Chonnam Med J.  2016 Jan;52(1):53-58. 10.4068/cmj.2016.52.1.53.

The Effects of Air Pollution on Ischemic Stroke Admission Rate

• Alimohammadi H
• Fakhri S
• Derakhshanfar H
• Hosseini-Zijoud SM
• Safari S
• Hatamabadi HR

• KMID: 2152656
• DOI: http://doi.org/10.4068/cmj.2016.52.1.53

Abstract

The present study aimed to determine the relationship between the level of air pollutants and the rate of ischemic stroke (IS) admissions to hospitals. In this retrospective cross-sectional study, stroke admissions (January-March 2012 and 2013) to an emergency department and air pollution and meteorological data were gathered. The relationship between air pollutant levels and hospital admission rates were evaluated using the generalize additive model. In all 379 patients with IS were referred to the hospital (52.5% male; mean age 68.2+/-13.3 years). Both transient (p<0.001) and long-term (p<0.001) rises in CO level increases the risk of IS. Increased weekly (p<0.001) and monthly (p<0.001) average O3 levels amplifies this risk, while a transient increase in NO2 (p<0.001) and SO2 (p<0.001) levels has the same effect. Long-term changes in PM(10) (p<0.001) and PM(2.5) (p<0.001) also increase the risk of IS. The findings showed that the level of air pollutants directly correlates with the number of stroke admissions to the emergency department.

Keyword

Air pollutants; Patient admission; Stroke

MeSH Terms

Air Pollutants
Air Pollution*
Cross-Sectional Studies
Emergency Service, Hospital
Humans
Male
Patient Admission
Retrospective Studies
Stroke*
Air Pollutants

Figure

• 

  FIG. 1 The relationship between air pollutant levels and stroke admission. Data are presented as relative risk with 95% confidence interval. aShows significance level at p<0.001 level, bShows significance level at p<0.05 level.

Reference

1. Saadat S, Yousefifard M, Asady H, Moghadas Jafari A, Fayaz M, Hosseini M. The most important causes of death in Iranian population; a Retrospective Cohort Study. Emerg (Tehran). 2015; 3:16–21.

2. Mathers C, Fat DM, Boerma J. The global burden of disease: 2004 update [Internet]. Geneva: World Health Organization;2008. Cited 2012 Jan 15. Available from: http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html.

3. Kasmaei HD, Baratloo A, Nasiri Z, Soleymani M, Yazdani MO. Recombinant tissue plasminogen activator administration in patients with cerebrovascular accident; a case series. Arch Neurosci. 2015; 2:e23315.

4. DeVol R, Bedroussian A, Charuworn A, Chatterjee A, Kim IK, Kim SJ, et al. An unhealthy America: the economic burden of chronic disease. Santa Monica, CA: Milken Institute;2007.

5. Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009; 8:355–369.

6. Zhou M, Liu Y, Wang L, Kuang X, Xu X, Kan H. Particulate air pollution and mortality in a cohort of Chinese men. Environ Pollut. 2014; 186:1–6.

7. Beverland IJ, Carderb M, Cohenc GR, Agius RM. Associations between short/medium-term variations in black smoke air pollution and mortality in the Glasgow conurbation, UK. Environ Int. 2014; 62:126–132.

8. Dimakopoulou K, Samoli E, Beelen R, Stafoggia M, Andersen ZJ, Hoffmann B, et al. Air pollution and nonmalignant respiratory mortality in 16 cohorts within the ESCAPE project. Am J Respir Crit Care Med. 2014; 189:684–696.

9. Masjedi MR, Naghan PA, Taslimi S, Yousefifard M, Ebrahimi SM, Khosravi A, et al. Opium could be considered an independent risk factor for lung cancer: a case-control study. Respiration. 2013; 85:112–118.

10. Tao Y, Mi S, Zhou S, Wang S, Xie X. Air pollution and hospital admissions for respiratory diseases in Lanzhou, China. Environ Pollut. 2014; 185:196–201.

11. Lin YK, Chang SC, Lin C, Chen YC, Wang YC. Comparing ozone metrics on associations with outpatient visits for respiratory diseases in Taipei Metropolitan area. Environ Pollut. 2013; 177:177–184.

12. Qorbani M, Yunesian M, Fotouhi A, Zeraati H, Sadeghian S, Rashidi Y. Relation between Air Pollution Exposure and Onset of Acute Coronary Syndrome in Tehran Heart Center Using a Case-Crossover Design. Iran J Epidemiol. 2007; 3:53–59.

13. Heo J, Schauer JJ, Yi O, Paek D, Kim H, Yi SM. Fine particle air pollution and mortality: importance of specific sources and chemical species. Epidemiology. 2014; 25:379–388.

14. Moolgavkar SH, McClellan RO, Dewanji A, Turim J, Luebeck EG, Edwards M. Time-series analyses of air pollution and mortality in the United States: a subsampling approach. Environ Health Perspect. 2013; 121:73–78.

15. Cesaroni G, Badaloni C, Gariazzo C, Stafoggia M, Sozzi R, Davoli M, et al. Long-term exposure to urban air pollution and mortality in a cohort of more than a million adults in Rome. Environ Health Perspect. 2013; 121:324–331.

16. Wing JJ, Adar SD, Sanchez BN, Morgenstern LB, Smith MA, Lisabeth LD. Ethnic differences in associations between short-term exposures to ambient air pollution and the risk of acute ischemic stroke. Stroke. 2015; 46:ATP151.

17. Shah AS, Lee KK, McAllister DA, Hunter A, Nair H, Whiteley W, et al. Short term exposure to air pollution and stroke: systematic review and meta-analysis. BMJ. 2015; 350:h1295.

18. Newman JD, Thurston GD, Cromar K, Guo Y, Rockman CB, Fisher EA, et al. Particulate air pollution and carotid artery stenosis. J Am Coll Cardiol. 2015; 65:1150–1151.

19. Ji M, Cohan DS, Bell ML. Meta-analysis of the association between short-term exposure to ambient ozone and respiratory hospital admissions. Environ Res Lett. 2011; 6:pii: 024006.

20. Chay KY, Greenstone M. The impact of air pollution on infant mortality: evidence from geographic variation in pollution shocks induced by a recession. Q J Econ. 2003; 118:1121–1167.

21. Akaike H. Factor analysis and AIC. Psychometrika. 1987; 52:317–332.

22. Tsai SS, Goggins WB, Chiu HF, Yang CY. Evidence for an association between air pollution and daily stroke admissions in Kaohsiung, Taiwan. Stroke. 2003; 34:2612–2616.

23. Hong YC, Lee JT, Kim H, Kwon HJ. Air pollution: a new risk factor in ischemic stroke mortality. Stroke. 2002; 33:2165–2169.

24. Wellenius GA, Burger MR, Coull BA, Schwartz J, Suh HH, Koutrakis P, et al. Ambient air pollution and the risk of acute ischemic stroke. Arch Intern Med. 2012; 172:229–234.

25. Chen SY, Lin YL, Chang WT, Lee CT, Chan CC. Increasing emergency room visits for stroke by elevated levels of fine particulate constituents. Sci Total Environ. 2014; 473-474:446–450.

26. Villeneuve PJ, Chen L, Stieb D, Rowe BH. Associations between outdoor air pollution and emergency department visits for stroke in Edmonton, Canada. Eur J Epidemiol. 2006; 21:689–700.

27. Cruz AM, Sarmento S, Almeida SM, Silva AV, Alves C, Freitas MC, et al. Association between atmospheric pollutants and hospital admissions in Lisbon. Environ Sci Pollut Res Int. 2015; 22:5500–5510.

28. Hosseinpoor AR, Forouzanfar MH, Yunesian M, Asghari F, Naieni KH, Farhood D. Air pollution and hospitalization due to angina pectoris in Tehran, Iran: a time-series study. Environ Res. 2005; 99:126–131.

29. Gärling T, Steg L. Threats from car traffic to the quality of urban life: Problems, causes, and solutions. Bingley, UK: Emerald Group Publishing;2007.

30. Schwela D. Urban traffic pollution. Taylor & Francis;1998.

31. Spiegel J, Maystre LY. Environmental pollution control and prevention. In : Stellman JM, editor. International Labour Office. Encyclopedia of Occupational Health and Safety. 4th ed. Geneva: International Labour Office;1998. Vol 2:Section 55.

32. Rudez G, Janssen NA, Kilinc E, Leebeek FW, Gerlofs-Nijland ME, Spronk HM, et al. Effects of ambient air pollution on hemostasis and inflammation. Environ Health Perspect. 2009; 117:995–1001.

33. Lokken RP, Wellenius GA, Coull BA, Burger MR, Schlaug G, Suh HH, et al. Air pollution and risk of stroke: underestimation of effect due to misclassification of time of event onset. Epidemiology. 2009; 20:137–142.