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Air pollution and the incidence of ischaemic and haemorrhagic stroke in the South London Stroke Register: a case-cross-over analysis.

Butland, BK; Atkinson, RW; Crichton, S; Barratt, B; Beevers, S; Spiridou, A; Hoang, U; Kelly, FJ; Wolfe, CD (2017) Air pollution and the incidence of ischaemic and haemorrhagic stroke in the South London Stroke Register: a case-cross-over analysis. J Epidemiol Community Health, 71 (7). pp. 707-712. ISSN 1470-2738 https://doi.org/10.1136/jech-2016-208025
SGUL Authors: Atkinson, Richard William Nicholas, Barbara Karen

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Abstract

BACKGROUND: Few European studies investigating associations between short-term exposure to air pollution and incident stroke have considered stroke subtypes. Using information from the South London Stroke Register for 2005-2012, we investigated associations between daily concentrations of gaseous and particulate air pollutants and incident stroke subtypes in an ethnically diverse area of London, UK. METHODS: Modelled daily pollutant concentrations based on a combination of measurements and dispersion modelling were linked at postcode level to incident stroke events stratified by haemorrhagic and ischaemic subtypes. The data were analysed using a time-stratified case-cross-over approach. Conditional logistic regression models included natural cubic splines for daily mean temperature and daily mean relative humidity, a binary term for public holidays and a sine-cosine annual cycle. Of primary interest were same day mean concentrations of particulate matter <2.5 and <10 µm in diameter (PM2.5, PM10), ozone (O3), nitrogen dioxide (NO2) and NO2+nitrogen oxide (NOX). RESULTS: Our analysis was based on 1758 incident strokes (1311 were ischaemic and 256 were haemorrhagic). We found no evidence of an association between all stroke or ischaemic stroke and same day exposure to PM2.5, PM10, O3, NO2 or NOX. For haemorrhagic stroke, we found a negative association with PM10 suggestive of a 14.6% (95% CI 0.7% to 26.5%) fall in risk per 10 µg/m(3) increase in pollutant. CONCLUSIONS: Using data from the South London Stroke Register, we found no evidence of a positive association between outdoor air pollution and incident stroke or its subtypes. These results, though in contrast to recent meta-analyses, are not inconsistent with the mixed findings of other UK studies.

Item Type: Article
Additional Information: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Keywords: AIR POLLUTION, Environmental epidemiology, STROKE, Epidemiology, 1117 Public Health And Health Services, 1604 Human Geography
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: J Epidemiol Community Health
ISSN: 1470-2738
Language: eng
Dates:
DateEvent
1 July 2017Published
13 April 2017Published Online
6 March 2017Accepted
Publisher License: Creative Commons: Attribution-Noncommercial 4.0
PubMed ID: 28408613
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/108689
Publisher's version: https://doi.org/10.1136/jech-2016-208025

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