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National Institute of Environmental Health Sciences (NIEHS), Environmental Health Perspectives, 9(122), p. 919-925, 2014

DOI: 10.1289/ehp.1307301

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Long-Term Exposure to Ambient Air Pollution and Incidence of Cerebrovascular Events: Results from 11 European Cohorts within the ESCAPE Project

Journal article published in 2014 by Massimo Stafoggia ORCID, Giulia Cesaroni ORCID, Annette Peters, Zorana Jovanovic Andersen ORCID, Chiara Badaloni, Rob Beelen, Barbara Caracciolo, Josef Cyrys, Ulf de Faire, Kees de Hoogh, Kirsten Thorup Eriksen, Laura Fratiglioni, Claudia Galassi, Bruna Gigante ORCID, Aki S. Havulinna and other authors.
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

BACKGROUND: Few studies have investigated effects of air pollution on the incidence of cerebrovascular events. OBJECTIVES: 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] below 2.5 µm in diameter), coarse PM (PM between 2.5 and 10 µm), PM10 (PM below 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: 99,446 subjects were included, 3,086 of whom developed stroke. A 5-μg/m(3) increase in annual PM2.5 exposure was associated with 19% increased risk of incident stroke (hazard ratio [HR] = 1.19, 95% confidence interval [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 co-exposure. The association with PM2.5 was apparent among those aged 60+ years (HR = 1.40, 95% CI: 1.05, 1.87), among never-smokers (HR = 1.74, 95% CI: 1.06, 2.88), and among subjects with PM2.5 exposure below 25 μg/m(3) (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.