title: Short-term effects of particulate matter on stroke attack: meta-regression and meta-analyses.
abstract: OBJECTIVE
  Currently there are more and more studies on the association between short-term effects of exposure to particulate matter (PM) and the morbidity of stroke attack, but few have focused on stroke subtypes. The objective of this study is to assess the relationship between PM and stroke subtypes attack, which is uncertain now.
  
  
  METHODS
  Meta-analyses, meta-regression and subgroup analyses were conducted to investigate the association between short-term effects of exposure to PM and the morbidity of different stroke subtypes from a number of epidemiologic studies (from 1997 to 2012).
  
  
  RESULTS
  Nineteen articles were identified. Odds ratio (OR) of stroke attack associated with particular matter ("thoracic particles" [PM10]<10 µm in aerodynamic diameter, "fine particles" [PM2.5]<2.5 µm in aerodynamic diameter) increment of 10 µg/m3 was as effect size. PM10 exposure was related to an increase in risk of stroke attack (OR per 10 µg/m3 = 1.004, 95%CI: 1.001 ∼ 1.008) and PM2.5 exposure was not significantly associated with stroke attack (OR per 10 µg/m3 = 0.999, 95%CI: 0.994 ∼ 1.003). But when focused on stroke subtypes, PM2.5 (OR per 10 µg/m3 = 1.025; 95%CI, 1.001∼1.049) and PM10 (OR per 10 µg/m3 = 1.013; 95%CI, 1.001 ∼ 1.025) exposure were statistically significantly associated with an increased risk of ischemic stroke attack, while PM2.5 (all the studies showed no significant association) and PM10 (OR per 10 µg/m3 = 1.007; 95%CI, 0.992 ∼ 1.022) exposure were not associated with an increased risk of hemorrhagic stroke attack. Meta-regression found study design and area were two effective covariates.
  
  
  CONCLUSIONS
  PM2.5 and PM10 had different effects on different stroke subtypes. In the future, it's worthwhile to study the effects of PM to ischemic stroke and hemorrhagic stroke, respectively.
authors.affiliation: Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China.
authors.forename: Xiao-Bo
authors.initials: XB
authors.lastname: Yu
authors.affiliation: Key Laboratory of Infectious Diseases Ministry of Public Health of China, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China.
authors.forename: Jun-Wei
authors.initials: JW
authors.lastname: Su
authors.affiliation: Department of Public Health, Zhejiang University, Hangzhou, P.R. China.
authors.forename: Xiu-Yang
authors.initials: XY
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China.
authors.forename: Gao
authors.initials: G
authors.lastname: Chen
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D052638:Particulate Matter / Q000009:adverse effects*; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*
chemical_list: D052638:Particulate Matter