Associations between short-term exposure to PM2.5 and stroke incidence and mortality in China: A case-crossover study and estimation of the burden

Ban, Jie; Wang, Qing; Ma, Runmei; Zhang, Yingjian; Shi, Wangying; Zhang, Yayi; Chen, Chen; Sun, Qinghua; Wang, Yanwen; Guo, Xinbiao; Li, Tiantian

doi:10.1016/j.envpol.2020.115743

Cited by 37 publications

(42 citation statements)

References 34 publications

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“…Extensive previous studies have reported that short-term exposure to particulate matter with an aerodynamic diameter ≤2.5 μm (PM 2.5 ) [5][6][7][8][9][10][11][12][13], particulate matter with an aerodynamic diameter ≤10 μm (PM 10 ) [3,4,6,[12][13][14][15], sulfur dioxide (SO 2 ) [3,4,15,16], nitrogen dioxide (NO 2 ) [3,4,10,13,15,[17][18][19], carbon monoxide (CO) [4,9,20], and/or ozone (O 3 ) [4,13,21] was associated with stroke mortality. As two main types of stroke, ischemic stroke and hemorrhagic stroke have different patterns of incidence and prognosis.…”

Section: Introductionmentioning

confidence: 99%

Association of short‐term exposure to ambient air pollution with mortality from ischemic and hemorrhagic stroke

Wang

Wei

et al. 2022

Euro J of Neurology

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Background Short‐term exposure to ambient air pollution has been linked to increased risk of stroke mortality, but its adverse effects on mortality from specific types of stroke including ischemic stroke and hemorrhagic stroke remain poorly understood. Methods Using the China National Mortality Surveillance System, we conducted a time‐stratified case‐crossover study among 412,567 stroke deaths in Jiangsu province, China during 2015–2019. Residential daily PM2.5, PM10, SO2, NO2, CO, and O3 exposure concentrations were extracted from the ChinaHighAirPollutants dataset for each subject. Conditional logistic regression models were performed to conduct exposure–response analyses. Results Each 10 μg/m3 increase of PM2.5, PM10, SO2, NO2, CO, and O3 was respectively associated with a 1.44%, 0.93%, 5.55%, 2.90%, 0.148%, and 0.54% increase in odds of mortality from ischemic stroke, which was significantly stronger than that from hemorrhagic stroke (percent change in odds: 0.74%, 0.51%, 3.11%, 1.15%, 0.090%, and 0.10%). The excess fraction of ischemic stroke mortality associated with PM2.5, PM10, SO2, NO2, CO, and O3 exposure was 6.90%, 6.48%, 8.21%, 8.61%, 9.67%, and 4.76%, respectively, which was also significantly higher than that of hemorrhagic stroke mortality (excess fraction: 3.49%, 3.48%, 4.69%, 3.48%, 5.86%, and 0.88%). These differences in adverse effects generally remained across sex, age, and season. Conclusions Short‐term exposure to ambient air pollution was significantly associated with increased risk of both ischemic and hemorrhagic stroke mortality and posed considerable excess mortality. Our results suggest that air pollution exposure may lead to substantially greater adverse effects on mortality from ischemic stroke than that from hemorrhagic stroke.

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Section: Introductionmentioning

confidence: 99%

Association of short‐term exposure to ambient air pollution with mortality from ischemic and hemorrhagic stroke

Wang

Wei

et al. 2022

Euro J of Neurology

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“…The influence of PM 2.5 on CbVD and ACS is well documented [29,30]. Ban et al reported that a 10 µg/m 3 increase in PM 2.5 increases the mortality risk by 0.71%, 1.09% and 0.43% for stroke, ischemic stroke and hemorrhagic stroke, respectively [31]. According to Bourdrel et al, a 10 µg/m 3 increment in the PM 2.5 concentration had an influence on admissions for stroke up to two days after the exposure [32].…”

Section: Discussionmentioning

confidence: 92%

Short-Term Effects of “Polish Smog” on Cardiovascular Mortality in the Green Lungs of Poland: A Case-Crossover Study with 4,500,000 Person-Years (PL-PARTICLES Study)

et al. 2021

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Previous studies conducted in highly polluted areas have reported associations between air pollution and daily mortality. The Green Lungs of Poland are characterized by unique natural features and a moderate pollution level. We aimed to assess the short-term impact of air pollution on cardiovascular (CVD)-, acute coronary syndrome (ACS)-, and cerebrovascular-related (CbVD) mortality. An analysis with 4,500,000 person-years and a time-stratified case-crossover design was performed. The interquartile range increase in the PM2.5 (OR 1.036, 95% CI 1.016–1.056, p < 0.001) and PM10 concentration (OR 1.034, 95% CI 1.015–1.053, p < 0.001) was associated with increased CVD mortality on lag 0, and this effect persisted on the following days. The effects of PMs were expressed more in association with ACS-related mortality (PM2.5-OR = 1.045, 95% CI 1.012–1.080, p = 0.01; PM10-OR = 1.044, 95% CI 1.010–1.078, p = 0.01) and CbVD mortality (PM10-OR = 1.099, 95% CI 1.019–1.343, p = 0.02). We also noted a higher CVD mortality OR in the cold season for PM10 in cities with area-source domination: Białystok (p = 0.001) and Suwałki (p = 0.047). The short-term impact of PMs on cardiovascular mortality is also observed in moderately polluted areas. This adverse health effect was more apparent in CbVD- and ACS-related mortality, and in the cold season. Further research focusing on the adverse health effects of “Polish smog” is sorely needed.

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“…Public holidays and days of the week were included in the model as indicator variables, and temperature and relative humidity indicate current-day air temperature and relative humidity, respectively. We used same-day air pollutant concentrations (lag 0) in our main analyses because lag 0 often produces the largest effect estimates ( 4 , 17 , 26 , 27 ).…”

Section: Methodsmentioning

confidence: 99%

“…In addition to genetic and lifestyle factors, adverse environmental factors such as air pollution and extreme temperatures have been identified as risk factors for stroke. The association of air pollution exposure with stroke incidence has been analyzed but with divergent findings by pollutant (4)(5)(6). Moreover, studies from low-and middle-income countries are relatively scarce, although the incidence and prevalence of stroke are higher in these regions (7) and air pollution is worse.…”

Section: Introductionmentioning

confidence: 99%

“…Climate change is another environmental concern with public health implications, in particular, for cardiovascular and cerebrovascular events (11,12). Several studies have shown that both higher levels of air pollution and nonoptimum temperature are associated with a higher incidence of stroke (4,5,(13)(14)(15), and other studies have suggested a possible modifying effect of temperature in associations between air pollution and stroke (11,16). Nonetheless, these studies showed conflicting results as to whether lower temperatures or higher temperatures could enhance the effects.…”

Section: Introductionmentioning

confidence: 99%

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Short-Term Association of Air Pollutant Levels and Hospital Admissions for Stroke and Effect Modification by Apparent Temperature: Evidence From Shanghai, China

Weng

Feng

et al. 2021

Front. Public Health

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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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Associations between short-term exposure to PM2.5 and stroke incidence and mortality in China: A case-crossover study and estimation of the burden

Cited by 37 publications

References 34 publications

Association of short‐term exposure to ambient air pollution with mortality from ischemic and hemorrhagic stroke

Association of short‐term exposure to ambient air pollution with mortality from ischemic and hemorrhagic stroke

Short-Term Effects of “Polish Smog” on Cardiovascular Mortality in the Green Lungs of Poland: A Case-Crossover Study with 4,500,000 Person-Years (PL-PARTICLES Study)

Short-Term Association of Air Pollutant Levels and Hospital Admissions for Stroke and Effect Modification by Apparent Temperature: Evidence From Shanghai, China

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