Background Living near major roadways has been associated with increased risk of cardiovascular events, but little is known about its impact on renal function. Methods We calculated estimated glomerular filtration rate (eGFR) for 1103 consecutive Boston-area patients hospitalized with acute ischemic stroke between 1999 and 2004. We used linear regression to evaluate the association between eGFR and categories of residential distance to major roadway (0 to ≤ 50, 50 to ≤ 100, 100 to ≤ 200, 200 to ≤ 400, 400 to ≤ 1000, and >1000 m) adjusting for age, sex, race, smoking, comorbid conditions, treatment with angiotensin-converting enzyme inhibitor, and neighborhood-level socioeconomic characteristics. In a second analysis, we considered the log of distance to major roadway as a continuous variable. Results Patients living closer to a major roadway had lower eGFR than patients living farther away (Ptrend=0.01). Comparing patients living 50 m versus 1000 m from a major roadway was associated with a 3.9 mL/min/1.73 m2 lower eGFR (95% CI: 1.0, 6.7; p=0.007); a difference comparable in magnitude to the reduction in eGFR observed for a 4 year increase in age in population-based studies. The magnitude of this association did not differ significantly across categories of age, sex, race, history of hypertension, diabetes, or socioeconomic status. Conclusions Living near a major roadway is associated with lower eGFR in a cohort of patients presenting with acute ischemic stroke. If causal, these results imply that exposures associated with living near a major roadway contribute to reduced renal function, an important risk factor for cardiovascular events.
Background Living in areas with higher levels of ambient air pollution has been associated with a higher incidence of ischemic stroke and all-cause mortality, but less is known about the relationship between traffic related pollution and long term survival following stroke. Methods We identified consecutive patients admitted to Beth Israel Deaconess Medical Center with ischemic stroke between 1999 and 2008 and determined distance to the nearest roadway with an average daily traffic count >10,000 vehicles/day. Categories of residential proximity were defined as ≤100 meters (m), 100 to 200, 200 to ≤400 or > 400m from a busy roadway. We identified deaths through June 2012 using the Social Security Death Index and used Cox proportional hazards models adjusted for medical history, and socioeconomic factors to calculate hazard ratios for the association between residential proximity to a high traffic roadway and all-cause mortality. Results Among 1683 stroke patients with complete data, there were 950 deaths [median follow-up = 4.6 years]. We observed higher post-stroke mortality among people living closer to high traffic roadways. Patients living ≤100m from high traffic roadways had a 20% (95% CI: 1%, 43%) higher rate of post-stroke mortality than patients living >400m away (p-trend=0.02). Conclusions In this study, living close to a high traffic roadway was associated with an elevated mortality rate. This relationship remained statistically significant after adjustment for individual and neighborhood- level factors, providing evidence that traffic-related pollution is associated with a higher mortality rate among stroke survivors.
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