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Author Notes:

Tszshan Ma, tsz.shan.ma@emory.edu

Liuhua Shi, liuhua.shi@emory.edu

L.S. designed research and directed its implementation; T.M. and L.S. analyzed data, T.M. and P.L. made the figures and tables, T.M., L.S., M.D.·Y, P.L., W.R., Q.D., Y.W., and J.S. prepared datasets. T.M. lead the writing of the manuscript, with input from all authors.

This study was supported by Emory HERCULES Center (P30 ES019776), the National Institute of Environmental Health Sciences (R21 ES032606) and the Emory Climate and Health Research Incubator. The authors acknowledge Dr. Joel Schwartz's lab for providing us with access to their estimated air pollution data.

The authors declare no competing interests.

Subjects:

Keywords:

  • Air pollution
  • Incidence
  • Medicare
  • Stroke

Long-term air pollution exposure and incident stroke in American older adults: A national cohort study

Tools:

Journal Title:

Global Epidemiology

Volume:

Volume 4

Publisher:

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Aims: Stroke is a leading cause of death and disability for Americans, and growing evidence suggests that air pollution may play an important role. To facilitate pollution control efforts, the National Academy of Sciences and the World Health Organization have prioritized determining which air pollutants are most toxic. However, evidence is limited for the simultaneous effects of multiple air pollutants on stroke. Methods and results: We constructed a nationwide population-based cohort study, using the Medicare Chronic Conditions Warehouse (2000–2017) and high-resolution air pollution data, to investigate the impact of long-term exposure to ambient PM2.5, NO2, and ground-level O3 on incident stroke. Hazard ratios (HR) for stroke incidence were estimated using single-, bi-, and tri-pollutant Cox proportional hazards models. We identified ~2.2 million incident stroke cases among 17,443,900 fee-for-service Medicare beneficiaries. Per interquartile range (IQR) increase in the annual average PM2.5 (3.7 μg/m3), NO2 (12.4 ppb), and warm-season O3 (6.5 ppb) one-year prior to diagnosis, the HRs were 1.022 (95% CI: 1.017–1.028), 1.060 (95% CI: 1.054–1.065), and 1.021 (95% CI: 1.017–1.024), respectively, from the tri-pollutant model. There was strong evidence of linearity in concentration-response relationships for all three air pollutants in single-pollutant models. This linear relationship remained robust for NO2 and O3 in tri-pollutant models while the effect of PM2.5 attenuated at the lower end of concentrations. Conclusion: Using a large nationwide cohort, our study suggests that long-term exposure to PM2.5, NO2, and O3 may independently increase the risk of stroke among the US elderly, among which traffic-related air pollution plays a particularly crucial role.

Copyright information:

© 2022 The Authors

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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