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Associations between outdoor air pollution and emergency department visits for stroke in Edmonton, Canada

  • Neurological Diseases
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Inconsistent results have been obtained from studies that have examined the relationship between air pollution and hospital visits for stroke. We undertook a time-stratified case-crossover study to evaluate associations between outdoor air pollution and emergency department visits for stroke among the elderly according to stroke type, season, and sex. Analyses are based on a total of 12,422 stroke visits among those 65 years of age and older in Edmonton, Canada between April 1, 1992 and March 31, 2002. Daily air pollution levels for SO2, NO2, PM2.5, PM10, CO and O3 were estimated using data from fixed-site monitoring stations. Particulate matter data were only available from 1998 onwards. Conditional logistic regression was used to estimate the odds ratios (ORs) and their 95% confidence intervals in relation to an increase in the interquartile range (IQR) of each pollutant. ORs were adjusted for the effects of temperature and relative humidity. We found no association between outdoor measures of air pollution and all stroke visits. In contrast, elevated risks were observed between levels of air pollution and acute ischemic stroke between April and September. During this season, the ORs associated with an increase in the IQR of the 3-day average for CO and NO2 were 1.32 (95% CI = 1.09–1.60) and 1.26 (95% CI = 1.09–1.46), respectively. CO exposures in the same season, lagged 1 day, were associated with an increased risk of hemorrhagic stroke with ORs was 1.20 (95% CI = 1.00–1.43). Our results suggest it is possible that vehicular traffic, which produces increased levels of NO2 and CO, contributes to an increased incidence of emergency department visits for stroke.

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Abbreviations

C.I.:

Confidence interval

ED:

Emergency Department

ICD-9:

International Classification of Diseases, 9th Revision

NAPS:

National Air Pollution Surveillance

OR:

Odds ratio

TIA:

Transient ischemic attack

WHO:

World Health Organization

References

  1. Heart and Stroke Foundation of Canada (1997) Heart Disease and Stroke in Canada. Ottawa: Heart and Stroke Foundation of Canada

    Google Scholar 

  2. Mayo NE, Neville D, Kirkland S, Ostbye T, Mustard CA, Reeder B et al (1996) Hospitalization and case-fatality rates for stroke in Canada from 1982 through 1991 The Canadian Collaborative Study Group of Stroke Hospitalizations. Stroke 27(7):1215–1220

    PubMed  CAS  Google Scholar 

  3. Hong YC, Lee JT, Kim H, Ha EH, Schwartz J, Christiani DC (2002) Effects of air pollutants on acute stroke mortality. Environ Health Perspect 110(2):187–191

    Article  PubMed  CAS  Google Scholar 

  4. Hoek G, Brunekreef B, Fischer P, van Wijnen J (2001) The association between air pollution and heart failure, arrhythmia, embolism, thrombosis, and other cardiovascular causes of death in a time series study. Epidemiology 12(3):355–357

    Article  PubMed  CAS  Google Scholar 

  5. Tsai SS, Goggins WB, Chiu HF, Yang CY (2003) Evidence for an association between air pollution and daily stroke admissions in Kaohsiung, Taiwan. Stroke 34(11):2612–2616

    Article  PubMed  CAS  Google Scholar 

  6. Moolgavkar SH (2000) Air pollution and daily mortality in three U.S. counties. Environ Health Perspect 108(8):777–784

    PubMed  CAS  Google Scholar 

  7. Ponka A, Virtanen M (1996) Low-level air pollution and hospital admissions for cardiac and cerebrovascular diseases in Helsinki. Am J Public Health 86(9):1273–1280

    PubMed  CAS  Google Scholar 

  8. Wordley J, Walters S, Ayres JG (1997) Short-term variations in hospital admissions and mortality and particulate air pollution. Occup Environ Med 54(2):108–116

    PubMed  CAS  Google Scholar 

  9. Sun Q, Wang A, Jin X, Natanzon A, Duquaine D, Brook RD et al. (2005) Long-term air pollution exposure and acceleration of atherosclerosis and vascular inflammation in an animal model. JAMA 294(23):3003–3010

    Article  PubMed  CAS  Google Scholar 

  10. Wellenius GA, Schwartz J, Mittleman MA (2005) Air pollution and hospital admissions for ischemic and hemorrhagic stroke among medicare beneficiaries. Stroke 36(12):2549–2553

    Article  PubMed  CAS  Google Scholar 

  11. Maheswaran R, Haining RP, Brindley P, Law J, Pearson T, Fryers PR et al. (2005) utdoor air pollution and stroke in Sheffield, United Kingdom: a small-area level geographical study. Stroke 36(2):239–243

    Article  PubMed  Google Scholar 

  12. Metzger KB, Tolbert PE, Klein M, Peel JL, Flanders WD, Todd K et al. (2004) Ambient air pollution and cardiovascular emergency department visits. Epidemiology 15(1):46–56

    Article  PubMed  Google Scholar 

  13. Le Tertre A, Medina S, Samoli E, Forsberg B, Michelozzi P, Boumghar A et al. (2002) Short-term effects of particulate air pollution on cardiovascular diseases in eight European cities. J Epidemiol Community Health 56(10):773–779

    Article  PubMed  CAS  Google Scholar 

  14. Poloniecki JD, Atkinson RW, de Leon AP, Anderson HR (1997) Daily time series for cardiovascular hospital admissions and previous day’s air pollution in London, UK. Occup Environ Med 54(8):535–540

    PubMed  CAS  Google Scholar 

  15. Wong TW, Lau TS, Yu TS, Neller A, Wong SL, Tam W et al. (1999) Air pollution and hospital admissions for respiratory and cardiovascular diseases in Hong Kong. Occup Environ Med 56(10):679–683

    Article  PubMed  CAS  Google Scholar 

  16. Ballester F, Iniguez C, Perez-Hoyos S, Tenias JM (2002) Particulate air pollution and health in Valencia [Spain] 1994–1996. Gac Sanit 16(6):464–479

    PubMed  CAS  Google Scholar 

  17. Burnett RT, Smith-Doiron M, Stieb D, Cakmak S, Brook JR (1999) Effects of particulate and gaseous air pollution on cardiorespiratory hospitalizations. Arch Environ Health 54(2):130–139

    Article  PubMed  CAS  Google Scholar 

  18. Seaton A, MacNee W, Donaldson K, Godden D (1995) Particulate air pollution and acute health effects. Lancet 345(8943):176–178

    Article  PubMed  CAS  Google Scholar 

  19. Peters A, Doring A, Wichmann HE, Koenig W (1997) Increased plasma viscosity during an air pollution episode: a link to mortality? Lancet 349(9065):1582–1587

    Article  PubMed  CAS  Google Scholar 

  20. Peters A, Perz S, Doring A, Stieber J, Koenig W, Wichmann HE (1999) Increases in heart rate during an air pollution episode. Am J Epidemiol 150(10):1094–1098

    PubMed  CAS  Google Scholar 

  21. Gold DR, Litonjua A, Schwartz J, Lovett E, Larson A, Nearing B et al. (2000) Ambient pollution and heart rate variability. Circulation 101(11):1267–1273

    PubMed  CAS  Google Scholar 

  22. Pekkanen J, Brunner EJ, Anderson HR, Tiittanen P, Atkinson RW (2000) Daily concentrations of air pollution and plasma fibrinogen in London. Occup Environ Med 57(12):818–822

    Article  PubMed  CAS  Google Scholar 

  23. Schwartz J (2001) Air pollution and blood markers of cardiovascular risk. Environ Health Perspect 109(Suppl 3):405–409

    PubMed  CAS  Google Scholar 

  24. Ionita CC, Xavier AR, Kirmani JF, Dash S, Divani AA, Qureshi AI (2005) What proportion of stroke is not explained by classic risk factors? Prev Cardiol 8(1):41–46

    PubMed  Google Scholar 

  25. Kunzli N, Jerrett M, Mack WJ, Beckerman B, LaBree L, Gilliland F et al. (2005) Ambient air pollution and atherosclerosis in Los Angeles. Environ Health Perspect 113(2):201–206

    Article  PubMed  CAS  Google Scholar 

  26. Schwela D (2000) Air pollution and health in urban areas. Rev Environ Health 15(1–2):13–42

    PubMed  CAS  Google Scholar 

  27. Kim CS, Hu SC (1998) Regional deposition of inhaled particles in human lungs: comparison between men and women. J Appl Physiol 84(6):1834–1844

    PubMed  CAS  Google Scholar 

  28. Boezen HM, Vonk JM, van der Zee SC, Gerritsen J, Hoek G, Brunekreef B et al. (2005) Susceptibility to air pollution in elderly males and females. Eur Respir J 25(6):1018–1024

    Article  PubMed  CAS  Google Scholar 

  29. Environment Canada. National Air Pollution Surveillance Network (NAPS) website. 2005 [cited 2005; Available from: http://www.etc-cte.ec.gc.ca/NAPS/

  30. SAS Institute Inc. SAS Version 8. In. Cary, North Carolina; 2004

  31. Maclure M (1991) The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol 133(2):144–153

    PubMed  CAS  Google Scholar 

  32. Janes H, Sheppard L, Lumley T (2005) Case-crossover analyses of air pollution exposure data: Referent selection strategies and their implications for bias. Epidemiology 16(6):717–726

    Article  PubMed  Google Scholar 

  33. Spengler JD, Sexton K (1983) Indoor air pollution: A public health perspective. Science 221(4605):9–17

    Article  PubMed  CAS  Google Scholar 

  34. Wallace L (1996) Indoor particles: A review. J Air Waste Manag Assoc 46(2):98–126

    PubMed  CAS  Google Scholar 

  35. Moolgavkar SH (2005) A review and critique of the EPA’s rationale for a fine particle standard. Regul Toxicol Pharmacol 42(1):123–144

    Article  PubMed  CAS  Google Scholar 

  36. Sorensen M, Daneshvar B, Hansen M, Dragsted LO, Hertel O, Knudsen L et al. (2003) Personal PM2.5 exposure and markers of oxidative stress in blood. Environ Health Perspect 111(2):161–166

    Article  PubMed  Google Scholar 

  37. Zeger SL, Thomas D, Dominici F, Samet JM, Schwartz J, Dockery D et al. (2000) Exposure measurement error in time-series studies of air pollution: Concepts and consequences. Environ Health Perspect 108(5):419–426

    PubMed  CAS  Google Scholar 

  38. Gordon DJ, Hyde J, Trost DC, Whaley FS, Hannan PJ, Jacobs DR et al. (1988) Cyclic seasonal variation in plasma lipid and lipoprotein levels: The Lipid Research Clinics Coronary Primary Prevention Trial Placebo Group. J Clin Epidemiol 41(7):679–689

    Article  PubMed  CAS  Google Scholar 

  39. Keatinge WR, Coleshaw SR, Easton JC, Cotter F, Mattock MB, Chelliah R (1986) Increased platelet and red cell counts, blood viscosity, and plasma cholesterol levels during heat stress, and mortality from coronary and cerebral thrombosis. Am J Med 81(5):795–800

    Article  PubMed  CAS  Google Scholar 

  40. Leibson CL, Naessens JM, Brown RD, Whisnant JP (1994) Accuracy of hospital discharge abstracts for identifying stroke. Stroke 25(12):2348–2355

    PubMed  CAS  Google Scholar 

  41. Benesch C, Witter DM Jr, Wilder AL, Duncan PW, Samsa GP, Matchar DB (1997) Inaccuracy of the International Classification of Diseases (ICD-9-CM) in identifying the diagnosis of ischemic cerebrovascular disease. Neurology 49(3):660–664

    PubMed  CAS  Google Scholar 

  42. Kessler C, Freyberger HJ, Dittman V, Ringerlstein EB (1991) Interrater reliability in the assessment of neurovascular disease. Cerebrovasc Dis 1:43–48

    Google Scholar 

  43. Suwa T, Hogg JC, Quinlan KB, Ohgami A, Vincent R, van Eeden SF (2002) Particulate air pollution induces progression of atherosclerosis. J Am Coll Cardiol 39(6):935–942

    Article  PubMed  CAS  Google Scholar 

  44. Nemmar A, Hoet PH, Vanquickenborne B, Dinsdale D, Thomeer M, Hoylaerts MF et al. (2002) Passage of inhaled particles into the blood circulation in humans. Circulation 105(4):411–414

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

We acknowledge Environment Canada for providing the air pollution data from the National Air Pollution Surveillance (NAPS) network that was analyzed in this study. We appreciate the efforts of Ms. Chris Houston from Information Services, Capital Health for securing these data.

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Correspondence to Paul J. Villeneuve.

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Villeneuve, P.J., Chen, L., Stieb, D. et al. Associations between outdoor air pollution and emergency department visits for stroke in Edmonton, Canada. Eur J Epidemiol 21, 689–700 (2006). https://doi.org/10.1007/s10654-006-9050-9

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  • DOI: https://doi.org/10.1007/s10654-006-9050-9

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