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Short term exposure to air pollution and stroke: systematic review and meta-analysis
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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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“A meta-analysis of 53 studies showed a weak but significant association between ozone and hospital admission and mortality from stroke (41).”
From Ozone pollution: A Major health hazard worldwide (2019) · cites this paper as [41]
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“also found significantly positive associations between SO2, NO2, PM10 and stroke [9, 10].”
BackgroundLee, K. K., Stelzle, D., Bing, R., Anwar, M., Strachan, F. E., Bashir, S., Newby, D. E., Shah, J., Chung, M. H., Bloomfield, G. S., et al. (2019) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(19)30227-4 · Cited by 121
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Air quality during and after festivals: Aerosol concentrations, composition and health effects
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Taking a Stand Against Air Pollution—The Impact on Cardiovascular Disease
Brauer, M. D., Casadei, B., Harrington, R. A., Kovacs, R. J., Sliwa, K. S., Brauer, M. D., Davaakhuu, N., Hadley, M. B., Kass, D. E., Miller, M. R., et al. (2021) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2020.12.003 · Cited by 107
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Mirowsky, J. E., Carraway, M. S., Dhingra, R., Tong, H., Neas, L., Díaz-Sánchez, D., Cascio, W. E., Case, M., Crooks, J., Hauser, E. R., et al. (2017) · Environmental Health · doi:10.1186/s12940-017-0335-0 · Cited by 109
Jones, C. G., Rappold, A. G., Vargo, J., Cascio, W. E., Kharrazi, M., McNally, B., Hoshiko, S., & with the CARES Surveillance Group (2020) · Journal of the American Heart Association · doi:10.1161/jaha.119.014125 · Cited by 104
Association between environmental air pollution and rheumatoid arthritis flares
Adami, G., Viapiana, O., Rossini, M., Orsolini, G., Bertoldo, E., Giollo, A., Gatti, D., & Fassio, A. (2021) · Lara D. Veeken · doi:10.1093/rheumatology/keab049 · Cited by 104
Zhang, W., Lin, S., Hopke, P. K., Thurston, S. W., van Wijngaarden, E., Croft, D. P., Squizzato, S., Masiol, M., & Rich, D. Q. (2018) · Environmental Pollution · doi:10.1016/j.envpol.2018.08.030 · Cited by 103
Ambient air pollution exposure and risk of migraine: Synergistic effect with high temperature
Lee, H., Myung, W., Cheong, H., Yi, S., Hong, Y., Cho, S., & Kim, H. (2018) · Environment International · doi:10.1016/j.envint.2018.09.022 · Cited by 104
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“2015), ischemic stroke (Shah et al. 2015), cardiac arrhythmia (Link et al.”
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Effect of Air Pollution and Hospital Admission: A Systematic Review
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National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014
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Cardiovascular and respiratory mortality attributed to ground-level ozone in Ahvaz, Iran
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“Nowadays, the world is suffering from outdoor air pollution but it may be different in view of pollutant concentration from a region to another area (Boyce et al. 2015; Geravandi et al. 2015; Ren et al. 2010; Shah et al. 2015; Zallaghi et al. 2014b).”
BackgroundFine particle environmental pollution and cardiovascular diseases
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“Exposure to air pollution tends to increase risk of disease and mortality [33,44].”
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Can green structure reduce the mortality of cardiovascular diseases?
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“In addition to the difference in the mechanisms between hemorrhagic and ischemic stroke, the fewer hospital admissions of hemorrhagic stroke, reflecting the lower incidence of this subtype, might result in wider CIs for the estimate.(37) Notably, when stratified by temperature, Table 8.”
BackgroundEcology of the cardiovascular system: A focus on air-related environmental factors
Argacha, J., Bourdrel, T., & van de Borne, P. (2017) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2017.07.013 · Cited by 93
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“10 typically dominating: (1) The “classical” measurement error type, in which the exposure error is independent of the true exposure, and (2) the “Berkson” error type, in which the error is independent of the modeled exposure—e.”
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“The proposed aetio-pathogenic pathways of air pollution’s effect on cognitive decline include enhanced risk of hypertension, dyslipidemia, oxidative stress, insulin resistance, endothelial dysfunction, procoagulant states, and stroke [76,77].”
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The Curious Case of the Missing Strokes During the COVID-19 Pandemic
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“Primary air pollutants refers to the levels of various primary air pollutants, such as carbon monoxide (CO), nitrogen oxide (NO x ), sulfur dioxide (SO 2 ) and particulate matter with particle size ranging from 2.5 to 10 microns (PM 2.5–10 ) 53–56 .”
InfluentialHowell, N. A., Tu, J. V., Moineddin, R., Chen, H., Chu, A., Hystad, P., & Booth, G. L. (2019) · Environment International · doi:10.1016/j.envint.2019.04.070 · Cited by 85
Long-term exposure to air pollution and stroke incidence: A Danish Nurse cohort study
Amini, H., Dehlendorff, C., Lim, Y., Mehta, A. J., Jørgensen, J. T., Mortensen, L. H., Westendorp, R. G. J., Hoffmann, B. H., Loft, S. H., Cole‐Hunter, T., et al. (2020) · Environment International · doi:10.1016/j.envint.2020.105891 · Cited by 84
“Association between air pollution and stroke has been confirmed in a number of both short-term and long-term exposure studies (Shah et al., 2015; Shamsipour et al., 1990; Stafoggia et al., 2014; Yuan et al., 2019).”
BackgroundPathogenesis of PM2.5-Related Disorders in Different Age Groups: Children, Adults, and the Elderly
Amnuaylojaroen, T., & Parasin, N. (2024) · Epigenomes · doi:10.3390/epigenomes8020013 · Cited by 88
“Epidemiological studies have established a connection between PM 2.5 and cardiovascular disorders such as arrhythmia and coronary artery disease [81–83].”
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Metadata
- Authors
- Shah, A. S. V., Lee, K. K., McAllister, D. A., Hunter, A., Nair, H., Whiteley, W., Langrish, J. P., Newby, D. E., & Mills, N. L.
- Affiliations
- University of Edinburgh (GB)
- Corresponding author
- Shah, Anoop S V
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2015-03-24
- Volume
- 350
- Pages
- h1295
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC4373601
- OpenAlex
- W2101986715
- Cited by
- 870
- References
- 155
- Citations by year
- 2026: 42 · 2025: 62 · 2024: 87 · 2023: 86 · 2022: 109 · 2021: 102 · 2020: 98 · 2019: 83 · 2018: 64 · 2017: 68 · 2016: 52 · 2015: 17
- FWCI
- 6.34
- Type
- journal article
- Language
- en
- Update notices
- correction (2016-09-06)
- Open access
- hybrid
- doi.org
- Locations
- BMJ (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by-nc)
- Funders
- Wellcome Trust (103782)
- British Heart Foundation (CH09/002, RG/10/9/28286, SS/CH/09/002, PG/11/27/28842, FS/10/024/28266)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Climate Change and Health Impacts
- Keywords
- air pollution, stroke, short-term exposure, hospitalization, stroke mortality, particulate matter, PM2.5, PM10, nitrogen dioxide, sulfur dioxide, carbon monoxide, ozone, gaseous pollutants, lagged effects, environmental health policy, air pollution regulation, air pollution health effects
- MeSH terms
- Air Pollutants, Air Pollution, Environmental Exposure, Humans, Patient Admission, Risk Factors, Stroke, Particulate Matter
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