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.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.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.doi http://dx.doi.org/10.1016/j.envint.2022.107147
• dc.identifier.issn 0160-4120
• dc.identifier.uri http://hdl.handle.net/10230/52960
• 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.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• 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.title Air pollution and surrounding greenness in relation to ischemic stroke: A population-based cohort study
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion