Exposure to air pollution and its effect on ischemic strokes (EP-PARTICLES study)

Abstract

It is well known that exceeded levels of particulate matter in the air and other air pollutants harmfully affect the cardiovascular system. Empirical analyses of the effects of these factors on stroke incidence and mortality are still limited. The main objective of our analyses was to determine the association between short-term exposure to air pollutants and stroke incidence in non-industrial areas, more specifically in north-eastern Poland. To achieve this aim, we used data from the National Health Fund on patients hospitalized for stroke between 2011 and 2020 in the largest city of the region described as the Green Lungs of Poland. The pollution levels and atmospheric conditions data were obtained from the Provincial Inspectorate for Environmental Protection and the Institute of Meteorology and Water Management. Using daily data on hospitalizations, atmospheric conditions, and pollution, as well as ordered logistic regression models the hypotheses on the impact of weather and air pollution conditions on ischemic strokes were tested. The study group included 4838 patients, 45.6% of whom were male; the average patient age was approximately 74 years. The average concentrations of PM2.5 were 19.09 µg/m3, PM10 26.66 µg/m3 and CO 0.35 µg/m3. Analyses showed that an increase in PM2.5 and PM10 concentrations by 10 µg/m3 was associated with an increase in the incidence of stroke on the day of exposure (OR = 1.075, 95% CI 0.999–1.157, P = 0.053; OR = 1.056, 95% CI 1.004–1.110, P = 0.035) and the effect was even several times greater on the occurrence of a stroke event in general (PM2.5: OR = 1.120, 95% CI 1.013–1.237, P = 0.026; PM10: OR = 1.103, 95% CI 1.028–1.182, P = 0.006). Furthermore, a short-term (up to 3 days) effect of CO on stroke incidence was observed in the study area. An increase of 1 μg/m3 CO was associated with a lower incidence of stroke 2 days after the exposure (OR = 0.976, 95% CI 0.953–0.998, P = 0.037) and a higher incidence 3 days after the exposure (OR = 1.026, 95% CI 1.004–1.049, P = 0.022).

Short-term effects of air pollution on hospital admissions for cardiovascular diseases and diabetes mellitus in Sofia, Bulgaria (2009–2018)

“…We also observed some counterintuitive behaviour for CO at several lags, in line with studies reporting strange patterns with CO at specific lags ( 28 ). However, our multicollinearity test suggests that there is no reason for concern.…”

Multi-City Analysis of the Acute Effect of Polish Smog on Cause-Specific Mortality (EP-PARTICLES Study)

“…In a large cohort of postmenopausal women, there was no association between five analyzed air pollutants and IS occurrence [ 11 ]. Moreover, in a study performed in Poland, it was demonstrated that carbon monoxide (CO) might have a protective effect on IS onset, whereas other air pollutants increased IS-related morbidity on different days after exposure depending on age and sex [ 12 ]. Other unclear matters remaining in the available literature are lag patterns and vulnerability to smog in specific subgroups.…”

“…Its formation is favored by high atmospheric pressure and low temperature, especially in winter when heat demand increases causing higher emissions of air pollution from household heating systems [ 18 , 19 ]. The adverse effect of Polish smog has been well documented in one of the analyzed cities, as it increased hospitalization rates due to acute coronary syndromes (ACS) and IS [ 12 , 20 ]. However, the influence of air pollution in the other four cities has never been analyzed.…”

The impact of Polish smog on public regional health – baseline results of the EP-PARTICLES study

“…In the EP-PARTICLES study, the aim was to investigate temporal variations of ischemic stroke incidence in the 'capital of the green lungs of Poland' -Bialystok -and its link with short-term exposure to air pollution [23]. In 11 years, from 2010 to 2020, we recorded 4838 cases of ischemic stroke with a daily mean of 1.3 cases.…”