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Stroke. 2015 Nov;46(11):3058-66. doi: 10.1161/STROKEAHA.115.009913. Epub 2015 Oct 13.

Long-Term Exposure to Particulate Matter Air Pollution Is a Risk Factor for Stroke: Meta-Analytical Evidence.

Author information

1
From the Environmental Health Unit, Department of Public Health and Primary Care (H.S., L.C., B.N., T.S.N.) and Hypertension and Cardiovascular Epidemiology Unit, Department of Cardiovascular Sciences (L.J.), KULeuven, Leuven, Belgium; and Centre for Environmental Sciences, UHasselt, Hasselt, Belgium (T.S.N.).
2
From the Environmental Health Unit, Department of Public Health and Primary Care (H.S., L.C., B.N., T.S.N.) and Hypertension and Cardiovascular Epidemiology Unit, Department of Cardiovascular Sciences (L.J.), KULeuven, Leuven, Belgium; and Centre for Environmental Sciences, UHasselt, Hasselt, Belgium (T.S.N.). tim.nawrot@uhasselt.be.

Abstract

BACKGROUND AND PURPOSE:

Epidemiological studies suggest an association between stroke incidence and stroke mortality and long-term exposure to particulate matter (PM) air pollution. However, the magnitude of the association is still unclear.

METHODS:

We searched the Pubmed citation database for epidemiological studies and reviews on stroke and PM exposure. Then, we carried out a meta-analysis to quantify the pooled association between stroke incidence and mortality and long-term exposure to PM. Meta-analyses were performed for stroke events and stroke mortality and for PM10 and PM2.5 separately and jointly.

RESULTS:

We identified 20 studies, including a total of >10 million people, on long-term PM exposure and stroke event or stroke mortality. For exposure to PM10 (including estimated exposure to PM10 from studies using PM2.5), the pooled hazard ratio for each 10-μg/m3 increment in PM10 was 1.061 (95% confidence interval, 1.018-1.105) and 1.080 (0.992-1.177) for overall stroke events and stroke mortality, respectively. A stratified analysis by continent revealed that the association between stroke and long-term PM10 exposure was positive in North America (1.062 [1.015-1.110]) and Europe (1.057 [0.973-1.148]), but studies in Asia (1.010 [0.885-1.153]) showed a high degree of heterogeneity. Considering exposure to PM2.5 (Europe and North America combined), the hazard ratios for a 5-μg/m3 increment were 1.064 (1.021-1.109) and 1.125 (1.007-1.256) for stroke events and mortality, respectively.

CONCLUSIONS:

The scientific evidence of the past decade identifies long-term exposure to PM, and PM2.5 in particular, as a risk factor for stroke. However, we found some currently unexplained geographical variability in this association.

KEYWORDS:

cerebrovascular disorders; epidemiology; meta-analysis; mortality; particulate matter

PMID:
26463695
DOI:
10.1161/STROKEAHA.115.009913
[Indexed for MEDLINE]
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