Dataset Information

Acute effects of air pollution on ischaemic stroke onset and deaths: a time-series study in Changzhou, China.

ABSTRACT:

Objective

To investigate the acute effect of air pollutants on ischaemic stroke (IS) and IS-related death.

Setting

Five urban districts in Changzhou, China, between 9 January 2015 and 31 December 2016.

Participants

A total of 32 840 IS cases and 4028 IS deaths were enrolled.

Main outcome measures

A time-series design, generalised additive model and multivariable regression model were used to examine the percentage change (95% CI) in daily IS counts and deaths with an IQR increase in air pollutant levels for different single or multiple lag days in single-pollutant and two-pollutant models.

Results

Daily IS counts increased 0.208% (95% CI 0.036% to 0.381%) with an IQR increment in the levels of nitrogen dioxide (NO₂). The estimated risk of NO₂ was more robust in males and in the cold season. For daily IS counts, the estimated effects of NO₂ and sulfur dioxide (SO₂) were more significant when adjusted for particulate matter with aerodynamic diameters <2.5 µm (PM_2.5) and PM₁₀. An IQR increment in the concentration of PM₁₀, SO₂ and NO₂ significantly increased IS deaths with 6 days of cumulative effects (0.268%, 95%?CI 0.007% to 1.528%; 0.34%, 0.088% to 0.592%; and 0.263%, 0.004% to 0.522%, respectively). Young individuals (<65 years old) had a higher IS mortality risk for PM_2.5, PM₁₀, NO₂ and CO. For IS death, the effect estimates of SO₂ in the elderly, females and the cold season were more pronounced; statistical significance was also identified for SO₂ when adjusted for carbon monoxide (CO).

Conclusions

This study suggested that short-term exposure to ambient NO₂ was associated with increased IS risk. In addition, SO₂ was associated with increased IS onset and death.

SUBMITTER: Dong H

PROVIDER: S-EPMC6059268 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Acute effects of air pollution on ischaemic stroke onset and deaths: a time-series study in Changzhou, China.

Dong Huibin H Yu Yongquan Y Yao Shen S Lu Yan Y Chen Zhiyong Z Li Guiying G Yao Yao Y Yao Xingjuan X Wang Shou-Lin SL Zhang Zhan Z

BMJ open 20180723 7

<h4>Objective</h4>To investigate the acute effect of air pollutants on ischaemic stroke (IS) and IS-related death.<h4>Setting</h4>Five urban districts in Changzhou, China, between 9 January 2015 and 31 December 2016.<h4>Participants</h4>A total of 32 840 IS cases and 4028 IS deaths were enrolled.<h4>Main outcome measures</h4>A time-series design, generalised additive model and multivariable regression model were used to examine the percentage change (95% CI) in daily IS counts and deaths with an ...[more]

PMID: 30037864

Similar Datasets

Project description:Air pollution remains a major threat to cardiovascular health and most acute myocardial infarction (AMI) deaths occur at home. However, currently established knowledge on the deleterious effect of air pollution on AMI has been limited to routinely monitored air pollutants and overlooked the place of death. In this study, we examined the association between short-term residential exposure to China's routinely monitored and unmonitored air pollutants and the risk of AMI deaths at home. A time-stratified case-crossover analysis was undertaken to associate short-term residential exposure to air pollution with 0.1 million AMI deaths at home in Jiangsu Province (China) during 2016-2019. Individual-level residential exposure to five unmonitored and monitored air pollutants including PM1 (particulate matter with an aerodynamic diameter ≤ 1 μm) and PM2.5 (particulate matter with an aerodynamic diameter ≤ 2.5 μm), SO2 (sulfur dioxide), NO2 (nitrogen dioxide), and O3 (ozone) was estimated from satellite remote sensing and machine learning technique. We found that exposure to five air pollutants, even below the recently released stricter air quality standards of the World Health Organization (WHO), was all associated with increased odds of AMI deaths at home. The odds of AMI deaths increased by 20% (95% confidence interval: 8 to 33%), 22% (12 to 33%), 14% (2 to 27%), 13% (3 to 25%), and 7% (3 to 12%) for an interquartile range increase in PM1, PM2.5, SO2, NO2, and O3, respectively. A greater magnitude of association between NO2 or O3 and AMI deaths was observed in females and in the warm season. The greatest association between PM1 and AMI deaths was found in individuals aged ≤ 64 years. This study for the first time suggests that residential exposure to routinely monitored and unmonitored air pollutants, even below the newest WHO air quality standards, is still associated with higher odds of AMI deaths at home. Future studies are warranted to understand the biological mechanisms behind the triggering of AMI deaths by air pollution exposure, to develop intervention strategies to reduce AMI deaths triggered by air pollution exposure, and to evaluate the cost-effectiveness, accessibility, and sustainability of these intervention strategies.

Project description: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 ?g/m3 in particulate matter with aerodynamic diameter <2.5 ?m (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.

Project description:BackgroundThe impacts of air pollution on circulatory and respiratory systems have been extensively studied. However, the associations between air pollution exposure and the risk of noncommunicable diseases of other organ systems, including diseases of the digestive, musculoskeletal, and genitourinary systems, remain unclear or inconclusive. We aimed to systematically assess the associations between short-term exposure to main air pollutants (fine particulate matter [PM2.5] and ozone) and cause-specific risk of hospital admission in China over a wide spectrum of human diseases.Methods and findingsDaily data on hospital admissions for primary diagnosis of 14 major and 188 minor disease categories in 252 Chinese cities (107 cities in North China and 145 cities in South China) from January 1, 2013, to December 31, 2017, were obtained from the Hospital Quality Monitoring System of China (covering 387 hospitals in North China and 614 hospitals in South China). We applied a 2-stage analytic approach to assess the associations between air pollution and daily hospital admissions. City-specific associations were estimated with quasi-Poisson regression models and then pooled by random-effects meta-analyses. Each disease category was analyzed separately, and the P values were adjusted for multiple comparisons. A total of 117,338,867 hospital admissions were recorded in the study period. Overall, 51.7% of the hospitalized cases were male, and 71.3% were aged <65 years. Robust positive associations were found between short-term PM2.5 exposure and hospital admissions for 7 major disease categories: (1) endocrine, nutritional, and metabolic diseases; (2) nervous diseases; (3) circulatory diseases; (4) respiratory diseases; (5) digestive diseases; (6) musculoskeletal and connective tissue diseases; and (7) genitourinary diseases. For example, a 10-μg/m3 increase in PM2.5 was associated with a 0.21% (95% CI 0.15% to 0.27%; adjusted P < 0.001) increase in hospital admissions for diseases of the digestive system on the same day in 2-pollutant models (adjusting for ozone). There were 35 minor disease categories significantly positively associated with same-day PM2.5 in both single- and 2-pollutant models, including diabetes mellitus, anemia, intestinal infection, liver diseases, gastrointestinal hemorrhage, renal failure, urinary tract calculus, chronic ulcer of skin, and back problems. The association between short-term ozone exposure and respiratory diseases was robust. No safety threshold in the exposure-response relationships between PM2.5 and hospital admissions was observed. The main limitations of the present study included the unavailability of data on personal air pollution exposures.ConclusionsIn the Chinese population during 2013-2017, short-term exposure to air pollution, especially PM2.5, was associated with increased risk of hospitalization for diseases of multiple organ systems, including certain diseases of the digestive, musculoskeletal, and genitourinary systems; many of these associations are important but still not fully recognized. The effect estimates and exposure-response relationships can inform policy making aimed at protecting public health from air pollution in China.

Dataset Information

Acute effects of air pollution on ischaemic stroke onset and deaths: a time-series study in Changzhou, China.

Objective

Setting

Participants

Main outcome measures

Results

Conclusions

Publications

Acute effects of air pollution on ischaemic stroke onset and deaths: a time-series study in Changzhou, China.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets