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Air pollution and surrounding greenness in relation to ischemic stroke: A population-based cohort study

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dc.contributor.author Avellaneda Gómez, Carla
dc.contributor.author Vivanco Hidalgo, Rosa María
dc.contributor.author Olmos, Sergio
dc.contributor.author Lazcano Dobao, Uxue
dc.contributor.author Valentín, Antònia
dc.contributor.author Milà, Carles
dc.contributor.author Ambrós, Albert
dc.contributor.author Roquer, Jaume
dc.contributor.author Tonne, Cathryn
dc.date.accessioned 2022-05-03T05:51:43Z
dc.date.available 2022-05-03T05:51:43Z
dc.date.issued 2022
dc.identifier.citation Avellaneda-Gómez C, Vivanco-Hidalgo RM, Olmos S, Lazcano U, Valentin A, Milà C, Ambrós A, Roquer J, Tonne C. Air pollution and surrounding greenness in relation to ischemic stroke: A population-based cohort study. Environ Int. 2022 Mar;161:107147. DOI: 10.1016/j.envint.2022.107147
dc.identifier.issn 0160-4120
dc.identifier.uri http://hdl.handle.net/10230/52960
dc.description.abstract Background: Evidence for the association between environmental exposures and ischemic stroke (IS) is limited and inconsistent. We aimed to assess the relationship between exposure to air pollutants, residential surrounding greenness, and incident IS, and to identify population subgroups particularly sensitive to these exposures. Methods: We used data from administrative health registries of the public healthcare system in Catalonia, Spain to construct a cohort of individuals aged 18 years and older without a previous stroke diagnosis at 1st January 2016 (n = 3 521 274). We collected data on sociodemographic characteristics and cerebrovascular risk factors, and derived exposure at the participant's residence to ambient levels of fine particulate matter (PM2.5), black carbon (BC), nitrogen dioxide (NO2), and Normalized Difference Vegetation Index (NDVI) in a 300 m buffer as an indicator of greenness. The primary outcome was IS diagnosis at any point during the follow-up. We used Cox proportional hazards models to estimate associations between environmental exposures and incident IS and stratified analyses to investigate effect modification. Results: Between 1st January 2016 and 31st December 2017, 10 865 individuals were admitted to public hospitals with an IS diagnosis. Median exposure levels were: 17 µg/m3 PM2.5, 35 µg/m3 NO2, 2.28 µg/m3 BC and 0.27 NDVI. Individuals with higher residential exposure to air pollution were at greater risk of IS: HR 1·04 (95% CI:0·99-1·10) per 5 µg/m3 of PM2.5; HR 1.05 (95% CI:1·00-1·10) per 1 µg/m3 of BC; HR 1·04 (95% CI:1·03-1·06) per 10 µg/m3 of NO2. Conversely, individuals with higher residential surrounding green space, had lower risk of IS (HR 0·84; CI 95%:0·7-1.0). There was no evidence of effect modification by individual characteristics. Conclusions: Higher incidence of IS was observed in relation to long-term exposures to air pollution, particularly NO2, in a region that meets European health-based air quality standards. Residential surrounding greenness was associated with lower incidence of IS.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartof Environ Int. 2022 Mar;161:107147
dc.rights © 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
dc.rights.uri http://creativecommons.org/licenses/by/4.0/
dc.title Air pollution and surrounding greenness in relation to ischemic stroke: A population-based cohort study
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1016/j.envint.2022.107147
dc.subject.keyword Black carbon
dc.subject.keyword Green space
dc.subject.keyword Nitrogen dioxide
dc.subject.keyword Particulate matter
dc.subject.keyword Stroke incidence
dc.subject.keyword Transient ischemic attack
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion


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