• Jiangshao Gu, Ying Shi, Ning Chen, Haibo Wang, and Ting Chen.
• Center for Big Data Research in Health and Medicine, Institute for Data Sciences, Tsinghua University, Beijing 100084, China; Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing 100084, China; Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Department of Computer Science and Technology, Tsinghua University, Beijing 100084, China.
• Sci. Total Environ. 2020 May 1; 715: 136896.

AbstractFew studies have investigated the acute effects of fine particulate matter (PM2.5) on the risk of stroke subtypes and transient ischemic attack (TIA) in low- and middle-income countries. The primary aim of this study was to assess the associations between short-term exposure to PM2.5 and daily hospital admissions for total cerebrovascular disease, ischemic and hemorrhagic strokes, and TIA in China. A total of 8,359,162 hospital admissions in 248 Chinese cities from 2013 to 2017 were identified from the Hospital Quality Monitoring System of China. Generalized additive models with quasi-Poisson regression were used to estimate the associations in each city, and random-effect meta-analyses were conducted to combine the city-specific estimates. We found that a 10 μg/m3 increase in PM2.5 concentration was significantly associated with a 0.19% (95% CI, 0.13% to 0.25%), 0.26% (95% CI, 0.17% to 0.35%), and 0.26% (95% CI, 0.13% to 0.38%) increase in same-day hospital admissions for total cerebrovascular disease, ischemic stroke, and TIA, respectively. In contrast, a non-significant negative association with PM2.5 was observed for hemorrhagic stroke in the main analyses (lag 0 day), which became statistically significant when using other single-day exposures (lag 1 or 2 days) or moving average exposures (lag 0-1, 0-2, or 0-3 days) as exposure metric. These associations were robust to adjustment for other criteria air pollutants in two-pollutant models. For ischemic stroke, the effect estimates were significantly larger in people aged 65-74 years, in cool season, and in cities with lower annual average PM2.5 concentrations. The exposure-response curves were nonlinear with a leveling off at high concentrations. These results contribute to the relatively limited literature on the PM2.5-related risks of cerebrovascular events in low- and middle-income countries.Copyright © 2020 Elsevier B.V. All rights reserved.

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