Short-term changes in ambient particulate matter and risk of stroke: a systematic review and meta-analysis.
Short-term changes in ambient particulate matter and risk of stroke: a systematic review and meta-analysis.
复制标题
环境颗粒物和中风风险的短期变化：系统的审查和荟萃分析。
DOI：
10.1161/jaha.114.000983
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发表时间：
2014-08-07
影响因子：
5.4
通讯作者：
Wellenius GA
中科院分区：
文献类型：
--
作者：
Wang Y;Eliot MN;Wellenius GA
在美国，中风是导致死亡和长期残疾的主要原因。环境颗粒物空气污染(PM)与心血管疾病发病率和死亡率之间有很好的相关性。鉴于这些效应的病理生理学机制，PM的短期升高也可能增加缺血性和/或出血性卒中的发病率和死亡率，但证据尚未得到系统回顾。我们对所有观察性人体研究(1966年1月至2014年1月)关于环境PM水平的短期变化与脑血管事件之间的关系进行了全面的综述。我们还进行了Meta分析，以评估每种PM大小分数(PM2.5、PM10、PM2.5-10)与每种结局(总脑血管疾病、缺血性中风/短暂性脑缺血发作、出血性中风)之间死亡率和入院时间的相关性的证据。我们使用随机效应模型来估计PM每增加10-μg/m~3结果的相对风险的汇总百分比变化我们发现PM2.5和PM10分别与1.4%(95%可信区间0.9%至1.9%)和0.5%(95%可信区间0.3%至0.7%)的脑血管疾病总死亡率相关，并有证据表明，与全脑血管疾病或缺血性或出血性中风住院的相关性不一致。目前有限的证据表明，PM2.5-10与脑血管死亡或发病率之间没有关联。我们讨论了不同研究结果的潜在变异性来源，强调了一些观察结果，找出了文献中的差距，并为未来的研究提出了建议。
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. 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/m3 increase in PM. 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.