Long-term exposure to ambient air pollution and incidence of cerebrovascular events: results from 11 European cohorts within the ESCAPE project.
BACKGROUND
Few studies have investigated effects of air pollution on the incidence of cerebrovascular events.


OBJECTIVE
We assessed the association between long-term exposure to multiple air pollutants and the incidence of stroke in European cohorts.


METHODS
Data from 11 cohorts were collected, and occurrence of a first stroke was evaluated. Individual air pollution exposures were predicted from land-use regression models developed within the European Study of Cohorts for Air Pollution Effects (ESCAPE). The exposures were: PM2.5 [particulate matter (PM) ≤ 2.5 μm in diameter], coarse PM (PM between 2.5 and 10 μm), PM10 (PM ≤ 10 μm), PM2.5 absorbance, nitrogen oxides, and two traffic indicators. Cohort-specific analyses were conducted using Cox proportional hazards models. Random-effects meta-analysis was used for pooled effect estimation.


RESULTS
A total of 99,446 study participants were included, 3,086 of whom developed stroke. A 5-μg/m3 increase in annual PM2.5 exposure was associated with 19% increased risk of incident stroke [hazard ratio (HR) = 1.19, 95% CI: 0.88, 1.62]. Similar findings were obtained for PM10. The results were robust to adjustment for an extensive list of cardiovascular risk factors and noise coexposure. The association with PM2.5 was apparent among those ≥ 60 years of age (HR = 1.40, 95% CI: 1.05, 1.87), among never-smokers (HR = 1.74, 95% CI: 1.06, 2.88), and among participants with PM2.5 exposure < 25 μg/m3 (HR = 1.33, 95% CI: 1.01, 1.77).


CONCLUSIONS
We found suggestive evidence of an association between fine particles and incidence of cerebrovascular events in Europe, even at lower concentrations than set by the current air quality limit value.
Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
Massimo
M
Stafoggia
Giulia
G
Cesaroni
Annette
A
Peters
Zorana J
ZJ
Andersen
Chiara
C
Badaloni
Rob
R
Beelen
Barbara
B
Caracciolo
Josef
J
Cyrys
Ulf
U
de Faire
Kees
K
de Hoogh
Kirsten T
KT
Eriksen
Laura
L
Fratiglioni
Claudia
C
Galassi
Bruna
B
Gigante
Aki S
AS
Havulinna
Frauke
F
Hennig
Agneta
A
Hilding
Gerard
G
Hoek
Barbara
B
Hoffmann
Danny
D
Houthuijs
Michal
M
Korek
Timo
T
Lanki
Karin
K
Leander
Patrik K
PK
Magnusson
Christa
C
Meisinger
Enrica
E
Migliore
Kim
K
Overvad
Claes-Göran
CG
Ostenson
Nancy L
NL
Pedersen
Juha
J
Pekkanen
Johanna
J
Penell
Goran
G
Pershagen
Noreen
N
Pundt
Andrei
A
Pyko
Ole
O
Raaschou-Nielsen
Andrea
A
Ranzi
Fulvio
F
Ricceri
Carlotta
C
Sacerdote
Wim J R
WJ
Swart
Anu W
AW
Turunen
Paolo
P
Vineis
Christian
C
Weimar
Gudrun
G
Weinmayr
Kathrin
K
Wolf
Bert
B
Brunekreef
Francesco
F
Forastiere
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000633:toxicity; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009589:Nitrogen Oxides / Q000633:toxicity; D009624:Noise, Transportation; D010316:Particle Size; D052638:Particulate Matter / Q000633:toxicity; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology
D000393:Air Pollutants; D009589:Nitrogen Oxides; D052638:Particulate Matter