Abstract
ObjectiveFew studies investigating associations between fine particulate air pollution and hemorrhagic stroke have considered subtypes. Additionally, less is known about the modification of such association by factors measured at the individual level. We aimed to investigate the risk of fatal intracerebral hemorrhage (ICH) incidence in case of PM2.5 (particles ≤ 2.5 μm in aerodynamic diameter) exposure.MethodsData on incidence of fatal ICH from 1 June 2012 to 31 May 2014 were extracted from the acute stroke mortality database in Shanghai Municipal Center for Disease Control and Prevention (SCDC). We used the time-stratified case-crossover approach to assess the association between daily concentrations of PM2.5 and fatal ICH incidence in Shanghai, China.ResultsA total of 5286 fatal ICH cases occurred during our study period. The averaged concentration of PM2.5 was 77.45 μg/m3. The incidence of fatal ICH was significantly associated with PM2.5 concentration. Substantial differences were observed among subjects with diabetes compared with those without; following the increase of PM2.5 in lag2, the OR (95% CI) for subjects with diabetes was 1.26 (1.09–1.46) versus 1.05 (0.98–1.12) for those without. We did not find evidence of effect modification by hypertension and cigarette smoking.ConclusionsFatal ICH incidence was associated with PM2.5 exposure. Our results also suggested that diabetes may increase the risk for ICH incidence in relation to PM2.5.
Highlights
Stroke is listed as the second leading cause of death in the Global Burden of Disease, and the incidence of stroke is increasing, in low- and middle-income countries, which accounts for two thirds of all strokes [1]
Compared with the sizeable body of literatures concerning ischemic stroke (IS) and hemorrhagic stroke (HS), only a few of them have reported the association between air pollutants and intracerebral hemorrhage (ICH), and more importantly, limited studies have been conducted to examine the modification of such association by factors measured at the individual level, which presented an obstacle to a better understanding of the biological mechanisms of their association [14,15,16,17,18,19]
When the subjects were stratified by sex or whether body mass index (BMI) ≥ 25, we found that increase of PM2.5 concentration in lag2 was both associated with a 10% (1–19%) increase of incidence in male and 20% (5–36%) in the BMI ≥ 25 group
Summary
Stroke is listed as the second leading cause of death in the Global Burden of Disease, and the incidence of stroke is increasing, in low- and middle-income countries, which accounts for two thirds of all strokes [1]. Several studies reported associations between air pollutants and hemorrhagic stroke (HS), especially from studies conducted in Asia, where frequency of HS. Compared with the sizeable body of literatures concerning IS and HS, only a few of them have reported the association between air pollutants and ICH, and more importantly, limited studies have been conducted to examine the modification of such association by factors measured at the individual level, which presented an obstacle to a better understanding of the biological mechanisms of their association [14,15,16,17,18,19]. The objective of the present study was to investigate the influence of exposure to PM2.5 (particles ≤ 2.5 μm in aerodynamic diameter) on incidence of fatal ICH and to
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