Short-term Exposure to Air Pollution and Ischemic Stroke: A Systematic Review and Meta-analysis.

Abstract

Approximately 5 million fatalities occur annually due to stroke, along with its substantial effects on patient well-being and functional impairment. Research has established a connection between extended exposure to air pollutants and ischemic stroke. However, the link between short-term exposure to air pollutants and stroke remains less definitive. A comprehensive search was conducted on MEDLINE, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Sciences databases up until February 2023, without any language restrictions. The inclusion criteria encompassed observational or interventional studies that examined the correlation between short-term exposure to air pollutants (carbon monoxide [CO], sulfur dioxide [SO₂], nitrogen dioxide [NO₂], ozone [O₃]) and particulate matter with diameters of less than 1 µm, less than 2.5 µm, or less than 10 µm (PM₁, PM_2.5, and PM₁₀), with the incidence and mortality of ischemic stroke. Short-term exposure was defined as exposure occurring within 5 days of the onset of stroke. A total of 18,035,408 cases of ischemic stroke were included in the analysis, derived from 110 observational studies. Asia accounted for most included studies, representing 58.8% of the total. By contrast, Europe and the Americas contributed 24.6% and 16.7% of the studies, respectively. Notably, none of the included studies were conducted in Africa. Stroke incidence was significantly associated with an increase in the concentration of NO₂ (RR = 1.28; 95% CI 1.21-1.36), O₃ (RR = 1.05; 95% CI 1.03-1.07), CO (RR = 1.26; 95% CI 1.21-1.32), SO₂ (RR = 1.15; 95% CI 1.11-1.19), PM₁ (RR = 1.09; 95% CI 1.06-1.12), PM_2.5 (RR = 1.15; 95% CI 1.13-1.17), and PM₁₀ (RR = 1.14; 95% CI 1.12-1.16). Moreover, an increase in the concentration of NO₂ (RR = 1.33; 95% CI 1.07-1.65), SO₂ (RR = 1.60; 95% CI 1.05-2.44), PM_2.5 (RR = 1.09; 95% CI 1.04-1.15), and PM₁₀ (RR = 1.02; 95% CI 1.00-1.04) was associated with an increase in stroke mortality. There is a strong and significant correlation between gaseous and particulate air pollutants and the occurrence and mortality rates of stroke. This close temporal association underscores the importance of implementing global initiatives to develop policies aimed at reducing air pollution. By doing so, alleviate the burden of ischemic stroke and its consequences.