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Publication Date:
January 2009
ISSN:
1896-494X
DOI:
10.2478/v10001-008-0029-5

Ambient Air Pollution and Daily Emergency Department Visits for Ischemic Stroke in Edmonton, Canada

Mieczysław Szyszkowicz1

Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada1

Citation Information: International Journal of Occupational Medicine and Environmental Health. Volume 21, Issue 4, Pages 295–300, ISSN (Online) 1896-494X, ISSN (Print) 1232-1087, DOI: 10.2478/v10001-008-0029-5, January 2009

Publication History:
Published Online:
2009-01-21

Ambient Air Pollution and Daily Emergency Department Visits for Ischemic Stroke in Edmonton, Canada

Objectives: In this report, we examine the associations between emergency department (ED) visits for acute ischemic stroke and environmental conditions. Materials and Methods: The study concerned 10 881 ED visits for acute ischemic stroke (ICD-9: 434, 436) recorded at Edmonton hospitals between 1992 and 2002. Generalized linear mixed models technique was applied to build the statistical models. The logarithm of daily counts of ED visits for stroke was regressed on the levels of air pollutants (CO, NO2, SO2, and O3) and two meteorological variables. The analyses were performed by (a) age: two age groups were distinguished: 20-64 years (n = 2873) and 65-100 years (n = 8008); (b) season (all seasons: January-December, warm: April-September, cold: October-March); and (c) gender (both, male, female). Results: The results are reported as an excess risk in relation to an increase in the interquartile range (IQR) of the pollutants. In the age group 65-100 years, the excess risk for particular pollutants was as follows: for NO2 — 8.2% (95% CI: 0.4-16.7) for both genders, in the warm season; for SO2 — 9.1% (95% CI: 2.2-16.4), for males, in the warm season: for a 1-day lagged SO2 — 6.0% (95% CI: 0.5-11.8), for females, in the cold season. Among the patients aged 20-64 years, the excess risk for NO2 was 6.3% (95% CI: 0.2-12.8), for both genders, and all seasons; and 13.8% (95% CI: 2.1-26.7), for females, in the cold season; for a 1-day lagged O3 — 17.8% (95% CI: 2.2-35.6), for males, in the warm season; for a 1-day lagged SO2 — 10.3% (95% CI: 0.7-20.9) for females, in the cold season. Conclusions: The findings provide evidence that exposure to air pollutants is significantly associated with ED visits for acute ischemic stroke.

Keywords: Air pollution; Emergency department visit; Acute ischemic stroke; Risk; Temperature; Relative humidity

  • Heart and Stroke Foundation of Canada. Heart disease and stroke in Canada. Ottawa: Heart and Stroke Foundation of Canada; 1997.

  • Iribarren C, Darbinian J, Klatsky AL, Friedman GD Cohort study of exposure to environmental tobacco smoke and risk of first ischemic stroke and transient ischemic attack.Neuroepidemiology 2004;23(1-2):38-44.

  • Bai N, Khazaei M, van Eeden SF, Laher I The pharmacology of particulate matter air pollution-induced cardiovascular dysfunction.Pharamacol Ther 2007;113(1):16-29.

  • Hong YC, Lee JT, Kim H, Kwon HJ Air pollution: a new risk factor for ischemic stroke mortality.Stroke 2002;33(9):2165-9.

  • Hong YC, Lee JT, Kim H, Ha EH, Schwartz J, Christiani DC Effects of air pollutants on acute stroke mortality.Environ Health Perspect 2002;110:187-91.

  • Barnett AG, Williams GM, Schwartz J, Best TL, Neller AH, Petroeschevsky AL, et al. The effects of air pollution on hospitalizations for cardiovascular disease in elderly people in Australian and New Zealand cities.Environ Health Perspect 2006;114(7);1018-23.

  • Lee JT, Kim H, Cho YS, Hong YC, Ha EH, Park H Air pollution and hospital admissions for ischemic heart diseases among individuals 64+ years of age residing in Seoul, Korea.Arch Environ Health 2003;58:617-23.

  • Wellenius GA, Schwartz J, Mittleman MA Air pollution and hospital admissions for ischemic and hemorrhagic stroke among medicare beneficiaries.Stroke 2005;36(12):1549-53.

  • Sunyer J, Ballester F, Tertre AL, Atkinson R, Ayres JG, Forastiere F, et al. The association of daily sulfur dioxide air pollution levels with hospital admissions for cardiovascular diseases in Europe (The Aphea-II study).Eur Heart J 2003;24:752-60.

  • Yang CY, Chen YS, Chiu HF, Goggins WB Effects of Asian dust storm events on daily stroke admission in Taipei, Taiwan.Environ Res 2005;99(1):79-84.

  • Tsai SS, Goggins WB, Chiu HF, Yang CY Evidence for an association between air pollution and daily stroke admissions in Kaohsiung, Taiwan.Stroke 2003;34(11):2612-6.

  • Villeneuve PJ, Chen L, Stieb D, Rowe BH Associations between outdoor air pollution and emergency department visits for stroke in Edmonton, Canada.Eur J Epidemiol 2006;21(9):689-700.

  • World Health Organization. The International Classification of Diseases, 9th Revision. Geneva: WHO; 1997.

  • Molenberghs G, Verbeke G Models for discrete longitudinal data. New York: Springer; 1997.

  • R Development Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing. Vienna; 2008. ISBN 3-900051-07-0. Available from: URL: http://www.R-project.org

  • Szyszkowicz M Use of generalized linear mixed models to examine the association between air pollution and health outcomes.Int J Occup Med Environ Health 2006;19(4):224-7.

  • Sørensen M, Daneshvar B, Hansen M, Dragsted LO, Hertel O, Knudsen L, et al. Personal PM2.5 exposure and markers of oxidative stress in blood.Environ Health Perspect 2003;111(2):161-6.

  • Maclure M The case-crossover design: a method for studying transient effects on the risk of acute events.Am J Epidemiol 1991:133(2):144-53.

  • Franklin M, Zeka A, Schwartz J Association between PM2.5 and all-cause and specific-cause mortality in 27 US communities.J Expo Sci Environ Epidemiol 2007;17(3):279-87.

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