Background: Few studies have investigated effects of air pollution on the incidence of cerebrovascular events.
Objectives: We assessed the association between long-term exposure to multiple air pollutants and the incidence of stroke in European cohorts.
Methods: Data from 11 cohorts were collected, and occurrence of a first stroke was evaluated. Individual air pollution exposures were predicted from land-use regression models developed within the European Study of Cohorts for Air Pollution Effects (ESCAPE). The exposures were: PM2.5 [particulate matter (PM) ≤ 2.5 μm in diameter], coarse PM (PM between 2.5 and 10 μm), PM10 (PM ≤ 10 μm), PM2.5 absorbance, nitrogen oxides, and two traffic indicators. Cohort-specific analyses were conducted using Cox proportional hazards models. Random-effects meta-analysis was used for pooled effect estimation.
Results: A total of 99,446 study participants were included, 3,086 of whom developed stroke. A 5-μg/m3 increase in annual PM2.5 exposure was associated with 19% increased risk of incident stroke [hazard ratio (HR) = 1.19, 95% CI: 0.88, 1.62]. Similar findings were obtained for PM10. The results were robust to adjustment for an extensive list of cardiovascular risk factors and noise coexposure. The association with PM2.5 was apparent among those ≥ 60 years of age (HR = 1.40, 95% CI: 1.05, 1.87), among never-smokers (HR = 1.74, 95% CI: 1.06, 2.88), and among participants with PM2.5 exposure < 25 μg/m3 (HR = 1.33, 95% CI: 1.01, 1.77).
Conclusions: We found suggestive evidence of an association between fine particles and incidence of cerebrovascular events in Europe, even at lower concentrations than set by the current air quality limit value.
1Department of Epidemiology, Lazio Regional Health Service, Rome, Italy; 2Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; 3Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark; 4Center for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; 5Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; 6Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet, Stockholm, Sweden; 7Environment Science Center, University of Augsburg, Augsburg, Germany; 8Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; 9MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom; 10Stockholm Gerontology Research Center, Stockholm, Sweden; 11Division of Clinical Geriatrics, Karolinska University Hospital, Stockholm, Sweden; 12Unit of Cancer Epidemiology, “Città della Salute e della Scienza” Hospital-University of Turin, and Center for Cancer Prevention Piemonte, Turin, Italy; 13Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland; 14IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany; 15Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; 16Medical Faculty, University of Düsseldorf, Düsseldorf, Germany; 17National Institute for Public Health and the Environment, Bilthoven, the Netherlands; 18Department of Environmental Health, National Institute for Health and Welfare, Kuopio, Finland; 19Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; 20MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany; 21Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark; 22Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; 23Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany; 24Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia-Romagna, Modena, Italy; 25Molecular and Genetic Epidemiology Unit, Human Genetics Foundation, Turin, Italy; 26Department of Neurology, University of Duisburg-Essen, Essen, Germany; 27Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; 28Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
Recommended Citation:
Massimo Stafoggia,1 Giulia Cesaroni,1 Annette Peters,et al. Long-Term Exposure to Ambient Air Pollution and Incidence of Cerebrovascular Events: Results from 11 European Cohorts within the ESCAPE Project[J]. Environmental Health Perspectives,2014-01-01,Volume 122(Issue 9):919