Ambient PM2.5 and Stroke: Effect Modifiers and Population Attributable Risk in Six Low- and Middle-Income Countries

Hualiang Lin, Yanfei Guo, Qian Di, Yang Zheng, Paul Kowal, Jianpeng Xiao, Tao Liu, Xing Li, Weilin Zeng, Steven W. Howard, Erik J. Nelson, Zhengmin Qian, Wenjun Ma, Fan Wu

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background and Purpose - Short-term exposure to ambient fine particulate pollution (PM2.5) has been linked to increased stroke. Few studies, however, have examined the effects of long-term exposure. Methods - A total of 45 625 participants were interviewed and included in this study, the participants came from the Study on Global Ageing and Adult Health, a prospective cohort in 6 low- and middle-income countries. Ambient PM2.5 levels were estimated for participants' communities using satellite data. A multilevel logistic regression model was used to examine the association between long-term PM2.5 exposure and stroke. Potential effect modification by physical activity and consumption of fruit and vegetables was assessed. Results - The odds of stroke were 1.13 (95% confidence interval, 1.04-1.22) for each 10 μg/m3 increase in PM2.5. This effect remained after adjustment for confounding factors including age, sex, smoking, and indoor air pollution (adjusted odds ratio=1.12; 95% confidence interval, 1.04-1.21). Further stratified analyses suggested that participants with higher levels of physical activity had greater odds of stroke, whereas those with higher consumption of fruit and vegetables had lower odds of stroke. These effects remained robust in sensitivity analyses. We further estimated that 6.55% (95% confidence interval, 1.97%-12.01%) of the stroke cases could be attributable to ambient PM2.5 in the study population. Conclusions - This study suggests that ambient PM2.5 may increase the risk of stroke and may be responsible for the astounding stroke burden in low- and middle-income countries. In addition, greater physical activity may enhance, whereas greater consumption of fruit and vegetables may mitigate the effect.

Original languageEnglish (US)
Pages (from-to)1191-1197
Number of pages7
JournalStroke
Volume48
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Stroke
Population
Vegetables
Fruit
Confidence Intervals
Logistic Models
Indoor Air Pollution
Age Factors
Smoking
Odds Ratio
Health

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Lin, Hualiang ; Guo, Yanfei ; Di, Qian ; Zheng, Yang ; Kowal, Paul ; Xiao, Jianpeng ; Liu, Tao ; Li, Xing ; Zeng, Weilin ; Howard, Steven W. ; Nelson, Erik J. ; Qian, Zhengmin ; Ma, Wenjun ; Wu, Fan. / Ambient PM2.5 and Stroke : Effect Modifiers and Population Attributable Risk in Six Low- and Middle-Income Countries. In: Stroke. 2017 ; Vol. 48, No. 5. pp. 1191-1197.
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title = "Ambient PM2.5 and Stroke: Effect Modifiers and Population Attributable Risk in Six Low- and Middle-Income Countries",
abstract = "Background and Purpose - Short-term exposure to ambient fine particulate pollution (PM2.5) has been linked to increased stroke. Few studies, however, have examined the effects of long-term exposure. Methods - A total of 45 625 participants were interviewed and included in this study, the participants came from the Study on Global Ageing and Adult Health, a prospective cohort in 6 low- and middle-income countries. Ambient PM2.5 levels were estimated for participants' communities using satellite data. A multilevel logistic regression model was used to examine the association between long-term PM2.5 exposure and stroke. Potential effect modification by physical activity and consumption of fruit and vegetables was assessed. Results - The odds of stroke were 1.13 (95{\%} confidence interval, 1.04-1.22) for each 10 μg/m3 increase in PM2.5. This effect remained after adjustment for confounding factors including age, sex, smoking, and indoor air pollution (adjusted odds ratio=1.12; 95{\%} confidence interval, 1.04-1.21). Further stratified analyses suggested that participants with higher levels of physical activity had greater odds of stroke, whereas those with higher consumption of fruit and vegetables had lower odds of stroke. These effects remained robust in sensitivity analyses. We further estimated that 6.55{\%} (95{\%} confidence interval, 1.97{\%}-12.01{\%}) of the stroke cases could be attributable to ambient PM2.5 in the study population. Conclusions - This study suggests that ambient PM2.5 may increase the risk of stroke and may be responsible for the astounding stroke burden in low- and middle-income countries. In addition, greater physical activity may enhance, whereas greater consumption of fruit and vegetables may mitigate the effect.",
author = "Hualiang Lin and Yanfei Guo and Qian Di and Yang Zheng and Paul Kowal and Jianpeng Xiao and Tao Liu and Xing Li and Weilin Zeng and Howard, {Steven W.} and Nelson, {Erik J.} and Zhengmin Qian and Wenjun Ma and Fan Wu",
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doi = "10.1161/STROKEAHA.116.015739",
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Lin, H, Guo, Y, Di, Q, Zheng, Y, Kowal, P, Xiao, J, Liu, T, Li, X, Zeng, W, Howard, SW, Nelson, EJ, Qian, Z, Ma, W & Wu, F 2017, 'Ambient PM2.5 and Stroke: Effect Modifiers and Population Attributable Risk in Six Low- and Middle-Income Countries', Stroke, vol. 48, no. 5, pp. 1191-1197. https://doi.org/10.1161/STROKEAHA.116.015739

Ambient PM2.5 and Stroke : Effect Modifiers and Population Attributable Risk in Six Low- and Middle-Income Countries. / Lin, Hualiang; Guo, Yanfei; Di, Qian; Zheng, Yang; Kowal, Paul; Xiao, Jianpeng; Liu, Tao; Li, Xing; Zeng, Weilin; Howard, Steven W.; Nelson, Erik J.; Qian, Zhengmin; Ma, Wenjun; Wu, Fan.

In: Stroke, Vol. 48, No. 5, 01.05.2017, p. 1191-1197.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Ambient PM2.5 and Stroke

T2 - Effect Modifiers and Population Attributable Risk in Six Low- and Middle-Income Countries

AU - Lin, Hualiang

AU - Guo, Yanfei

AU - Di, Qian

AU - Zheng, Yang

AU - Kowal, Paul

AU - Xiao, Jianpeng

AU - Liu, Tao

AU - Li, Xing

AU - Zeng, Weilin

AU - Howard, Steven W.

AU - Nelson, Erik J.

AU - Qian, Zhengmin

AU - Ma, Wenjun

AU - Wu, Fan

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Background and Purpose - Short-term exposure to ambient fine particulate pollution (PM2.5) has been linked to increased stroke. Few studies, however, have examined the effects of long-term exposure. Methods - A total of 45 625 participants were interviewed and included in this study, the participants came from the Study on Global Ageing and Adult Health, a prospective cohort in 6 low- and middle-income countries. Ambient PM2.5 levels were estimated for participants' communities using satellite data. A multilevel logistic regression model was used to examine the association between long-term PM2.5 exposure and stroke. Potential effect modification by physical activity and consumption of fruit and vegetables was assessed. Results - The odds of stroke were 1.13 (95% confidence interval, 1.04-1.22) for each 10 μg/m3 increase in PM2.5. This effect remained after adjustment for confounding factors including age, sex, smoking, and indoor air pollution (adjusted odds ratio=1.12; 95% confidence interval, 1.04-1.21). Further stratified analyses suggested that participants with higher levels of physical activity had greater odds of stroke, whereas those with higher consumption of fruit and vegetables had lower odds of stroke. These effects remained robust in sensitivity analyses. We further estimated that 6.55% (95% confidence interval, 1.97%-12.01%) of the stroke cases could be attributable to ambient PM2.5 in the study population. Conclusions - This study suggests that ambient PM2.5 may increase the risk of stroke and may be responsible for the astounding stroke burden in low- and middle-income countries. In addition, greater physical activity may enhance, whereas greater consumption of fruit and vegetables may mitigate the effect.

AB - Background and Purpose - Short-term exposure to ambient fine particulate pollution (PM2.5) has been linked to increased stroke. Few studies, however, have examined the effects of long-term exposure. Methods - A total of 45 625 participants were interviewed and included in this study, the participants came from the Study on Global Ageing and Adult Health, a prospective cohort in 6 low- and middle-income countries. Ambient PM2.5 levels were estimated for participants' communities using satellite data. A multilevel logistic regression model was used to examine the association between long-term PM2.5 exposure and stroke. Potential effect modification by physical activity and consumption of fruit and vegetables was assessed. Results - The odds of stroke were 1.13 (95% confidence interval, 1.04-1.22) for each 10 μg/m3 increase in PM2.5. This effect remained after adjustment for confounding factors including age, sex, smoking, and indoor air pollution (adjusted odds ratio=1.12; 95% confidence interval, 1.04-1.21). Further stratified analyses suggested that participants with higher levels of physical activity had greater odds of stroke, whereas those with higher consumption of fruit and vegetables had lower odds of stroke. These effects remained robust in sensitivity analyses. We further estimated that 6.55% (95% confidence interval, 1.97%-12.01%) of the stroke cases could be attributable to ambient PM2.5 in the study population. Conclusions - This study suggests that ambient PM2.5 may increase the risk of stroke and may be responsible for the astounding stroke burden in low- and middle-income countries. In addition, greater physical activity may enhance, whereas greater consumption of fruit and vegetables may mitigate the effect.

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