Abstract
The epidemiological evidence on relationships between air pollution, temperature, and stroke remains inconclusive. Limited evidence is available for the effect modification by apparent temperature, an indicator reflecting reactions to the thermal environment, on short-term associations between air pollution and hospital admissions for stroke. We used a generalized additive model with Poisson regression to estimate the relative risk (RR) of stroke admissions in Shanghai, China, between 2014 and 2016 associated with air pollutants, with subgroup analyses by age, sex, apparent temperature, and season. During the study period, changes in the daily number of stroke admissions per 10 μg/m3 increase in nitrogen dioxide (at lags 0, 1, 0–1, and 0–2) ranged from 1.05 (95% CI: 0.82%, 2.88%) to 2.24% (95% CI: 0.84%, 3.65%). For each 10 μg/m3 increase in sulfur dioxide concentrations at lags 1, 2, 0–1, and 0–2, the RR of daily stroke admissions increased by 3.34 (95% CI: 0.955%, 5.79%), 0.32 (95% CI: −1.97%, 2.67%), 3.33 (95% CI: 0.38%, 6.37%), and 2.86% (95% CI: −0.45%, 6.28%), respectively. The associations of same-day exposure to nitrogen dioxide with stroke admissions remained significant after adjustment for ozone levels. These associations were not modified by sex, age, apparent temperature, or season. More research is warranted to determine whether apparent temperature modifies the associations between air pollution and stroke admissions.
Highlights
Stroke is an important driver of the growing global disease burden and the second largest contributor to disability-adjusted life lost years in individuals aged over 50 years [1]
We identified a total of 18,651 hospital admissions for stroke in four general hospitals in Shanghai between 2014 and 2016, namely, 15,554 admissions for ischemic stroke, 2,888 admissions for intracerebral hemorrhage stroke, and 209 admissions for subarachnoid hemorrhage
Our findings indicated that transient increases in sulfur dioxide (SO2) and nitrogen dioxide (NO2) were associated with increased hospitalization for stroke in the single-pollutant models
Summary
Stroke is an important driver of the growing global disease burden and the second largest contributor to disability-adjusted life lost years in individuals aged over 50 years [1]. In addition to ambient temperature, natural factors such as relative humidity, air pressure, precipitation, and wind speed could have a significant effect on the pattern of air pollution in China [8, 17]. It might be, imperative to examine the modifying effect of a biometeorological index combining several meteorological factors. Some studies have explored the effects of AT on several health outcomes; only limited evidence exists for the effect modification of AT in air pollution-stroke associations [18]
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