G, Guo Y. Health benefits from improved outdoor air quality and intervention in China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2016; 214:17-25. [PMID: 27061471 DOI: 10.1016/j.envpol.2016.03.066] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/25/2016] [Indexed: 06/05/2023]
Abstract
China is at its most critical stage of outdoor air quality management. In order to prevent further deterioration of air quality and to protect human health, the Chinese government has made a series of attempts to reduce ambient air pollution. Unlike previous literature reviews on the widespread hazards of air pollution on health, this review article firstly summarized the existing evidence of human health benefits from intermittently improved outdoor air quality and intervention in China. Contents of this paper provide concrete and direct clue that improvement in outdoor air quality generates various health benefits in China, and confirm from a new perspective that it is worthwhile for China to shift its development strategy from economic growth to environmental economic sustainability. Greater emphasis on sustainable environment design, consistently strict regulatory enforcement, and specific monitoring actions should be regarded in China to decrease the health risks and to avoid long-term environmental threats.
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Affiliation(s)
- Shanshan Li
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
| | - Gail Williams
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Yuming Guo
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Rao M, Meng TQ, Hu SH, Guan HT, Wei QY, Xia W, Zhu CH, Xiong CL. Evaluation of semen quality in 1808 university students, from Wuhan, Central China. Asian J Androl 2016; 17:111-6. [PMID: 25337834 PMCID: PMC4291853 DOI: 10.4103/1008-682x.135984] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the semen quality of university students in Wuhan, the largest city in the world in terms of the number of university students. All student sperm donors recorded in the Hubei Province Human Sperm Bank from 1 March 2010 to 31 December 2013 were screened. At last, a total of 3616 semen samples from 1808 university student sperm donors were eligible and retrospectively analyzed. Each donor's semen parameters were averaged over two samples and compared with the World Health Organization criteria, and a generalized linear regression model was used to examine several determinants of semen quality. We found that the mean and median values were 3.0 ml and 2.8 ml for semen volume, 50.2 × 106 ml−1 and 50.0 × 106 ml−1 for sperm concentration, 148.1 × 106 and 142.1 × 106 for total sperm count, and 58.6% and 60.0% for total sperm motility. About 85.0% of donors had parameters that were all normal. Season and duration of abstinence were critical factors affecting semen quality. We also found a decrease in sperm concentration during the 4 years observation; however, this may not be a strong evidence to confirm the declining trend of semen quality. In conclusion, semen quality of university students in Wuhan was not optimal and should be paid high attention, long-term observation and further study should be carried out to confirm the present situation.
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Affiliation(s)
| | | | | | | | | | - Wei Xia
- Family Planning Research Institute; Reproductive Medicine Center, Tongji Medical College, Huazhong University of Science and Technology; Hubei Province Human Sperm Bank, Wuhan, Hubei 430030, China
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Han MH, Yi HJ, Ko Y, Kim YS, Lee YJ. Association between hemorrhagic stroke occurrence and meteorological factors and pollutants. BMC Neurol 2016; 16:59. [PMID: 27146603 PMCID: PMC4855484 DOI: 10.1186/s12883-016-0579-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 04/26/2016] [Indexed: 12/11/2022] Open
Abstract
Background The purpose of this study is to determine whether intracerebral hemorrhage and subarachnoid hemorrhage have different incidence patterns based on monthly variations in meteorological and air pollution parameters in the Seongdong district of Seoul, South Korea. Methods From January 1, 2004 to December 31, 2014, 1,477 consecutive hemorrhagic stroke events (>19 years old) were registered among residents of the Seongdong district, Seoul, South Korea. The authors calculated the relative risk of hemorrhagic stroke and its subtype incidence based on meteorological and air pollution factors. We also estimated relative risk with 95 % confidence intervals using a multivariate Poisson regression model to identify potential independent variables among meteorological factors and pollutants associated with either intracerebral hemorrhage or subarachnoid hemorrhage occurrence. Results We observed a negative correlation between intracerebral hemorrhage and mean temperature. In the multivariate Poisson model, particulate matter with an aerodynamic diameter < 10 μm showed positive correlations with intracerebral hemorrhage (relative risk, 1.09; 95 % confidence interval, 1.02 to 1.15; P = 0.012). In contrast, ozone correlated significantly with subarachnoid hemorrhage occurrence (relative risk, 1.32; 95 % confidence interval, 1.10 to 1.58; P = 0.003). Conclusions Our findings show the relationship between hemorrhagic stroke and meteorological parameters and pollutants under similar weather and environmental conditions in a small area. Among meteorological and pollutant variables, only higher particulate matter concentrations correlated independently with intracerebral hemorrhage occurrence, while only ozone was independently associated with subarachnoid hemorrhage occurrence. These findings suggest the possibility that there are pathogenic associations between hemorrhagic stroke and meteorological factors and pollutants.
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Affiliation(s)
- Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Medical Center, 222 Haengdang-ro, Seoul, 133-792, South Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, 222 Haengdang-ro, Seoul, 133-792, South Korea.
| | - Yong Ko
- Department of Neurosurgery, Hanyang University Medical Center, 222 Haengdang-ro, Seoul, 133-792, South Korea
| | - Young-Soo Kim
- Department of Neurosurgery, Hanyang University Medical Center, 222 Haengdang-ro, Seoul, 133-792, South Korea
| | - Young-Jun Lee
- Department of Radiology, Hanyang University Medical Center, Seoul, South Korea
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Han MH, Yi HJ, Kim YS, Ko Y, Kim YS. Association between Diurnal Variation of Ozone Concentration and Stroke Occurrence: 24-Hour Time Series Study. PLoS One 2016; 11:e0152433. [PMID: 27015421 PMCID: PMC4807846 DOI: 10.1371/journal.pone.0152433] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 03/14/2016] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Increasing ozone concentrations have been known to damage human health and ecosystems. Although ozone tends to display diurnal variation, most studies have reported only on the association between daily ozone concentrations and ischemic stroke occurrence on the same day, or with a 1-day lag. We investigated the effect of the diurnal variation of ozone on ischemic stroke occurrence during the same day. Methods We included a consecutive series of 1,734 patients from January 1, 2008, to December 31, 2014, at a single tertiary hospital in Seoul, South Korea. We evaluated differences between temperature and pollutants at the time of stroke onset for each time interval and averaged those parameters across the 7-year study period. Results During the interval from 13:00 to 16:59, we found a positive association between ischemic stroke occurrence and ozone concentration relative to other time periods. Upper median ozone levels from 13:00 to 16:59 were positively correlated with ischemic stroke (odds ratio, 1.550; 95% confidence intervals, 1.220 to 1.970; P = <0.001) when compared with lower median levels. Conclusions The results show diurnal patterns of ischemic stroke occurrence based on upper and lower median ozone levels for a 24-hour period, which extends understanding of the association between stroke occurrence and environmental influences.
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Affiliation(s)
- Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471–701, Gyonggi-do, Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, 222–1, Wangsimni-ro, Seongdong-gu, Seoul, Korea
- * E-mail:
| | - Young-Seo Kim
- Department of Neurology, Hanyang University Medical Center, 222–1, Wangsimni-ro, Seongdong-gu, Seoul, Korea
| | - Yong Ko
- Department of Neurosurgery, Hanyang University Medical Center, 222–1, Wangsimni-ro, Seongdong-gu, Seoul, Korea
| | - Young-Soo Kim
- Department of Neurosurgery, Hanyang University Medical Center, 222–1, Wangsimni-ro, Seongdong-gu, Seoul, Korea
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Fabbian F, Manfredini R, De Giorgi A, Gallerani M, Cavazza M, Grifoni S, Fabbri A, Cervellin G, Ferrari AM, Imberti D. "Timing" of arrival and in-hospital mortality in a cohort of patients under anticoagulant therapy presenting to the emergency departments with cerebral hemorrhage: A multicenter chronobiological study in Italy. Chronobiol Int 2016; 33:245-56. [PMID: 26852790 DOI: 10.3109/07420528.2015.1133636] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Therapy with oral anticoagulants (OACs) is a risk factor for cerebral hemorrhage (CH). Although different studies have been undertaken to investigate the timing of the onset of major cardiovascular events, no data exist on temporal patterns of the onset of CH in subjects treated with OACs. The aim of this study is to evaluate the timing of CH in patients treated with OACs. All patients who developed CH under OACs therapy and admitted to 28 Italian Emergency Departments (EDs) between September 2011 and July 2013 were enrolled. Age, sex, time and location of the hemorrhagic lesion, type of the bleeding events (idiopathic or post-traumatic), anticoagulant therapy (warfarin or new oral anticoagulants - NOAs) and time of ED admission (i.e., hour, day, month and season) were recorded. Five hundred and seventeen patients (63.2% male aged 80 ± 7.9 yrs) with CH were involved. Warfarin was taken by 494 patients (95.6%), and NOAs by 23 (4.4%). In-hospital mortality (IHM) was recorded in 208 cases (40.2%). Cosinor analysis showed a peak of CH arrival between 12:00 and 14:00 h both in the whole population (PR 73.9%, p = 0.002) and the male subgroup (PR 65.2%, p = 0.009), whereas females showed an anticipated morning peak between 08:00 and 10:00 h (PR 65.7%, p = 0.008). A further analysis between idiopathic and post-traumatic CH confirmed the presence of a 24 h pattern with a peak between 12:00 and 14:00 h (PR 58.5%, p = 0.019) and between 08:00 and 10:00 h (PR80.1%, p < 0.001) for idiopathic events and post-traumatic hemorrhages, respectively. Moreover, a seasonal winter peak was identified for idiopathic forms (PR 74%, p = 0.035), and a summer peak for post-traumatic forms (PR 77%, p = 0.025). The present study suggests the presence of a temporal pattern of ED arrivals in CH patients treated with OACs.
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Affiliation(s)
- Fabio Fabbian
- a School of Medicine , University of Ferrara , Ferrara , Italy
| | | | | | - Massimo Gallerani
- b Department of Internal Medicine , University Hospital of Ferrara , Ferrara , Italy
| | - Mario Cavazza
- c Department of Emergency Medicine, General Surgery and Transplants , S. Orsola-Malpighi Hospital , Bologna , Italy
| | - Stefano Grifoni
- d Department of Emergency Medicine , University Hospital Careggi , Firenze , Italy
| | - Andrea Fabbri
- e Department of Emergency Medicine , Hospital of Forlì , Forlì , Italy
| | - Gianfranco Cervellin
- f Department of Emergency Medicine , University Hospital of Parma , Parma , Italy
| | - Anna Maria Ferrari
- g Department of Emergency Medicine , Hospital of Reggio Emilia , Reggio Emilia , Italy
| | - Davide Imberti
- h Internal Medicine , Hospital Guglielmo da Saliceto , Piacenza , Italy
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48
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Feng Y, Huang X, Sun H, Liu C, Zhang B, Zhang Z, Sharma Tengur V, Chen W, Wu T, Yuan J, Zhang X. Framingham risk score modifies the effect of PM10 on heart rate variability. THE SCIENCE OF THE TOTAL ENVIRONMENT 2015; 523:146-151. [PMID: 25863505 DOI: 10.1016/j.scitotenv.2015.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 06/04/2023]
Abstract
Health conditions may greatly modify the association between particulate matter (PM) and heart rate variability (HRV), but whether the modification of PM effect by coronary artery disease (CAD) risk status depends on the PM levels remains unknown. We investigated the associations between personal exposures to PM with aerodynamic diameter of ≤10μm (PM10) and ≤2.5μm (PM2.5) and concurrent HRV, and whether the effect of PM on HRV was modified by Framingham risk score (FRS) in healthy subjects with different PM exposure levels. Personal exposures to PM10 and PM2.5 were measured for 24h in 152 volunteers of community residents who were free of cardiovascular disease in two cities (Zhuhai and Wuhan) that differ in air quality. Simultaneously, 24h HRV indices were obtained from 3-channel Holter monitor. FRS was calculated based on age, sex, lipid profiles, blood pressure, diabetes, and smoking status. Linear regression models were constructed after adjusting for potential confounders. We found significant decrease in total power (TP) and low power (LF) with increased PM10 concentrations (P for trend<0.05) in the high PM levels city (Wuhan) and total population, but not in the low PM levels city (Zhuhai). We also observed significant modification of FRS on PM10 effect in Wuhan. Interestingly, elevated PM10 was associated in a greater decreased HRV in the low FRS subgroup, but not in the high FRS subgroup. However, we did not find any significant main effects of PM2.5 or PM2.5-FRS interactions on HRV in city-specified or city-combined analyses. Overall, the findings indicate that individual coronary risk profiles may modulate the association between particulate air pollution and HRV in high PM exposure levels.
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Affiliation(s)
- Yingying Feng
- Department of Occupational and Environmental Health, Ministry of Education Key Lab for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiji Huang
- Department of Occupational and Environmental Health, Ministry of Education Key Lab for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Huizhen Sun
- Department of Occupational and Environmental Health, Ministry of Education Key Lab for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Chuanyao Liu
- Department of Occupational and Environmental Health, Ministry of Education Key Lab for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Bing Zhang
- Department of Occupational and Environmental Health, Ministry of Education Key Lab for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhihong Zhang
- Department of Occupational and Environmental Health, Ministry of Education Key Lab for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Vashish Sharma Tengur
- Department of Occupational and Environmental Health, Ministry of Education Key Lab for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Weihong Chen
- Department of Occupational and Environmental Health, Ministry of Education Key Lab for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Tangchun Wu
- Department of Occupational and Environmental Health, Ministry of Education Key Lab for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jing Yuan
- Department of Occupational and Environmental Health, Ministry of Education Key Lab for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Xiaomin Zhang
- Department of Occupational and Environmental Health, Ministry of Education Key Lab for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Liu Y, Chen X, Huang S, Tian L, Lu Y, Mei Y, Ren M, Li N, Liu L, Xiang H. Association between air pollutants and cardiovascular disease mortality in Wuhan, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:3506-16. [PMID: 25815523 PMCID: PMC4410199 DOI: 10.3390/ijerph120403506] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/11/2015] [Accepted: 03/18/2015] [Indexed: 11/16/2022]
Abstract
We examined the associations of daily mean concentrations of ambient air pollutants (particulate matter (PM10), sulfur dioxide (SO2), nitric oxide (NO2)) and daily cardiovascular diseases (CVD) mortality in Wuhan, China using a case-crossover design to analyze four years of data (2006–2009) collected from the Hubei Provincial Center for Disease Control and Prevention and the Wuhan Environmental Protection Bureau. From 2006 to 2009, daily average concentrations of PM10, SO2 and NO2 were 115.60 µg/m3, 53.21 µg/m3 and 53.08 µg/m3, respectively. After adjusting for temperature and relative humidity, a 10 µg/m3 increase in SO2 and NO2 over a 24-h period was associated with CVD mortality relative risk (R.R.) of 1.010 (95% CI: 1.000, 1.020) for SO2 and 1.019 (95% CI: 1.005, 1.033) for NO2, but there was no significant association between increases in PM10 and mortality. Subgroup analysis on by gender showed a significant association of 1.026 (95% CI: 1.007, 1.045) between NO2 and CVD among males, while no significant statistical effect was shown among females. Subgroup analysis by age showed that for those older than 65 years, every 10 µg/m3 increase in NO2 was associated with a 1.6% (95% CI: 0.1%, 3.1%) increase in CVD mortality. Subgroup analysis on different types of CVD showed that every 10 µg/m3 increase in PM10 and SO2 were significantly associated with an approximately 1.012 (95% CI: 1.002, 1.022) and 1.021 (95% CI: 1.002, 1.040) increase, respectively, in ischemic heart disease (ICH) mortality. In conclusion, exposure to NO2 is significantly associated with CVD mortality. Larger, multi-center studies in Chinese cities are being currently conducted to validate these findings.
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Affiliation(s)
- Yisi Liu
- School of Public Health, Wuhan University, Wuhan 430071, Hubei Province, China.
- Global Health Institute, Wuhan University, Wuhan 430071, Hubei Province, China.
| | - Xi Chen
- School of Public Health, Wuhan University, Wuhan 430071, Hubei Province, China.
- Global Health Institute, Wuhan University, Wuhan 430071, Hubei Province, China.
| | - Shuqiong Huang
- Hubei Provincial Center for Disease Control and Prevention, Wuhan 430079, Hubei Province, China.
| | - Liqiao Tian
- State Key Laboratory of Information Engineering in Surveying, Mapping and Remote Sensing, Wuhan University, Wuhan 430079, China.
| | - Yuan'an Lu
- Environmental Health Laboratory, Department of Public Health Sciences, Univ Hawaii at Manoa, 1960 East West Rd., Biomed Bldg., D105, Honolulu, HI 96822, USA.
| | - Yan Mei
- School of Stomatology, Wuhan University, Wuhan 430071, Hubei Province, China.
| | - Meng Ren
- School of Public Health, Wuhan University, Wuhan 430071, Hubei Province, China.
- Global Health Institute, Wuhan University, Wuhan 430071, Hubei Province, China.
| | - Na Li
- School of Public Health, Wuhan University, Wuhan 430071, Hubei Province, China.
- Global Health Institute, Wuhan University, Wuhan 430071, Hubei Province, China.
| | - Li Liu
- Department of Epidemiology and Biostatistics, Guangdong Key Lab of Molecular Epidemiology, School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China.
| | - Hao Xiang
- School of Public Health, Wuhan University, Wuhan 430071, Hubei Province, China.
- Global Health Institute, Wuhan University, Wuhan 430071, Hubei Province, China.
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Shah ASV, Lee KK, McAllister DA, Hunter A, Nair H, Whiteley W, Langrish JP, Newby DE, Mills NL. Short term exposure to air pollution and stroke: systematic review and meta-analysis. BMJ 2015; 350:h1295. [PMID: 25810496 PMCID: PMC4373601 DOI: 10.1136/bmj.h1295] [Citation(s) in RCA: 479] [Impact Index Per Article: 53.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To review the evidence for the short term association between air pollution and stroke. DESIGN Systematic review and meta-analysis of observational studies DATA SOURCES Medline, Embase, Global Health, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science searched to January 2014 with no language restrictions. ELIGIBILITY CRITERIA Studies investigating the short term associations (up to lag of seven days) between daily increases in gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide, ozone) and particulate matter (<2.5 µm or <10 µm diameter (PM2.5 and PM10)), and admission to hospital for stroke or mortality. MAIN OUTCOME MEASURES Admission to hospital and mortality from stroke. RESULTS From 2748 articles, 238 were reviewed in depth with 103 satisfying our inclusion criteria and 94 contributing to our meta-estimates. This provided a total of 6.2 million events across 28 countries. Admission to hospital for stroke or mortality from stroke was associated with an increase in concentrations of carbon monoxide (relative risk 1.015 per 1 ppm, 95% confidence interval 1.004 to 1.026), sulphur dioxide (1.019 per 10 ppb, 1.011 to 1.027), and nitrogen dioxide (1.014 per 10 ppb, 1.009 to 1.019). Increases in PM2.5 and PM10 concentration were also associated with admission and mortality (1.011 per 10 μg/m(3) (1.011 to 1.012) and 1.003 per 10 µg/m(3) (1.002 to 1.004), respectively). The weakest association was seen with ozone (1.001 per 10 ppb, 1.000 to 1.002). Strongest associations were observed on the day of exposure with more persistent effects observed for PM(2·5). CONCLUSION Gaseous and particulate air pollutants have a marked and close temporal association with admissions to hospital for stroke or mortality from stroke. Public and environmental health policies to reduce air pollution could reduce the burden of stroke. SYSTEMATIC REVIEW REGISTRATION PROSPERO-CRD42014009225.
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Affiliation(s)
- Anoop S V Shah
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Kuan Ken Lee
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - David A McAllister
- Centre of Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Amanda Hunter
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Harish Nair
- Centre of Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - William Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jeremy P Langrish
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - David E Newby
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Nicholas L Mills
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
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