TY - JOUR
T1 - Long-term exposure to traffic-related air pollution and stroke: A systematic review and meta-analysis
AU - Haddad, P.
AU - Kutlar Joss, M.
AU - Weuve, J.
AU - Vienneau, D.
AU - Atkinson, R.
AU - Brook, J.
AU - Chang, H.
AU - Forastiere, F.
AU - Hoek, G.
AU - Kappeler, R.
AU - Lurmann, F.
AU - Sagiv, S.
AU - Samoli, E.
AU - Smargiassi, A.
AU - Szpiro, A.
AU - Patton, A. P.
AU - Boogaard, H.
AU - Hoffmann, B.
N1 - Publisher Copyright:
© 2022 The Authors
PY - 2023
Y1 - 2023
N2 - Background Stroke remains the second cause of death worldwide. The mechanisms underlying the adverse association of exposure to traffic-related air pollution (TRAP) with overall cardiovascular disease may also apply to stroke. Our objective was to systematically evaluate the epidemiological evidence regarding the associations of long-term exposure to TRAP with stroke. Methods PubMed and LUDOK electronic databases were searched systematically for observational epidemiological studies from 1980 through 2019 on long-term exposure to TRAP and stroke with an update in January 2022. TRAP was defined according to a comprehensive protocol based on pollutant and exposure assessment methods or proximity metrics. Study selection, data extraction, risk of bias (RoB) and confidence assessments were conducted according to standardized protocols. We performed meta-analyses using random effects models; sensitivity analyses were assessed by geographic area, RoB, fatality, traffic specificity and new studies. Results Nineteen studies were included. The meta-analytic relative risks (and 95% confidence intervals) were: 1.03 (0.98–1.09) per 1 μg/m3 EC, 1.09 (0.96–1.23) per 10 μg/m3 PM10, 1.08 (0.89–1.32) per 5 μg/m3 PM2.5, 0.98 (0.92; 1.05) per 10 μg/m3 NO2 and 0.99 (0.94; 1.04) per 20 μg/m3 NOx with little to moderate heterogeneity based on 6, 5, 4, 7 and 8 studies, respectively. The confidence assessments regarding the quality of the body of evidence and separately regarding the presence of an association of TRAP with stroke considering all available evidence were rated low and moderate, respectively. Conclusion The available literature provides low to moderate evidence for an association of TRAP with stroke.
AB - Background Stroke remains the second cause of death worldwide. The mechanisms underlying the adverse association of exposure to traffic-related air pollution (TRAP) with overall cardiovascular disease may also apply to stroke. Our objective was to systematically evaluate the epidemiological evidence regarding the associations of long-term exposure to TRAP with stroke. Methods PubMed and LUDOK electronic databases were searched systematically for observational epidemiological studies from 1980 through 2019 on long-term exposure to TRAP and stroke with an update in January 2022. TRAP was defined according to a comprehensive protocol based on pollutant and exposure assessment methods or proximity metrics. Study selection, data extraction, risk of bias (RoB) and confidence assessments were conducted according to standardized protocols. We performed meta-analyses using random effects models; sensitivity analyses were assessed by geographic area, RoB, fatality, traffic specificity and new studies. Results Nineteen studies were included. The meta-analytic relative risks (and 95% confidence intervals) were: 1.03 (0.98–1.09) per 1 μg/m3 EC, 1.09 (0.96–1.23) per 10 μg/m3 PM10, 1.08 (0.89–1.32) per 5 μg/m3 PM2.5, 0.98 (0.92; 1.05) per 10 μg/m3 NO2 and 0.99 (0.94; 1.04) per 20 μg/m3 NOx with little to moderate heterogeneity based on 6, 5, 4, 7 and 8 studies, respectively. The confidence assessments regarding the quality of the body of evidence and separately regarding the presence of an association of TRAP with stroke considering all available evidence were rated low and moderate, respectively. Conclusion The available literature provides low to moderate evidence for an association of TRAP with stroke.
KW - Stroke Traffic related air pollution Long-term exposure Confidence assessment Systematic review meta-Analysis
U2 - 10.1016/j.ijheh.2022.114079
DO - 10.1016/j.ijheh.2022.114079
M3 - Article
SN - 1438-4639
VL - 247
JO - International Journal of Hygiene and Environmental Health
JF - International Journal of Hygiene and Environmental Health
M1 - 114079
ER -