The DOI matches its Crossref record; 155 of the 155 references it cites were found in a registry or an index.
Short term exposure to air pollution and stroke: systematic review and meta-analysis
Open accessAbstract
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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Impact of light rail transit on traffic-related pollution and stroke mortality
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Griffiths, C. J., & Mudway, I. (2018) · BMJ · doi:10.1136/bmj.k4904 · Cited by 20
Fujii, T., Arima, H., Takashima, N., Kita, Y., Miyamatsu, N., Tanaka‐Mizuno, S., Shitara, S., Urushitani, M., Miura, K., & Nozaki, K. (2021) · Cerebrovascular Diseases · doi:10.1159/000518370 · Cited by 19
Li, B., Xiong, J., Liu, H., Li, D., & Chen, G. (2022) · Medical Gas Research · doi:10.4103/2045-9912.337993 · Cited by 22
“Shah et al.(11) 2015 Global Systematic review and Meta-analysis Gaseous and particulate air pollutants have a marked and close temporal association with admissions to hospital for stroke or mortality from stroke.”
BackgroundWu, Y.-H., Wu, C., Chung, M., Chen, C., Wu, L.-Y., Chung, C., & Hsu, H. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.858655 · Cited by 19
Air Pollution and Ischaemic Stroke
Ho, J. S. Y., Jou, E., Tan, B. Y., & Sharma, V. K. (2022) · Annals of Indian Academy of Neurology · doi:10.4103/aian.aian_1130_21 · Cited by 19
“and Shah et al.[12,14,15] Studies on CO and O3 were mostly performed in Asia, particularly in China[34,41] and Korea,[35,42] with few studies from other regions such as Iran[28] and Finland.”
BackgroundResultInfluentialFan, Y., Zhang, W., Li, W., Ma, Y.-J., & Zhang, H. (2024) · BMC Public Health · doi:10.1186/s12889-024-20230-4 · Cited by 19
“A growing body of observational studies confirmed that rising concentrations of air pollutants corresponded with increased incidence and mortality of stroke for both short-term and long-term exposure [9–11].”
BackgroundZhai, K., Kong, X., Liu, B., & Lou, J. (2017) · Medicine · doi:10.1097/md.0000000000007564 · Cited by 19
Magnoni, P., Murtas, R., & Russo, A. G. (2021) · International Journal of Epidemiology · doi:10.1093/ije/dyab068 · Cited by 19
“5), is an established trigger of AVEs occurring within hours to a few days after exposure.(4,5) However, long-term exposure has been recently studied in more detail and would seem to increase this risk to an even greater extent.”
BackgroundPeters, R., Mudway, I., Booth, A., Peters, J., & Anstey, K. J. (2021) · Neuroepidemiology · doi:10.1159/000515394 · Cited by 17
Effect of PM2.5 on burden of mortality from non-communicable diseases in northern Thailand
Parasin, N., & Amnuaylojaroen, T. (2024) · PeerJ · doi:10.7717/peerj.18055 · Cited by 20
“Also, Brook et al. (2010) and Shah et al. (2015) found similar results.”
Tang, H., Huang, J., Lin, H., Zhang, X., Yang, Q., Luo, N., Lin, M., Tian, C., Wu, S., Hong, J., et al. (2025) · Journal of Translational Medicine · doi:10.1186/s12967-025-06375-9 · Cited by 19
Tian, F., Qi, J., Qian, Z. M., Li, H., Wang, L., Wang, C., Geiger, S. D., McMillin, S. E., Yin, P., Lin, H., et al. (2022) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2022.154037 · Cited by 18
Ambient Air Pollution and Risk for Stroke Hospitalization: Impact on Susceptible Groups
Chang, C.-H., Chen, S., Liu, P.-H., Huang, K., Chiu, I.-M., Pan, H.-Y., & Cheng, F. (2022) · Toxics · doi:10.3390/toxics10070350 · Cited by 18
“5, PM10, NO2, and SO2 on stroke hospitalization and mortality [35].”
BackgroundDhiman, V., Trushna, T., Raj, D., & Tiwari, R. (2022) · Neurology India · doi:10.4103/0028-3886.349654 · Cited by 18
Li, X., Li, Y., Yu, B., Zhu, H., Zhou, Z.-L., Yang, Y., Liu, S., Tian, Y., Xiao, J., Xing, X., et al. (2022) · Journal of Global Health · doi:10.7189/jogh.12.11012 · Cited by 18
“A systematic review and meta-analysis showed that increased PM 10 concentrations were associated with HAs for stroke [60] and provided evidence linking air pollution to cerebrovascular diseases.”
BackgroundPariona-Vargas, F., Mun, K. T., Lo, E. H., Starkman, S., Sanossian, N., Hosseini, M. B., Stratton, S. J., Eckstein, M. K., CONWIT, R. A., Liebeskind, D. S., et al. (2023) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2023.107106 · Cited by 17
Ma, Y., Zhang, J., Li, D., Tang, L., Li, Y., Cui, F., Wang, J., Chen, W., Yang, J., & Tian, Y. (2023) · Stroke · doi:10.1161/strokeaha.123.044284 · Cited by 18
The Climate Crisis and Breastfeeding: Opportunities for Resilience
Cerceo, E. A., Saxer, K., Grossman, L., Shapley-Quinn, K., & Feldman‐Winter, L. (2023) · Journal of Human Lactation · doi:10.1177/08903344231216726 · Cited by 25
The health risk reduction of PM2.5 via a green curtain system in Taiwan
Chang, Y. H., Chen, T.-H., Chung, H.-Y., Hsiao, H.-Y., Tseng, P.-C., Wang, Y.-C., Lung, S. C., Su, H.-J. J., & Tsay, Y.-S. (2024) · Building and Environment · doi:10.1016/j.buildenv.2024.111459 · Cited by 20
Recency and projection biases in air quality valuation by Chinese residents.
Chen, S., Qin, P., Tan-Soo, J.-S., & Wei, C. (2019) · Science of the Total Environment · doi:10.1016/j.scitotenv.2018.08.153 · Cited by 20
Is breathing our polluted air a risk factor for stroke?
Estol, C. J. (2019) · International Journal of Stroke · doi:10.1177/1747493019832999 · Cited by 18
“The significant methodological disparities between studies evaluating the interaction between air pollution and stroke limit the validity of inter-study comparisons (Tables 1 to 5).(47) Ischemic versus hemorrhagic stroke”
BackgroundInfluentialHigh temperature effect on daily all-cause mortality in Tunis 2005–2007
Bettaieb, J., Toumi, A., Leffondré, K., Chlif, S., & Salah, A. B. (2019) · Revue d Épidémiologie et de Santé Publique · doi:10.1016/j.respe.2019.09.007 · Cited by 18
Extracellular vesicles as actors in the air pollution related cardiopulmonary diseases
Alkoussa, S., Hulo, S., Courcot, D., Billet, S., & Martin, P. J. (2020) · Critical Reviews in Toxicology · doi:10.1080/10408444.2020.1763252 · Cited by 20
“5 (Shah et al. 2015).”
Wolhuter, K., Arora, M., & Kovacic, J. C. (2021) · BioEssays · doi:10.1002/bies.202100046 · Cited by 17
“Extensive epidemiological studies have correlated air pollution to various CVDs, including atherosclerosis,[21] venous thrombosis,[22] stroke,[23] arrhythmia,[24] cardiac arrest[25] and heart failure.”
BackgroundLi, B., Chen, M., Guo, L., Yun, Y., Li, G., & Sang, N. (2016) · Journal of Environmental Sciences · doi:10.1016/j.jes.2016.05.031 · Cited by 18
Qi, J., Zhang, D., Zhang, X., Yin, P., Liu, J., Pan, Y., Tanaka, T., Xie, P., Wang, Z., Liu, S., et al. (2020) · medRxiv · doi:10.1101/2020.08.28.20183699 · Cited by 18
Atmen: Luftschadstoffe und Gesundheit – Teil I
Schulz, H., Karrasch, S., Bölke, G., Cyrys, J., Hornberg, C., Pickford, R., Schneider, A. E., Witt, C. M., & Hoffmann, B. H. (2019) · Pneumologie · doi:10.1055/a-0882-9366 · Cited by 18
What are the implications of climate change for speech and language therapists?
Sherratt, S. (2020) · International Journal of Language & Communication Disorders · doi:10.1111/1460-6984.12587 · Cited by 19
Li, F., Liu, W., Hu, C., Tang, M., Zhang, Y., Ho, H. C., Peng, S., Li, Z., Wang, Q., Li, X., et al. (2023) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2023.162773 · Cited by 16
Environmental factors and stroke: Risk and prevention
Ranta, A. A., Öztürk, Ş., Wasay, M., Giroud, M., Béjot, Y., & Reis, J. J. (2023) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2023.120860 · Cited by 23
Feltgen, N., & Pielen, A. (2017) · Der Ophthalmologe · doi:10.1007/s00347-016-0432-4 · Cited by 17
Mehta, A., Singh, S., Saeed, A., Mahtta, D., Bittner, V., Sperling, L. S., & Virani, S. S. (2020) · Current Diabetes Reviews · doi:10.2174/1573399816666200703182458 · Cited by 17
Saeed, A., Virani, S. S., Mulukutla, S. R., & Chow, C. K. (2021) · Current Diabetes Reviews · doi:10.2174/1573399817999210112192419 · Cited by 18
Linking PM2.5 organic constituents, relative toxicity and health effects in Puerto Rico
Toro-Heredia, J., Jirau-Colón, H., & Jiménez-Velez, B. D. (2021) · Environmental Challenges · doi:10.1016/j.envc.2021.100350 · Cited by 18
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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