Cited by 870Air Quality and Health ImpactsIndoor Air Quality and Microbial ExposureClimate Change and Health Impacts

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Short term exposure to air pollution and stroke: systematic review and meta-analysis

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Shah, Anoop S V, Lee, Kuan Ken, McAllister, David A, Hunter, Amanda, Nair, Harish, Whiteley, William, Langrish, Jeremy P, Newby, David E, Mills, Nicholas L·2015·BMJ

DOI 10.1136/bmj.h1295PMC PMC4373601

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Abstract

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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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: Shah, Anoop S V
Lee, Kuan Ken
McAllister, David A
Hunter, Amanda
Nair, Harish
Whiteley, William
Newby, David E
Mills, Nicholas L
Venue: BMJ
Publisher: BMJ
Published: 2015-03-24
Volume: 350
Pages: h1295
ISSN: 1756-1833 (ISSN-L)
DOI: 10.1136/bmj.h1295
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
Licence: cc-by
www.bmj.org/licenses/tdm/1.0/terms-and-conditions.html (tdm)
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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Short term exposure to air pollution and stroke: systematic review and meta-analysis

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