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

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 access
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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Crossref · 10.1136/bmj.h1295

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Figures

Fig 1 Association between gaseous and particulate air pollutants and admission for stroke or mortality from stroke stratified by time lag (days)
Fig 1 Association between gaseous and particulate air pollutants and admission for stroke or mortality from stroke stratified by time lag (days)CC BY-NC · PubMed Central
Fig 2 Associations across all gaseous and particulate air pollutants stratified by outcome, age, and study design
Fig 2 Associations across all gaseous and particulate air pollutants stratified by outcome, age, and study designCC BY-NC · PubMed Central
Fig 3 Cartogram identifying association between nitrogen dioxide and particulate matter (PM10) and admission to hospital for stroke or mortality from stroke in countries stratified as high and low to middle income
Fig 3 Cartogram identifying association between nitrogen dioxide and particulate matter (PM10) and admission to hospital for stroke or mortality from stroke in countries stratified as high and low to middle incomeCC BY-NC · PubMed Central

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Citations

Cites

Research works printed but not linked: 5

  1. Lumley TL, D. Bias in the case-crossover design: implications for studies of air pollution. Environmetrics 2000;11:689-704.
  2. O'Donnell MJ, Xavier D, Liu L, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010;376:112-23.
  3. Donaldson K, Duffin R, Langrish JP, et al. Nanoparticles and the cardiovascular system: a critical review. Nanomedicine (Lond) 2013;8:403-23.
  4. Romieu I, Gouveia N, Cifuentes LA, et al. Multicity study of air pollution and mortality in Latin America (the ESCALA study). Res Rep Health Eff Inst 2012;171:5-86. 124
  5. No commercial reuse: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe 129

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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)
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
Licence
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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