Meta-analysis on correlations between short-term exposures to 6 common air pollutants and incidence of ischemic stroke

HUO Ran; YE Rongrong; ZHANG Fang; DI Zhengli

doi:10.11836/JEOM22307

Volume 40 Issue 2

Feb. 2023

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Journal of Environmental and Occupational Medicine > 2023 > 40(2): 184-189, 195. > DOI: 10.11836/JEOM22307

HUO Ran, YE Rongrong, ZHANG Fang, DI Zhengli. Meta-analysis on correlations between short-term exposures to 6 common air pollutants and incidence of ischemic stroke[J]. Journal of Environmental and Occupational Medicine, 2023, 40(2): 184-189, 195. DOI: 10.11836/JEOM22307

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Meta-analysis on correlations between short-term exposures to 6 common air pollutants and incidence of ischemic stroke

Department of Neurology, Xi´an Central Hospital, Xi´an, Shaanxi 710003, China

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Corresponding author:
DI Zhengli, E-mail: zhenglidi@126.com
Received Date: July 23, 2022
Accepted Date: December 15, 2022
Available Online: March 01, 2023

Graphical Abstract

Abstract

Abstract

Background
Previous studies using meta-analysis to explore the relationship between air pollution exposure and ischemic stroke (IS) mostly focus on particulate matter-related themes, few include gaseous pollutants in the study, and subgroup analyses of factors such as different lag days, seasons, and genders are rarely been reported.
Objective
To quantitatively evaluate the relationships between short-term exposures to 6 common air pollutants, including fine particulate matter (PM_2.5), inhalable particulate matter (PM₁₀), carbon monoxide (CO), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and ozone (O₃), and the incidence of IS.
Methods
A systematic search was conducted to collect literature studying the 6 common air pollutants and IS published up to May 1, 2022 in 6 databases (China Journal Full-text Database, China Biology Medicine Disc, PubMed, Cochrane Library, Web of Science, and Embase). Literature quality evaluation was performed using the Newcastle-Ottawa Scale. Stata 16.0 software was used to conduct meta-analysis including heterogeneity test, combined effect size, meta-regression, subgroup analysis, sensitivity analysis, and publication bias test.
Results
A total of 33 articles were qualified for inclusion. The total number of samples included in the literature was 7195631. The meta-analysis results showed that short-term exposures to PM_2.5 (OR=1.0082, 95%CI: 1.0049−1.0116), PM₁₀ (OR=1.0017, 95%CI: 1.0008−1.0026), CO (OR=1.0328, 95%CI: 1.0231−1.0426), NO₂ (OR=1.0150, 95%CI: 1.0079−1.0222), SO₂ (OR=1.0158, 95%CI: 1.0078-1.0238), and O₃ (OR=1.0017, 95%CI: 1.0003−1.0032) were associated with an increased risk of IS. PM₁₀ and O₃ increased the risk of IS in both lag0 and lag1, while PM_2.5, CO, NO₂, and SO₂ all showed an associated increased risk of IS only in lag0. The results of sensitivity analysis showed stable results for all pollutants studied, and there was no publication bias in the literature on the association of the remaining five pollutants with IS incidence except for the PM_2.5-related literature.
Conclusion
Short-term exposures to PM_2.5, PM₁₀, CO, NO₂, SO₂, and O₃ may increase the incidence of IS, with this risk showing the most significant level on the day of IS onset.
- air pollution,
- ischemic stroke,
- short-term exposure,
- meta-analysis

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References

[1]	EKKER M S, VERHOEVEN J I, VAARTJES I, et al. Association of stroke among adults aged 18 to 49 years with long-term mortality[J]. JAMA, 2019, 321(21): 2113-2123. doi: 10.1001/jama.2019.6560
[2]	FEIGIN V L, ROTH G A, NAGHAVI M, et al. Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013[J]. Lancet Neurol, 2016, 15(9): 913-924. doi: 10.1016/S1474-4422(16)30073-4
[3]	ATKINSON R W, KANG S, ANDERSON H R, et al. Epidemiological time series studies of PM_2.5 and daily mortality and hospital admissions: a systematic review and meta-analysis[J]. Thorax, 2014, 69(7): 660-665. doi: 10.1136/thoraxjnl-2013-204492
[4]	石修权, 王增珍. Meta回归与亚组分析在异质性处理中的应用[J]. 中华流行病学杂志, 2008, 29(5): 497-501. doi: 10.3321/j.issn:0254-6450.2008.05.018 SHI X Q, WANG Z Z. Application of Meta-regression and subgroup analyses of heterogeneity disposal in Meta-analysis[J]. Chin J Epidemiol, 2008, 29(5): 497-501. doi: 10.3321/j.issn:0254-6450.2008.05.018
[5]	许瑞君, 叶韵韶, 林巧绚, 等. 大气污染物短期暴露对老年人缺血性脑卒中住院的影响研究[J]. 公共卫生与预防医学, 2022, 33(1): 6-11. doi: 10.3969/j.issn.1006-2483.2022.01.002 XU R J, YE Y S, LIN Q X, et al. Association of short-term exposure to ambient air pollution with hospital admission for ischemic stroke among older adults[J]. J Pub Health Prev Med, 2022, 33(1): 6-11. doi: 10.3969/j.issn.1006-2483.2022.01.002
[6]	HU W, CHEN Y, CHEN J. Short-term effect of fine particular matter on daily hospitalizations for ischemic stroke: A time-series study in Yancheng, China[J]. Ecotoxicol Environ Saf, 2021, 208: 111518. doi: 10.1016/j.ecoenv.2020.111518
[7]	BAN J, WANG Q, MA R, et al. Associations between short-term exposure to PM_2.5 and stroke incidence and mortality in China: A case-crossover study and estimation of the burden[J]. Environ Pollut, 2021, 268: 115743. doi: 10.1016/j.envpol.2020.115743
[8]	SHEN S, LI X, YUAN C, et al. Association of short-term exposure to sulfur dioxide and hospitalization for ischemic and hemorrhagic stroke in Guangzhou, China[J]. BMC Public Health, 2020, 20(1): 263. doi: 10.1186/s12889-020-8354-0
[9]	QIU X, WEI Y, WANG Y, et al. Inverse probability weighted distributed lag effects of short-term exposure to PM_2.5 and ozone on CVD hospitalizations in New England Medicare participants - Exploring the causal effects[J]. Environ Res, 2020, 182: 109095. doi: 10.1016/j.envres.2019.109095
[10]	QI X, WANG Z, GUO X, et al. Short-term effects of outdoor air pollution on acute ischaemic stroke occurrence: a case-crossover study in Tianjin, China[J]. Occup Environ Med, 2020, 77(12): 862-867. doi: 10.1136/oemed-2019-106301
[11]	GU J, SHI Y, CHEN N, et al. Ambient fine particulate matter and hospital admissions for ischemic and hemorrhagic strokes and transient ischemic attack in 248 Chinese cities[J]. Sci Total Environ, 2020, 715: 136896. doi: 10.1016/j.scitotenv.2020.136896
[12]	CHEN L, ZHANG Y, ZHANG W, et al. Short-term effect of PM₁ on hospital admission for ischemic stroke: A multi-city case-crossover study in China[J]. Environ Pollut, 2020, 260: 113776. doi: 10.1016/j.envpol.2019.113776
[13]	SUN S, STEWART J D, ELIOT M N, et al. Short-term exposure to air pollution and incidence of stroke in the Women's Health Initiative[J]. Environ Int, 2019, 132: 105065. doi: 10.1016/j.envint.2019.105065
[14]	FISHER J A, PUETT R C, LADEN F, et al. Case-crossover analysis of short-term particulate matter exposures and stroke in the health professionals follow-up study[J]. Environ Int, 2019, 124: 153-160. doi: 10.1016/j.envint.2018.12.044
[15]	罗征进, 侯博通, 王美瑶, 等. 短期环境臭氧暴露对急性缺血性卒中住院的影响: 中国武汉的时间序列分析[J]. 国际脑血管病杂志, 2018, 26(12): 897-901. doi: 10.3760/cma.j.issn.1673-4165.2018.12.004 LUO Z J, HOU B T, WANG M Y, et al. Effect of short-term environmental ozone exposure on hospitalization of ischemic stroke: a time series analysis of Wuhan, China[J]. Int J Cerebrovasc Dis, 2018, 26(12): 897-901. doi: 10.3760/cma.j.issn.1673-4165.2018.12.004
[16]	TIAN Y, LIU H, ZHAO Z, et al. Association between ambient air pollution and daily hospital admissions for ischemic stroke: A nationwide time-series analysis[J]. PLoS Med, 2018, 15(10): e1002668. doi: 10.1371/journal.pmed.1002668
[17]	COLLART P, DUBOURG D, LEVÊQUE A, et al. Short-term effects of nitrogen dioxide on hospital admissions for cardiovascular disease in Wallonia, Belgium[J]. Int J Cardiol, 2018, 255: 231-236. doi: 10.1016/j.ijcard.2017.12.058
[18]	TIAN Y, XIANG X, WU Y, et al. Fine particulate air pollution and first hospital admissions for ischemic stroke in Beijing, China[J]. Sci Rep, 2017, 7(1): 3897. doi: 10.1038/s41598-017-04312-5
[19]	GUO P, WANG Y, FENG W, et al. Ambient air pollution and risk for ischemic stroke: a short-term exposure assessment in South China[J]. Int J Environ Res Public Health, 2017, 14(9): 1091. doi: 10.3390/ijerph14091091
[20]	MAHESWARAN R, PEARSON T, BEEVERS S D, et al. Air pollution and subtypes, severity and vulnerability to ischemic stroke-a population based case-crossover study[J]. PLoS One, 2016, 11(6): e0158556. doi: 10.1371/journal.pone.0158556
[21]	HUANG F, LUO Y, GUO Y, et al. Particulate matter and hospital admissions for stroke in Beijing, China: modification effects by ambient temperature[J]. J Am Heart Assoc, 2016, 5(7): e003437. doi: 10.1161/JAHA.116.003437
[22]	MONTRESOR-LÓPEZ J A, YANOSKY J D, MITTLEMAN M A, et al. Short-term exposure to ambient ozone and stroke hospital admission: A case-crossover analysis[J]. J Expo Sci Environ Epidemiol, 2016, 26(2): 162-166. doi: 10.1038/jes.2015.48
[23]	CHEN S Y, LIN Y L, CHANG W T, et al. Increasing emergency room visits for stroke by elevated levels of fine particulate constituents[J]. Sci Total Environ, 2014, 473-474: 446-450. doi: 10.1016/j.scitotenv.2013.12.035
[24]	XU X, SUN Y, HA S, et al. Association between ozone exposure and onset of stroke in allegheny county, Pennsylvania, USA, 1994-2000[J]. Neuroepidemiology, 2013, 41(1): 2-6. doi: 10.1159/000345138
[25]	XIANG H, MERTZ K J, ARENA V C, et al. Estimation of short-term effects of air pollution on stroke hospital admissions in Wuhan, China[J]. PLoS One, 2013, 8(4): e61168. doi: 10.1371/journal.pone.0061168
[26]	CHIU H F, YANG C Y. Short-term effects of fine particulate air pollution on ischemic stroke occurrence: A case-crossover study[J]. J Toxicol Environ Health Part A, 2013, 76(21): 1188-1197. doi: 10.1080/15287394.2013.842463
[27]	WELLENIUS G A, BURGER M R, COULL B A, et al. Ambient air pollution and the risk of acute ischemic stroke[J]. Arch Intern Med, 2012, 172(3): 229-234. doi: 10.1001/archinternmed.2011.732
[28]	VILLENEUVE P J, JOHNSON J Y M, PASICHNYK D, et al. Short-term effects of ambient air pollution on stroke: who is most vulnerable?[J]. Sci Total Environ, 2012, 430: 193-201. doi: 10.1016/j.scitotenv.2012.05.002
[29]	TURIN T C, KITA Y, RUMANA N, et al. Short-term exposure to air pollution and incidence of stroke and acute myocardial infarction in a Japanese population[J]. Neuroepidemiology, 2012, 38(2): 84-92. doi: 10.1159/000335654
[30]	SZYSZKOWICZ M, PORADA E, TREMBLAY N, et al. Sulfur dioxide and emergency department visits for stroke and seizure[J]. Stroke Res Treat, 2012, 2012: 824724.
[31]	MECHTOUFF L, CANOUI-POITRINE F, SCHOTT A M, et al. Lack of association between air pollutant exposure and short-term risk of ischaemic stroke in Lyon, France[J]. Int J Stroke, 2012, 7(8): 669-674. doi: 10.1111/j.1747-4949.2011.00737.x
[32]	ANDERSEN Z J, OLSEN T S, ANDERSEN K K, et al. Association between short-term exposure to ultrafine particles and hospital admissions for stroke in Copenhagen, Denmark[J]. Eur Heart J, 2010, 31(16): 2034-2040. doi: 10.1093/eurheartj/ehq188
[33]	LISABETH L D, ESCOBAR J D, DVONCH J T, et al. Ambient air pollution and risk for ischemic stroke and transient ischemic attack[J]. Ann Neurol, 2008, 64(1): 53-59. doi: 10.1002/ana.21403
[34]	HENROTIN J B, BESANCENOT J P, BEJOT Y, et al. Short-term effects of ozone air pollution on ischaemic stroke occurrence: A case-crossover analysis from a 10-year population-based study in Dijon, France[J]. Occup Environ Med, 2007, 64(7): 439-445. doi: 10.1136/oem.2006.029306
[35]	VILLENEUVE P J, CHEN L, STIEB D, et al. Associations between outdoor air pollution and emergency department visits for stroke in Edmonton, Canada[J]. Eur J Epidemiol, 2006, 21(9): 689-700. doi: 10.1007/s10654-006-9050-9
[36]	CHAN C C, CHUANG K J, CHIEN L C, et al. Urban air pollution and emergency admissions for cerebrovascular diseases in Taipei, Taiwan[J]. Eur Heart J, 2006, 27(10): 1238-1244. doi: 10.1093/eurheartj/ehi835
[37]	WELLENIUS G A, SCHWARTZ J, MITTLEMAN M A. Air pollution and hospital admissions for ischemic and hemorrhagic stroke among medicare beneficiaries[J]. Stroke, 2005, 36(12): 2549-2553. doi: 10.1161/01.STR.0000189687.78760.47
[38]	GUO Y, BARNETT A G, ZHANG Y, et al. The short-term effect of air pollution on cardiovascular mortality in Tianjin, China: comparison of time series and case-crossover analyses[J]. Sci Total Environ, 2010, 409(2): 300-306. doi: 10.1016/j.scitotenv.2010.10.013
[39]	REN M, LI N, WANG Z, et al. The short-term effects of air pollutants on respiratory disease mortality in Wuhan, China: comparison of time-series and case-crossover analyses[J]. Sci Rep, 2017, 7: 40482. doi: 10.1038/srep40482
[40]	WANG Z, PENG J, LIU P, et al. Association between short-term exposure to air pollution and ischemic stroke onset: a time-stratified case-crossover analysis using a distributed lag nonlinear model in Shenzhen, China[J]. Environ Health, 2020, 19(1): 1. doi: 10.1186/s12940-019-0557-4
[41]	PENG R D, DOMINICI F, PASTOR-BARRIUSO R, et al. Seasonal analyses of air pollution and mortality in 100 US cities[J]. Am J Epidemiol, 2005, 161(6): 585-594. doi: 10.1093/aje/kwi075
[42]	LIN H, TAO J, DU Y, et al. Differentiating the effects of characteristics of PM pollution on mortality from ischemic and hemorrhagic strokes[J]. Int J Hyg Environ Health, 2016, 219(2): 204-211. doi: 10.1016/j.ijheh.2015.11.002
[43]	SHAH A S V, LEE K K, MCALLISTER D A, et al. Short term exposure to air pollution and stroke: systematic review and meta-analysis[J]. BMJ, 2015, 350: h1295.
[44]	DOMINICI F, PENG R D, BELL M L, et al. Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases[J]. JAMA, 2006, 295(10): 1127-1134. doi: 10.1001/jama.295.10.1127