title: Air Pollution and Ischemic Stroke Among Young Adults.
abstract: OBJECTIVE
  Studies have demonstrated consistent associations between cardiovascular illness and particulate matter (PM) <10 and <2.5 μm in diameter, but stroke received less attention. We hypothesized that air pollution, an inflammation progenitor, can be associated with stroke incidence in young patients in whom the usual risk factors for stroke are less prevalent. We aimed to evaluate the association between stroke incidence and exposure to PM <10 and <2.5 μm, in a desert area characterized by a wide range of PM.
  
  
  METHODS
  We included all members of the largest health maintenance organization in Israel, who were admitted to a local hospital with stroke between 2005 and 2012. Exposure assessment was based on a hybrid model incorporating daily satellite remote sensing data at 1-km spatial resolution. We performed case-crossover analysis, stratified by personal characteristics and distance from main roads.
  
  
  RESULTS
  We identified 4837 stroke cases (89.4% ischemic stroke). Interquartile range of PM <10 and <2.5 μm was 36.3 to 54.7 and 16.7 to 23.3 μg/m(3), respectively. The subjects' average age was 70 years; 53.4% were males. Associations between ischemic stroke and increases of interquartile range average concentrations of particulate matter <10 or <2.5 μm at the day of the event were observed among subjects <55 years (odds ratio [95% confidence interval], 1.11 [1.02-1.20] and 1.10 [1.00-1.21]). Stronger associations were observed in subjects living within 75 m from a main road (1.22 [1.03-1.43] and 1.26 [1.04-1.51]).
  
  
  CONCLUSIONS
  We observed higher risk for ischemic stroke associated with PM among young adults. This finding can be explained by the inflammatory mechanism, linking air pollution and stroke.
authors.affiliation: From the Department of Medicine, Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel (M.Y.S., V.N.); Clinical Research Center (M.Y.S., V.N.) and Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I., A.H.); and Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University, Beer Sheva, Israel (I.K.).
authors.forename: Maayan
authors.initials: M
authors.lastname: Yitshak Sade
authors.affiliation: From the Department of Medicine, Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel (M.Y.S., V.N.); Clinical Research Center (M.Y.S., V.N.) and Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I., A.H.); and Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University, Beer Sheva, Israel (I.K.).
authors.forename: Victor
authors.initials: V
authors.lastname: Novack
authors.affiliation: From the Department of Medicine, Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel (M.Y.S., V.N.); Clinical Research Center (M.Y.S., V.N.) and Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I., A.H.); and Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University, Beer Sheva, Israel (I.K.).
authors.forename: Gal
authors.initials: G
authors.lastname: Ifergane
authors.affiliation: From the Department of Medicine, Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel (M.Y.S., V.N.); Clinical Research Center (M.Y.S., V.N.) and Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I., A.H.); and Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University, Beer Sheva, Israel (I.K.).
authors.forename: Anat
authors.initials: A
authors.lastname: Horev
authors.affiliation: From the Department of Medicine, Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel (M.Y.S., V.N.); Clinical Research Center (M.Y.S., V.N.) and Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I., A.H.); and Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University, Beer Sheva, Israel (I.K.). ikloog@bgu.ac.il.
authors.forename: Itai
authors.initials: I
authors.lastname: Kloog
mesh_terms: D000328:Adult; D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects*; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology*; D018592:Cross-Over Studies; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000393:Air Pollutants
keywords: air pollution; inflammation; particulate matter; risk factor; stroke