Effects of fine particulate matter on hospital admission due to stroke in a business city of Thailand
Keywords:
Fine particulate matter, PM2.5, hemorrhagic stroke, ischemic strokeAbstract
Background: About 99.0% of global population was living in the area where air pollutant levels exceed World Health Organization Standard. Particulate matter whose diameter is equal to or less than 2.5 microns (PM2.5), is an important risk factor for chronic diseases including chronic respiratory diseases, heart diseases and lung cancer. However, the association between PM2.5 and cerebrovascular event is still controversial, especially in Asian populations.
Objective: To assess the association between PM2.5 and hospital admissions due to stroke.
Methods: A retrospective study was conducted using air monitoring and health data during 2017 - 2019 in Hatyai, a business city in Thailand. The daily mean concentrations of PM2.5 were obtained from the Thai Pollution Control Department. The daily numbers of hospital admissions due to stroke such as ischemic stroke, hemorrhagic stroke and all stroke were obtained from the Thai National Health Security Office Regional Office 12. The association between PM2.5 and outcome were assessed using Zero-inflated Negative Binomial regression, applied with the lag time of 0 to 4. For sensitivity analysis, the subgroup analysis by age and sex was performed.
Results: The mean daily concentration of PM2.5 during the study period was 17.10 µg/m3 (4.00 - 74.10 µg/m3 ). Every 10 µg/ m3 increase in daily concentration of PM2.5 was associated with incidence rate ratio (95%CI) of hospital admissions due to hemorrhagic stroke of 1.26 (1.09 - 1.46), 1.27 (1.10 - 1.48) and 1.18 (1.02 - 1.38) at lag0, lag1 and lag2, respectively. No association was observed between the daily concentration of PM2.5 and ischemic stroke. According to sensitivity analysis, only positive association between PM2.5 and stroke were found in male sex subgroup at lag0.
Conclusion: Exposure to PM2.5 was associated with hemorrhagic stroke, a severe clinical condition. Therefore, health surveillance should also include monitoring the incidence of the hemorrhagic stroke, especially when the PM2.5 exceeds standard limits
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References
World Health Organization. Air pollution. Geneva:WHO;2022.
Apte JS, Marshall JD, Cohen AJ, Brauer M. Addressingglobal mortality from ambient PM2.5. Environ SciTechnol 2015;49:8057-66. https://doi.org/10.1021/acs.est.5b01236
Klatsky AL, Armstrong MA, Friedman GD. Racialdifferences in cerebrovascular disease hospitalizations.Stroke 1991;22:299-304. https://doi.org/10.1161/01.STR.22.3.299
Chang JH, Hsu SC, Bai KJ, Huang SK, Hsu CW.Association of time-serial changes in ambientparticulate matters (PMs) with respiratory emergencycases in Taipei's Wenshan District. PloS One 2017;12:e0181106. https://doi.org/10.1371/journal.pone.0181106
Laithaisong T, Tultrairatana S. Acute effect of PM2.5from biomass burning on asthma-related hospitalvisits in Mae Sot, Tak province of Thailand: Atime-series study. J Prev Med Assoc Thai 2020;10:36-48.
Villeneuve PJ, Chen L, Rowe BH, Coates F. Outdoorair pollution and emergency department visits forasthma among children and adults: A case-crossoverstudy in Northern Alberta, Canada. Environ Health2007;6:40. https://doi.org/10.1186/1476-069X-6-40
Strickland MJ, Hao H, Hu X, Chang HH, Darrow LA,Liu Y. Pediatric emergency visits and short-termchanges in PM2.5 concentrations in the U.S. State ofGeorgia. Environ Health Perspect 2016;124:690-6. https://doi.org/10.1289/ehp.1509856
Tian Y, Xiang X, Juan J, Song J, Cao Y, Huang C, et al.Short-term effects of ambient fine particulate matterpollution on hospital visits for chronic obstructivepulmonary disease in Beijing, China. Environ Health2018;17:21. https://doi.org/10.1186/s12940-018-0369-y
Xu Q, Wang S, Guo Y, Wang C, Huang F, Li X, et al. Acute exposure to fine particulate matter andcardiovascular hospital emergency room visits inBeijing, China. Environ Pollut 2017;220 (Pt A):317-27.
https://doi.org/10.1016/j.envpol.2016.09.065
Dominici F, Peng RD, Bell ML, Pham L, McDermott A,Zeger SL, et al. Fine particulate air pollution andhospital admission for cardiovascular and respiratorydiseases. JAMA 2006;295:1127.
https://doi.org/10.1001/jama.295.10.1127
Hamra GB, Guha N, Cohen A, Laden F, Raaschou-Nielsen O, Samet JM, et al. Outdoor particulate matterexposure and lung cancer: A systematic review andmeta-analysis. Environ Health Perspect 2014;122:906-11. https://doi.org/10.1289/ehp/1408092
Byrne CP, Bennett KE, Hickey A, Kavanagh P,Broderick B, O'Mahony M, et al. Short-term airpollution as a risk for stroke admission: A time-seriesanalysis. Cerebrovasc Dis 2020;49:404-11.
https://doi.org/10.1159/000510080
Villeneuve PJ, Chen L, Stieb D, Rowe BH. Associationsbetween outdoor air pollution and emergencydepartment visits for stroke in Edmonton, Canada.Eur J Epidemiol 2006;21:689-700.
https://doi.org/10.1007/s10654-006-9050-9
Fisher JA, Puett RC, Laden F, Wellenius GA, SapkotaA, Liao D, et al. Case-crossover analysis of short-term particulate matter exposures and stroke in thehealth professionals follow-up study. Environ Int2019;124:153-60. https://doi.org/10.1016/j.envint.2018.12.044
Zhang R, Liu G, Jiang Y, Li G, Pan Y, Wang Y, et al.Acute effects of particulate air pollution on ischemicstroke and hemorrhagic stroke mortality. Front Neurol2018;9:827.
https://doi.org/10.3389/fneur.2018.00827
Gu J, Shi Y, Chen N, Wang H, Chen T. Ambient fineparticulate matter and hospital admissions for ischemicand hemorrhagic strokes and transient ischemic attackin 248 Chinese cities. Sci Total Environ 2020;715:136896. https://doi.org/10.1016/j.scitotenv.2020.136896
Yorifuji T, Kawachi I, Sakamoto T, Doi H. Associationsof outdoor air pollution with hemorrhagic strokemortality. J Occup Environ Med 2011;53:124-6. https://doi.org/10.1097/JOM.0b013e3182099175
Denduangchai S, Wiwatanadate P, Jiamjarasrangsi W.Correlation between the daily fine particulate matter(PM2.5) level and the number of visits with respiratoryand cardiovascular diseases at Ratchaburi hospital,Amphoe Mueang, Ratchaburi province. Chiang MaiMed J 2021;60:345-61. (in Thai).
Pothirat C, Chaiwong W, Liwsrisakun C, BumroongkitC, Deesomchok A, Theerakittikul T, et al. Acute effectsof air pollutants on daily mortality and hospitalizationsdue to cardiovascular and respiratory diseases. JThorac Dis 2019;11:3070-83. https://doi.org/10.21037/jtd.2019.07.37
Cameron AC, Trivedi PK. Regression-based tests forover dispersion in the Poisson model. J Econom 1990;46:347-64. https://doi.org/10.1016/0304-4076(90)90014-K
Chen H, Cheng Z, Li M, Luo P, Duan Y, Fan J, et al.Ambient air pollution and hospitalizations for ischemicstroke: A time series analysis using a distributed lagnonlinear model in chongqing, China. Front PublicHealth 2022;9:762597. https://doi.org/10.3389/fpubh.2021.762597
Chiu HF, Chang CC, Yang CY. Relationship betweenhemorrhagic stroke hospitalization and exposure tofine particulate air pollution in Taipei, Taiwan. J ToxicolEnviron Health A 2014;77:1154-63.
https://doi.org/10.1080/15287394.2014.926801
Wu W, Jin Y, Carlsten C. Inflammatory health effectsof indoor and outdoor particulate matter. J AllergyClin Immunol 2018;141:833-44. https://doi.org/10.1016/j.jaci.2017.12.981
Terzano C, Di Stefano F, Conti V, Graziani E, PetroianniA. Air pollution ultrafine particles: toxicity beyondthe lung. Eur Rev Med Pharmacol Sci 2010;14:809-21.
Liang R, Zhang B, Zhao X, Ruan Y, Lian H, Fan Z.Effect of exposure to PM2.5 on blood pressure: asystematic review and meta-analysis. J Hypertens2014; 32:2130-40.
https://doi.org/10.1097/HJH.0000000000000342
Qian Y, Yu H, Cai B, Fang B, Wang C. Associationbetween incidence of fatal intracerebral hemorrhagicstroke and fine particulate air pollution. Environ HealthPrev Med 2019;24:38.
https://doi.org/10.1186/s12199-019-0793-9
Tian Y, Xiang X, Wu Y, Cao Y, Song J, Sun K, et al.Fine particulate air pollution and first hospitaladmissions for ischemic stroke in Beijing, China. SciRep 2017; 7:3897.
https://doi.org/10.1038/s41598-017-04312-5
Qiu H, Sun S, Tsang H, Wong CM, Lee RS, SchoolingCM, et al. Fine particulate matter exposure andincidence of stroke: A cohort study in Hong Kong.Neurology 2017;88:1709-17.
https://doi.org/10.1212/WNL.0000000000003903
Tian Y, Liu H, Zhao Z, Xiang X, Li M, Juan J, et al.Association between ambient air pollution and dailyhospital admissions for ischemic stroke: A nationwidetime-series analysis. PLoS Med 2018;15:e1002668. https://doi.org/10.1371/journal.pmed.1002668
Liu H, Tian Y, Xu Y, Zhang J. Ambient particulatematter concentrations and hospitalization for strokein 26 Chinese cities: A case-crossover study. Stroke2017;48:2052-9.
https://doi.org/10.1161/STROKEAHA.116.016482
Wardlaw JM. Radiology of stroke. J Neurol NeurosurgPsychiatry 2001;70:i7-11.
https://doi.org/10.1136/jnnp.70.suppl_1.i7
Wardlaw JM, Lewis SC, Dennis MS, Counsell C,McDowall M. Is visible infarction on computedtomography associated with an adverse prognosisin acute ischemic stroke? Stroke 1998;29:1315-9. https://doi.org/10.1161/01.STR.29.7.1315
Pan B, Jin X, Jun L, Qiu S, Zheng Q, Pan M.The relationship between smoking and stroke: A meta-analysis. Medicine (Baltimore) 2019;98:e14872. https://doi.org/10.1097/MD.0000000000014872
Shah RS, Cole JW. Smoking and stroke: the more yousmoke the more you stroke. Expert Rev CardiovascTher 2010;8:917-32. https://doi.org/10.1586/erc.10.56
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