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Review
. 2014 Aug 7;3(4):e000983.
doi: 10.1161/JAHA.114.000983.

Short-term changes in ambient particulate matter and risk of stroke: a systematic review and meta-analysis

Yi Wang  1 , Melissa N Eliot  2 , Gregory A Wellenius  2
Affiliations
Review

Short-term changes in ambient particulate matter and risk of stroke: a systematic review and meta-analysis

Yi Wang et al. J Am Heart Assoc. .

Abstract

Background: Stroke is a leading cause of death and long-term disability in the United States. There is a well-documented association between ambient particulate matter air pollution (PM) and cardiovascular disease morbidity and mortality. Given the pathophysiologic mechanisms of these effects, short-term elevations in PM may also increase the risk of ischemic and/or hemorrhagic stroke morbidity and mortality, but the evidence has not been systematically reviewed.

Methods and results: We provide a comprehensive review of all observational human studies (January 1966 to January 2014) on the association between short-term changes in ambient PM levels and cerebrovascular events. We also performed meta-analyses to evaluate the evidence for an association between each PM size fraction (PM2.5, PM10, PM2.5-10) and each outcome (total cerebrovascular disease, ischemic stroke/transient ischemic attack, hemorrhagic stroke) separately for mortality and hospital admission. We used a random-effects model to estimate the summary percent change in relative risk of the outcome per 10-μg/m(3) increase in PM.

Conclusions: We found that PM2.5 and PM10 are associated with a 1.4% (95% CI 0.9% to 1.9%) and 0.5% (95% CI 0.3% to 0.7%) higher total cerebrovascular disease mortality, respectively, with evidence of inconsistent, nonsignificant associations for hospital admission for total cerebrovascular disease or ischemic or hemorrhagic stroke. Current limited evidence does not suggest an association between PM2.5-10 and cerebrovascular mortality or morbidity. We discuss the potential sources of variability in results across studies, highlight some observations, and identify gaps in literature and make recommendations for future studies.

Keywords: air pollution; cerebrovascular disease; meta‐analysis; particulate matter; stroke.

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Figures

Figure 1.
Figure 1.
Search strategy and rationale for excluding 15 studies. CBVD indicates cerebrovascular disease; PM, particulate matter; TIA, transient ischemic attack.
Figure 2.
Figure 2.
Summary relative risk (95% CI) for the associations between short‐term exposure to particulate matter PM2.5, PM10, and PM2.5‐10 morality and hospitalization for cerebrovascular disease (CBVD) and hospitalization for ischemic or hemorrhagic stroke.
Figure 3.
Figure 3.
Individual study relative risk (95% CI) for the association between particulate matter PM2.5 and hospital admissions for cerebrovascular disease (CBVD).–,–,,–,
Figure 4.
Figure 4.
A, Funnel plot of individual study relative risk (95% CI) for the association between particulate matter PM2.5 and hospital admissions for cerebrovascular disease (CBVD); (B) after applying trim and fill methods to adjust for publication bias.
Figure 5.
Figure 5.
Individual study relative risk (95% CI) for the association between particulate matter PM2.5 and hospital admissions for ischemic stroke.,,,,,
Figure 6.
Figure 6.
Funnel plot of individual study relative risk (95% CI) for the association between particulate matter PM2.5 and hospital admissions for ischemic stroke.
Figure 7.
Figure 7.
Individual study relative risk (95% CI) for the association between particulate matter PM2.5 and hospital admissions for hemorrhagic stroke.,
Figure 8.
Figure 8.
Funnel plot of individual study relative risk (95% CI) for the association between particulate matter PM2.5 and hospital admissions for hemorrhagic stroke.
Figure 9.
Figure 9.
Individual study relative risk (95% CI) for the association between particulate matter PM2.5 and mortality for cerebrovascular disease (CBVD).,–,
Figure 10.
Figure 10.
Funnel plot of individual study relative risk (95% CI) for the association between particulate matter PM2.5 and mortality for cerebrovascular disease (CBVD).
Figure 11.
Figure 11.
Individual study relative risk (95% CI) for the association between particulate matter PM10 and hospital admissions for cerebrovascular disease (CBVD).,,,–
Figure 12.
Figure 12.
Funnel plot of individual study relative risk (95% CI) for the association between particulate matter PM10 and hospital admissions for cerebrovascular disease (CBVD).
Figure 13.
Figure 13.
Individual study relative risk (95% CI) for the association between PM10 and hospital admissions for ischemic stroke.,,,–,–
Figure 14.
Figure 14.
A, Funnel plot of individual study relative risk (95% CI) for the association between particulate matter PM10 and hospital admissions for ischemic stroke; (B) After applying trim and fill methods to adjust for publication bias.
Figure 15.
Figure 15.
Individual study relative risk (95% CI) for the association between particulate matter PM10 and hospital admissions for hemorrhagic stroke.,,,,
Figure 16.
Figure 16.
Funnel plot of individual study relative risk (95% CI) for the association between particulate matter PM10 and hospital admissions for hemorrhagic stroke.
Figure 17.
Figure 17.
Individual study relative risk (95% CI) for the association between particulate matter PM10 and mortality for cerebrovascular disease (CBVD).,,–,,–
Figure 18.
Figure 18.
A, Funnel plot of individual study relative risk (95% CI) for the association between particulate matter PM10 and mortality for cerebrovascular disease (CBVD); (B) After applying trim and fill methods to adjust for publication bias.
Figure 19.
Figure 19.
Individual study relative risk (95% CI) for the association between particulate matter PM2.5‐10 and hospital admissions for cerebrovascular disease (CBVD).,,,
Figure 20.
Figure 20.
Funnel plot of individual study relative risk (95% CI) for the association between particulate matter PM2.5‐10 and hospital admissions for cerebrovascular disease (CBVD).
Figure 21.
Figure 21.
Individual study relative risk (95% CI) for the association between particulate matter PM2.5‐10 and mortality for cerebrovascular disease (CBVD).,,
Figure 22.
Figure 22.
Funnel plot of individual study relative risk (95% CI) for the association between particulate matter PM2.5‐10 and mortality for cerebrovascular disease (CBVD).
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