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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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Economic fluctuations and cardiovascular diseases: A multiple-input time series analysis
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Global Health Risk Factors: Air Pollution
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“In addition, the built environment and associated exposures may also be relevant to cerebrovascular outcomes, given the regional differences in stroke prevalence [10] and associations between air pollution exposure and stroke [11].”
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“19 Low-and middle-income countries are also projected to have increasing air pollution due to industrialization and the energy demands of the approximately 85% of the world ’ s population that live in these developing nations.”
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Global hotspots and trends on environmental exposure and cardiovascular disease from 1999 to 2022
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“[115] Another meta-analysis suggested long-term exposure to PM 2.5 and PM 10 was consistently associated with increased stroke incidence and mortality.”
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“First, most studies emphasize short-term PM 2.5 exposure, focusing on mortality or hospitalization risks [13,14].”
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“…systemic vascular dysfunction, inflammation, autonomic imbalance, and activation of hypothalamic pathways, leading to increased RR of hospitalization due to myocardial infarction (MI) (RR 1.02), stroke (RR 1.01) and heart failure (RR 1.02) per 10 µg/ m 3 increase in PM 2.5 concentration [5, 6].”
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“dysfunction and nanoparticles, which can pass through alveolar-capillary barriers and affect the vasculature and circulating blood cells [7,32,35].”
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“It has been widely demonstrated that PM was positively associated with stroke admission (Liu et al. 2017; Shah et al. 2015; Tian et al. 2018b; Wei et al. 2019).”
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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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