Air Pollution and Stroke in a Bi-Ethnic Community: Associations with Incidence, Recurrence and Stroke Severity.

air pollution;ischemic stroke;stroke disparities;neighborhood disadvantage;Public Health;Health Sciences;Epidemiological Science

Wing, Jeffrey JamesMorgenstern, Lewis B. ;

University of Michigan

关键词: air pollution;    ischemic stroke;    stroke disparities;    neighborhood disadvantage;    Public Health;    Health Sciences;    Epidemiological Science;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/111413/wingjeff_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

Stroke is a leading cause of disability in the United States and costs related to stroke are enormous. Air pollution may be an aspect of the environment that contributes to stroke risk, but current evidence is inconsistent. The overarching aim of this dissertation was to advance the current understanding of the association between aspects of the environment and ischemic stroke and stroke severity using stroke cases identified from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project from 2000-2012. Specifically, this dissertation investigated three Aims: 1) ambient air pollution (particulate matter < 2.5μm in aerodynamic diameter (PM2.5) and ozone (O3)) and incident stroke and the potential effect modification by Mexican American ethnicity, 2) ambient air pollution and recurrent stroke and the identification of susceptible sociodemographic or clinical subgroups, and 3) both ambient air pollution and neighborhood disadvantage and their potential synergistic effects on initial stroke severity. A time-stratified case-crossover design and conditional logistic regression methods were used to investigate Aims 1 and 2. Aim 3 used traditional regression methods, and accounted for individual clustering within neighborhoods. Weak associations between higher short-term O3 exposures and increased odds of incident ischemic stroke were demonstrated, but no significant associations were observed between previous-day PM2.5 and O3 and recurrent ischemic stroke. Stronger associations between O3 and incident stroke were observed only among non-Hispanic whites. Although some modifications were suggested, effect modification of the air pollution-recurrent stroke association by sociodemographic and clinical factors was not observed consistently across the two pollutants. Findings suggested that living in more disadvantage neighborhoods increases the likelihood of severe ischemic stroke compared to less disadvantage neighborhoods, and an association between PM2.5 and severe stroke was only evident in areas of high neighborhood disadvantage. Higher O3 levels were associated with severity, but did not vary by neighborhood disadvantage. The culmination of this dissertation suggests that environmental factors influence stroke risk and severity. Future studies are necessary to understand air pollution-stroke associations, how the associations may vary by ethnicity, differential susceptibility to air pollutants, and to promote environmental justice for disadvantaged neighborhoods that may not have the ability to protect themselves.