Hourly Air Pollution Exposure and Emergency Hospital Admissions for Stroke: A Multicenter Case-Crossover Study

Abstract

BACKGROUND: Daily exposure to ambient air pollution is associated with stroke morbidity and mortality; however, the association between hourly exposure to air pollutants and risk of emergency hospital admissions for stroke and its subtypes remains relatively unexplored. METHODS: We obtained hourly concentrations of fine particulate matter (PM 2.5 ), respirable particulate matter (PM 10 ), nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ), ozone (O 3 ), and carbon monoxide (CO) from the China National Environmental Monitoring Center. We conducted a time-stratified case-crossover study among 86 635 emergency hospital admissions for stroke across 10 hospitals in 3 cities (Jinhua, Hangzhou, and Zhoushan) in Zhejiang province, China, between January 1, 2016 and December 31, 2021. Using a conditional logistic regression combined with a distributed lag linear model, we estimated the association between hourly exposure to multiple air pollutants and risk of emergency hospital admissions for total stroke, ischemic stroke, hemorrhagic stroke, and undetermined type. RESULTS: Hourly exposure to PM 2.5 , PM 10 , NO 2 , and SO 2 was associated with an increased risk of hospital admissions for total stroke and ischemic stroke. The associations were most pronounced during the concurrent hour of exposure and lasted for ≈2 hours. We found that the risk was more pronounced among male patients or those aged <65 years old. CONCLUSIONS: Our findings suggest that exposure to PM 2.5 , PM 10 , NO 2, and SO 2 , but not CO and O 3 , is associated with emergency hospital admissions for total stroke or ischemic stroke shortly after exposure. Implementing targeted pollution emission reduction measures may have significant public health implications in controlling and reducing the burden of stroke.

Residential Nitrogen Dioxide Exposure and Cause-Specific Cerebrovascular Mortality: An Individual-Level, Case-Crossover Study

“…A time-stratified case-crossover study conducted in the Beibu Gulf Region of China reported that an elevated NO 2 exposure of 11.2 μg/m 3 was significantly linked to an increased risk for hospitalizations of total stroke [OR: 1.040, 95% CI: 1.027–1.053] and ischemic stroke [OR: 1.052, 95% CI: 1.033–1.071], but there was no significant association with hemorrhagic stroke [ 12 ]. A multicenter case-crossover study also suggested an evident relationship between hourly exposure to NO 2 and an increased risk of hospital admissions for total stroke and ischemic stroke, while no evident impact was found on hemorrhagic stroke [ 23 ]. Another time-stratified case-crossover study among participants of the Women’s Health Initiative observed a positive association between risk for incidence of hemorrhagic stroke and NO 2 exposure, but negative association of total stroke, ischemic stroke or ischemic stroke subtypes [ 24 ].…”