Introduction
Methods
Search strategy
Inclusion and exclusion criteria
Data extraction
Quality assessment
Statistical analyses
Results
Literature search and characteristics of included studies
Reference | Study Location and period | Study population | Study design | Exposure | Exposure assessment method | Type of stroke | Outcome |
---|---|---|---|---|---|---|---|
Huang et al. [4] | 15 provinces in China, 2000–2015 | 117,575 Chinese men and women without stroke from the Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project | Cohort | PM2.5 | A satellite-based spatiotemporal model, 1 × 1-km spatial resolution | All types of stroke | Incidence |
Tian et al. [24] | 172 cities in China, 2014–2016 | 2,032,667 hospital admissions for ischemic stroke in 172 cities in China | Time-series | PM2.5 | 1–17 monitors in each city operated by the National Air Pollution Monitoring System | Ischemic stroke | Hospital admission |
Chen et al. [25] | Jinan, China, 2013–2015 | 56,922 stroke admissions | Case-crossover | PM2.5, PM10, SO2, NO2, O3 | 14 fix-sited monitoring stations in urban areas of Jinan operated by Jinan Environment Monitoring Center | All types of stroke | Hospital admission |
Chen et al. [26] | China, 2007–2008 | 12,291 ischemic stroke patients from first national hospital-based prospective registry cohort of stroke in China | Cohort | PM2.5, PM10, NO2 | Monitoring data, satellite remote sensing, meteorological and land use information | Ischemic stroke | Mortality |
Xue et al. [27] | China, 2013–2015 | 1356 first-ever stroke events | Case-crossover | O3 | 1463 continuous air pollution monitoring sites operated by the China Environmental Protection Ministry | All types of stroke | Incidence |
Qian et al. [28] | Shanghai, China, 2012–2014 | 5286 fatal intracerebral hemorrhage (ICH) case | Case-crossover | PM2.5 | The Shanghai Environmental Monitoring Center | Hemorrhagic stroke | Incidence |
Tian et al. [12] | 184 major cities in China, 2014–2017 | 8,834,533 hospital admissions for cardiovascular causes in 184 Chinese cities | Time-series | PM2.5 | The National Air Pollution Monitoring System | Ischemic, hemorrhagic stroke | Hospital admission |
Tian et al. [10] | 172 cities in China, 2014–2016 | 2,032,667 hospital admissions for ischemic stroke in 172 cities in China | Time-series | PM2.5, SO2, NO2, O3, CO | 1–17 monitors in each city operated by the National Air Pollution Monitoring System | Ischemic stroke | Hospital admission |
Dong et al. [1] | Changzhou, China, 2015–2016 | 32,840 ischemic stroke (IS) cases, 4028 IS deaths | Time-series | PM2.5, PM10, SO2, NO2, CO | 10 air quality monitoring stations operated by the Changzhou Environmental Monitoring Center | Ischemic stroke | Mortality, incidence |
Zhong et al. [29] | Changsha city, China, 2008–2009 | 1536 stroke patients | Case-crossover | PM10, NO2, SO2 | the Changsha Municipal Public Weather Information Service Website | All types of stroke | Hospital admission |
Vivanco-Hidalgo et al. [30] | Barcelona, Spain, 2005–2014 | 27,421,536 stroke patients | Time-series | PM2.5 | An urban background research site located in southwest Barcelona | Ischemic stroke | Incidence |
Yitshak-Sade et al. [31] | New England, 2001–2011 | 2,015,660 stroke admissions | Time-series | PM2.5 | Monitor PM data and aerosol optic depth (AOD) values (1 × 1 km) | Ischemic stroke | Hospital admission |
Liu et al. [32] | 272 cities in China, 2013–2015 | 294,199 deaths due to stroke in 272 Chinese cities | Time-series | CO | The National Urban Air Quality Real-time Publishing Platform | All types of stroke | Mortality |
Wang et al. [33] | 6 subtropical cities in China, 2013–2016 | 54,236 stroke deaths from six Chinese subtropical cities | Case-crossover | PM2.5, PM10 | Municipal air monitoring system | All types of stroke | Mortality |
Collart et al. [34] | Wallonia, Belgium, 2008–2011, | 113,147 hospital admissions due to stroke | Time-series | NO2 | ISSeP (the Scientific Institute of Public Services) | All types of stroke | Hospital admission |
Chen et al. [35] | 30 counties in China, 2013–2015 | 49,669 stroke deaths | Time-series | PM2.5 | Fixed-site monitoring station operated by the closest spatial distance to the county center. Daily air pollution data for PM2.5 and O3 concentrations were collected from the National Air pollution Monitoring System | All types of stroke | Mortality |
Wang et al. [36] | 272 cities in China, 2013–2015 | 294,199 deaths due to stroke in 272 Chinese cities | Time-series | SO2 | The National Urban Air Quality Real-time Publishing Platform | All types of stroke | Mortality |
Chen et al. [9] | 272 cities in China, 2013–2015 | 294,199 deaths due to stroke in 272 Chinese cities | Time-series | PM2.5 | The National Urban Air Quality Real-time Publishing Platform | All types of stroke | Mortality |
Yin et al. [37] | 272 cities in China, 2013–2015 | 294,199 deaths due to stroke in 272 Chinese cities | Time-series | O3 | The National Urban Air Quality Real-time Publishing Platform | All types of stroke | Mortality |
Ha et al. [38] | USA, 2002–2008 | 228,438 deliveries | Case-crossover | PM2.5, PM10, SO2, O3, CO | Community Multiscale Air Quality (CMAQ) models | All types of stroke | Incidence |
Huang et al. [39] | Beijing, China, 2013–2014 | 147,624 stroke admissions | Case-crossover | SO2, NO2, O3, CO | The Centre of City Environmental Protection Monitoring Website Platform of Beijing | All types of stroke | Hospital admission |
Guo et al. [5] | South China, 2013–2015 | 95,562 ischemic stroke cases | Time-series | PM2.5, NO2, SO2, O3, CO | The Qingyue Open Environmental Data (QOED) Center | Ischemic stroke | Hospital admission |
Liu et al. [40] | 14 large cities in China, 2014–2015 | 200,958 ischemic stroke and 41,746 hemorrhagic stroke hospitalizations | Case-crossover | PM10, SO2, O3, CO, O3 | The National Air Pollution Monitoring System | Ischemic, hemorrhagic stroke | Hospital admission |
Wing et al. [11] | Texas, USA, 2000–2012 | 3216 first-ever ischemic strokes | Case-crossover | PM2.5, O3 | The Texas Commission on Environmental Quality’s Texas Air Monitoring Information System from a centrally located monitor | Ischemic stroke | Incidence |
Liu et al. [41] | 26 cities in China, 2014–2015 | 348,379 stroke admissions | Case-crossover | PM2.5, PM10 | The National Air Pollution Monitoring System | Ischemic, hemorrhagic stroke | Hospital admission |
McClure et al. [42] | USA, 2003–2011 | 30,239 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, 746 incidences | Case-crossover | PM2.5 | Moderate Resolution Imaging Spectroradiometer instrument on the NASA Aqua satellite (10 km × 10 km) | All types of stroke | Incidence |
Tian et al. [43] | Beijing, China, 2010–2012 | 63,956 first hospital admissions due to stroke | Case-crossover | PM2.5 | An ambient air quality monitoring station on the rooftop of embassy building located in Chaoyang district, Beijing | Ischemic stroke | Hospital admission |
Lin et al. [44] | 6 low- and middle-income countries, 2007–2010 | 45,625 participants from the Study on Global Aging and Adult Health | Cohort | PM2.5 | Global estimates of ambient fine particulate matter concentrations from satellite-based aerosol optical depth | All types of stroke | Incidence |
Hong et al. [45] | Changzhou, China, 2015–2016 | 32,840 ischemic stroke (IS) cases, 4028 IS deaths | Time-series | O3 | 10 air quality monitoring stations operated by the Changzhou Environmental Monitoring Center | Ischemic stroke | Incidence, mortality |
Stockfelt et al. [46] | Gothenburg, Sweden, 1990–2011 | 1391 cases of stroke from the Primary Prevention Study (PPS) cohort and GOT-MONICA cohort | Cohort | PM2.5, PM10 | High-resolution dispersion modeling was performed for the period 1990–2011 over a Gothenburg region domain (93 × 112 km) | All types of stroke | Incidence |
Qiu et al. [47] | Hong Kong, China, 1998–2010, | 6,733 cases of incident stroke | Cohort | PM2.5 | Satellite-based aerosol optical depth (AOD) recordings and monitoring data from ground-based stations | All types of stroke | Incidence |
Crichton et al. [48] | South London, England, 2005–2012 | 1800 incidence due to stroke | Time-series | PM2.5, PM10, NO2, O3 | The KCLurban model developed at King’s College London | Ischemic, hemorrhagic stroke | Incidence |
Huang et al. [49] | Beijing, China, 2013–2014 | 147,624 stroke admissions | Case-crossover | PM2.5, PM10 | The Centre of City Environmental Protection Monitoring Website Platform of Beijing | Ischemic, hemorrhagic stroke | Hospital admission |
Lin et al. [50] | Guangzhou, China, 2007–2011 | 9066 stroke deaths | Time-series | PM2.5, PM10 | An automatic air monitoring system was installed on the rooftop of Panyu Meteorological Centre | All types of stroke | Mortality |
Han et al. [51] | South Korea, 2004–2014 | 1,477 consecutive hemorrhagic stroke events | Case-crossover | PM10, NO2, O3 | The Climate and Air Quality Management Division of South Korea | Hemorrhagic stroke | Incidence |
Montresor-López et al. [13] | South Carolina, USA, 2002–2006 | 21,301 stroke patients | Case-crossover | O3 | The US Environmental Protection Agency (USEPA), Hierarchical Bayesian Model (HBM) | All types of stroke | Hospital admission |
Korek et al. [52] | Stockholm, Sweden, 1991–2010 | 22,587 individuals in four cohorts | Cohort | PM10 | The Airviro Air Quality Management System | All types of stroke | Incidence |
Chang et al. [53] | Tropical City, Taiwan, 2006–2010 | 27,392 admissions due to stroke | Case-crossover | PM2.5 | 6 air quality monitoring stations in Kaohsiung city operated by the Taiwanese Environmental Protection Administration (EPA) | All types of stroke | Hospital admission |
Tian et al. [54] | Hong Kong, 2004–2011 | 140,774 emergency hospital admissions | Time-series | CO | 4 general monitoring stations operated by the Environmental Protection Department (EPD) of Hong Kong | All types of stroke | Hospital admission |
To et al. [55] | Canada, 1998–2006 | 89,835 women of the Canadian National Breast Screening Study (CNBSS) | Cohort | PM2.5 | Satellite-based estimates of surface concentrations of PM2.5 | All types of stroke | Incidence |
Hoffmann et al. [56] | German, 2008–2009 | 4433 subjects from the German Heinz Nixdorf Recall cohort | Cohort | PM2.5, PM10 | Land-use regression (LUR) models | All types of stroke | Incidence |
Chen et al. [57] | Taiwan, 2006–2010 | 27,392 hospital admissions due to stroke | Case-crossover | PM2.5, PM10 | 6 air quality monitoring stations established in Kaohsiung city operated by the Taiwanese Environmental Protection Administration (EPA) | All types of stroke | Hospital admission |
Amancio and Nascimento [58] | Brazil, 2005–2009 | 1,032 deaths due to stroke | Time-series | PM10, SO2 | A measuring station in downtown São José dos Campos | All types of stroke | Mortality |
Chen et al. [59] | Taiwan, 2004–2008, | 12,982 ischemic, 3362 hemorrhagic stroke cases | Time-series | PM2.5 | The Sinjhuang Supersite located in the center of the Taipei metropolitan area | Hemorrhage, ischemic stroke | Hospital admission |
Stafoggia et al. 2014 [60] | European, 2006–2010 | 99,446 study participants from 11 European Cohorts within the European Study of Cohorts for Air Pollution Effects (ESCAPE) Project | Cohort | PM2.5, PM10, NO2 | Land-use regression (LUR) models | All types of stroke | Incidence |
Chiu et al. [61] | Taipei, Taiwan, 2006–2010 | 12,520 hemorrhagic stroke (HS) hospital admissions for the 47 hospitals | Case-crossover | PM2.5 | Air quality monitoring stations operated by the Taiwanese Environmental Protection Administration (EPA) | Hemorrhagic stroke | Hospital admission |
Chen et al. [62] | 8 cities in China, 1996–2008 | 4820,000 subjects of 8 Chinese cities, approximately | Time-series | PM10, SO2, NO2 | 2–12 monitoring stations in each city operated by the Ministry of Environmental Protection of China | All types of stroke | Mortality |
Carlsen et al. [63] | Reykjavík, Iceland, 2003–2009 | 24,439 emergency hospital admissions due to stroke | Time-series | PM10, NO2, O3 | The Environmental Branch of the Municipality of Reykjavík (2003–2008) and the Icelandic Environmental Protection Agency (2009) | All types of stroke | Hospital admission |
Johnson et al. [64] | Canada, 2007–2009 | 4,696 stroke (cases) and 37,723 injury patients (controls) | Case-crossover | NO2 | Land-use regression (LUR) model for the city of Edmonton | All types of stroke | Hospital admission |
Atkinson et al. [65] | England, 2003–2007 | 836,557 patients | Cohort | PM10, NO2, NO2, O3 | Air dispersion models (1 × 1-km grids) | All types of stroke | Incidence |
Xu et al. [66] | Pennsylvania, USA, 1994–2000 | 26,210 hospital admissions due to stroke | Case-crossover | O3 | The repository of ambient air quality database of the US Environmental Protection Agency | All types of stroke | Hospital admission |
Xiang et al. [67] | Wuhan, China, 2006–2008 | 10,663 stroke hospital admissions from 4 major hospitals | Case-crossover | PM10, SO2, NO2 | 9 fixed-site stations operated by the Wuhan Environmental Monitoring Center | All types of stroke | Hospital admission |
Yorifuji et al. [68] | Shizuoka, Japan, 1999–2009 | 14,001 elderly residents | Cohort | NO2 | Land use regression (LUR) model | Hemorrhage, ischemic stroke | Mortality |
Qian et al. [69] | Shanghai, China, 2003–2008 | 66,366 stroke deaths for adults aged over 65 | Case-crossover | PM10, SO2, NO2 | 6 fixed-site stations operated by Shanghai Environmental Monitoring Center | All types of stroke | Mortality |
Andersen et al [70] | Denmark, 1971–2006 | 52,215 participants of the Danish Diet, Cancer and Health cohort | Cohort | NO2 | The Danish geographic information system-based air pollution and human exposure modeling system | All types of stroke | Incidence, Mortality |
Nascimento et al. [71] | São Paulo State, Brazil, 2007–2008, | 407 hospitalizations due to stroke | Time-series | PM10, SO2, O3 | Measuring station of the São Paulo State Environmental Agency | All types of stroke | Hospital admission |
OʼDonnell et al. [72] | Canada, 2003–2008, | 9202 patients hospitalized due to ischemic stroke | Case-crossover | PM2.5 | 19 monitoring stations in the vicinity of the 11 regional stroke centers participating in the Registry | Ischemic Stroke | Incidence |
Lipsett et al. [73] | California, USA, 1996–2005, | 124,614 women living in California | Cohort | PM2.5, PM10, SO2, NO2, CO, O3 | Fixed-site monitors, inverse distance weighting (IDW) interpolation | All types of stroke | Incidence |
Yorifuji et al. [68] | Tokyo, Japan, 2003–2008 | 41,440 deaths due to stroke | Time-series | PM2.5, NO2 | 2 monitoring stations in Tokyo’s 23 wards | Hemorrhagic stroke | Mortality |
Ren et al. [74] | Massachusetts, USA, 1995–2002 | 157,197 non-accident deaths aging 35 years or older | Case-crossover | O3 | The Environmental Protection Agency, USA | All types of stroke | Mortality |
Zanobetti and Schwartz [75] | USA, 1999–2005 | 330,613 deaths for stroke in 112 US cities | Time-series | PM2.5 | Air Quality System Technology Transfer Network | All types of stroke | Mortality |
Kettunen et al. [76] | Helsinki, Finland, 1998–2004 | 3265 deaths due to stroke | Time-series | PM2.5, PM10, NO2, CO, O3 | The Environmental Protection Agency, USA | All types of stroke | Mortality |
Franklin et al. [77] | USA,1997–2002 | 1310,781 deaths in 27 US communities | Case-crossover | PM2.5 | National, State, and Local Ambient Monitoring Stations | All types of stroke | Mortality |
Qian et al. [78] | Wuhan, China, 2001–2004 | 89,131 non-accidental death cases | Time-series | PM10 | Wuhan Environmental Monitoring Center | All types of stroke | Mortality |
Villeneuve et al. [79] | Edmonton, Canada, 1992–2002 | 12,422 stroke visits | Time-series | PM2.5, PM10, SO2, NO2, CO, O3 | Fixed-site monitoring stations maintained by Environment Canada | All types of stroke | Hospital admission |
Henrotin et al. [80] | Dijon, France, 1994–2004 | 1487 patients with ischemic stroke and 220 patients with hemorrhagic stroke | Case-crossover | PM10, SO2, CO, O3 | The monitoring station located in the town center, Dijon | Hemorrhage, ischemic stroke | Incidence |
Tsai et al. [81] | Kaohsiung, Taiwan, 1997–2000 | 23,179 hospital admissions due to stroke | Case-crossover | PM10, SO2, NO2, CO, O3 | 6 air-quality monitoring stations operated by the Environmental Protection Administration (EPA) | All types of stroke | Hospital admission |
Yu et al. [14] | Seoul, Korea, 1991–1997 | 7137 ischemic deaths due to stroke | Time-series | SO2, NO2, CO, O3 | 20 monitoring site and data operated by the Department of the Environment (Seoul) | Ischemic stroke | Mortality |
Air pollution and stroke hospital admission
Air pollution | Hospital admission | Heterogeneity | ||
NO. | HR (95% CI) | I2 (%) | P | |
PM2.5 | 19 | 1.008 (1.005, 1.011) | 96.6 | 0.000 |
PM10 | 15 | 1.004 (1.001, 1.006) | 92.7 | 0.000 |
SO2 | 13 | 1.013 (1.007, 1.020) | 94.5 | 0.000 |
NO2 | 15 | 1.023 (1.015, 1.030) | 92.6 | 0.000 |
CO | 8 | 1.000 (1.000, 1.001) | 92.7 | 0.000 |
O3 | 15 | 1.002 (1.000, 1.003) | 80.2 | 0.000 |
Air pollution and stroke incidence
Air pollution | Incidence | Heterogeneity | ||
NO. | OR (95% CI) | I2 (%) | P | |
PM2.5 | 18 | 1.048 (1.020, 1.076) | 82.3 | 0.000 |
PM10 | 13 | 1.017 (0.981, 1.055) | 51.9 | 0.010 |
SO2 | 4 | 1.002 (1.000, 1.003) | 20.3 | 0.288 |
NO2 | 7 | 1.002 (1.000, 1.003) | 0.0 | 0.512 |
CO | 5 | 0.999 (0.997, 1.001) | 0.0 | 0.763 |
O3 | 10 | 0.999 (0.999, 1.000) | 34.1 | 0.135 |
Air pollution and stroke mortality
Air pollution | Mortality | Heterogeneity | ||
NO. | OR (95% CI) | I2 (%) | P | |
PM2.5 | 12 | 1.008 (1.005, 1.012) | 89.2 | 0.000 |
PM10 | 10 | 1.006 (1.003, 1.010) | 83.3 | 0.000 |
SO2 | 6 | 1.006 (1.005, 1.008) | 45.8 | 0.100 |
NO2 | 10 | 1.009(1.003, 1.016) | 70.1 | 0.000 |
CO | 5 | 1.045 (0.980, 1.115) | 50.6 | 0.091 |
O3 | 6 | 1.005 (0.999, 1.010) | 84.8 | 0.000 |