Association between ambient air pollution and hospitalization for ischemic and hemorrhagic stroke in China: A multicity case-crossover study

Liu, Hui; Tian, Yaohua; Xu, Yan; Huang, Ze; Huang, Chao; Hu, Yonghua; Zhang, Jun

doi:10.1016/j.envpol.2017.06.057

Cited by 85 publications

(54 citation statements)

References 40 publications

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“…For example, the most informative pollutant of traffic emissions NO 2 . The association were comparable to previously studies [6,11,12,16].…”

Section: Discussionsupporting

confidence: 91%

“…The lower incidence of hemorrhagic stroke may lead to larger imprecision in the estimates [6]. In addition, we noted that 70.14% hemorrhagic stroke cases were < 65 years old, while 59.75% ischemic stroke cases were ≥ 65 years old, which was similar to previous observations [11]. But the different age distribution of ischemic and hemorrhagic stroke should not be ignored.…”

Section: Discussionsupporting

confidence: 86%

“…The discrepant results on hemorrhagic stroke may be explained by differences in average pollutant levels, meteorological patterns and population characteristics between studies [30]. For example, in the study of Liu et al [11], SO 2 concentration level was 39.6 ± 41.2 μg/m 3 with remarkably higher variation than that in Guangzhou (21.99 ± 6.37 μg/m 3 ) in our study. The exposure levels and exposure patterns might partly explain the difference.…”

Section: Discussioncontrasting

confidence: 78%

“…But when adjusted for other air pollutants in our models (except O 3 ), the magnitude of risk due to SO 2 exposure turned out to be statistically insignificant. Previous evidences on SO 2hemorrhagic stroke association are scarce and inconsistent [11,29]. The discrepant results on hemorrhagic stroke may be explained by differences in average pollutant levels, meteorological patterns and population characteristics between studies [30].…”

Section: Discussionmentioning

confidence: 97%

“…Short-term exposure to ambient SO 2 was associated with increased risk of stroke morbidity in a meta-analysis mainly based on developed countries [6]. However, in developing countries like China, the evidence is limited and very few studies [11] distinguished between ischemic and hemorrhagic stroke. Most studies only focused on ischemic stroke but the results have not been conclusive yet, with some finding evidence of a positive association [12] but not in other studies [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Association of short-term exposure to sulfur dioxide and hospitalization for ischemic and hemorrhagic stroke in Guangzhou, China

Shen

Yuan

et al. 2020

BMC Public Health

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Background: In developing countries, ambient sulfur dioxide (SO 2 ) 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 SO 2 exposure and the total number of hospital admissions for ischemic and hemorrhagic stroke. In addition, we evaluated the effect of ambient SO 2 by age (< 65 years and ≥ 65 years). Results: During the study period, a 24-h mean concentration of ambient SO 2 of 27.82 μg/m 3 , a total of 58,473 ischemic stroke and 9167 hemorrhagic stroke hospital admissions hospital were recorded. Ambient SO 2 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/m 3 increase in SO 2 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 SO 2 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 SO 2 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 SO 2 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 SO 2 .

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“…For example, the most informative pollutant of traffic emissions NO 2 . The association were comparable to previously studies [6,11,12,16].…”

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 86%