Exposure to ambient air pollution is a well-established determinant of health and disease. The Lancet Commission on pollution and health concludes that air pollution is the leading environmental cause of global disease and premature death. Indeed, there is a growing body of evidence that links air pollution not only to adverse cardiorespiratory effects but also to increased risk of cerebrovascular and neuropsychiatric disorders. Despite being a relatively new area of investigation, overall, there is mounting recent evidence showing that exposure to multiple air pollutants, in particular to fine particles, may affect the central nervous system (CNS) and brain health, thereby contributing to increased risk of stroke, dementia, Parkinson's disease, cognitive dysfunction, neurodevelopmental disorders, depression and other related conditions. The underlying molecular mechanisms of susceptibility and disease remain largely elusive. However, emerging evidence suggests inflammation and oxidative stress to be crucial factors in the pathogenesis of air pollution-induced disorders, driven by the enhanced production of proinflammatory mediators and reactive oxygen species in response to exposure to various air pollutants. From a public health perspective, mitigation measures are urgent to reduce the burden of disease and premature mortality from ambient air pollution.

Ambient Air Pollution Increases the Risk of Cerebrovascular and Neuropsychiatric Disorders through Induction of Inflammation and Oxidative Stress.

Previous studies have suggested that exposure to air pollution may increase stroke risk, but the results remain inconsistent. Evidence of more recent studies is highly warranted, especially gas air pollutants. We searched PubMed, Embase, and Web of Science to identify studies till February 2020 and conducted a meta-analysis on the association between air pollution (PM2.5, particulate matter with aerodynamic diameter less than 2.5 μm; PM10, particulate matter with aerodynamic diameter less than 10 μm; NO2, nitrogen dioxide; SO2, sulfur dioxide; CO, carbon monoxide; O3, ozone) and stroke (hospital admission, incidence, and mortality). Fixed- or random-effects model was used to calculate pooled odds ratios (OR)/hazard ratio (HR) and their 95% confidence intervals (CI) for a 10 μg/m3 increase in air pollutant concentration. A total of 68 studies conducted from more than 23 million participants were included in our meta-analysis. Meta-analyses showed significant associations of all six air pollutants and stroke hospital admission (e.g., PM2.5: OR = 1.008 (95% CI 1.005, 1.011); NO2: OR = 1.023 (95% CI 1.015, 1.030), per 10 μg/m3 increases in air pollutant concentration). Exposure to PM2.5, SO2, and NO2 was associated with increased risks of stroke incidence (PM2.5: HR = 1.048 (95% CI 1.020, 1.076); SO2: HR = 1.002 (95% CI 1.000, 1.003); NO2: HR = 1.002 (95% CI 1.000, 1.003), respectively). However, no significant differences were found in associations of PM10, CO, O3, and stroke incidence. Except for CO and O3, we found that higher level of air pollution (PM2.5, PM10, SO2, and NO2) exposure was associated with higher stroke mortality (e.g., PM10: OR = 1.006 (95% CI 1.003, 1.010), SO2: OR = 1.006 (95% CI 1.005, 1.008). Exposure to air pollution was positively associated with an increased risk of stroke hospital admission (PM2.5, PM10, SO2, NO2, CO, and O3), incidence (PM2.5, SO2, and NO2), and mortality (PM2.5, PM10, SO2, and NO2). Our study would provide a more comprehensive evidence of air pollution and stroke, especially SO2 and NO2.

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Association between exposure to ambient air pollution and hospital admission, incidence, and mortality of stroke: an updated systematic review and meta-analysis of more than 23 million participants.

Background and Purpose—There have been no multicity studies on the acute effects of air pollution on stroke mortality in China. This study was undertaken to examine the associations between daily stroke mortality and outdoor air pollution (particulate matter <10 μm in aerodynamic diameter, sulfur dioxide, and nitrogen dioxide) in 8 Chinese cities. Methods—We used Poisson regression models with natural spline-smoothing functions to adjust for long-term and seasonal trends, as well as other time-varying covariates. We applied 2-stage Bayesian hierarchical statistical models to estimate city-specific and national average associations of air pollution with daily stroke mortality. Results—Air pollution was associated with daily stroke mortality in 8 Chinese cities. In the combined analysis, an increase of 10 μg/m3 of 2-day moving average concentrations of particulate matter <10 μm in aerodynamic diameter, sulfur dioxide, and nitrogen dioxide corresponded to 0.54% (95% posterior intervals, 0.28–0.81), 0.88% (95...

Acute Effect of Ambient Air Pollution on Stroke Mortality in the China Air Pollution and Health Effects Study

Air pollution is a global problem with PM2.5 being one of the major pollutants causing many diseases. The concentrations of PM2.5 are found to exceed the World Health Organization (WHO) standards especially in lower middle-income countries (LMICs) that house around 40% of the global population. Studies conducted globally in the past 5 years (2015–2019) on health effects of PM2.5 were systematically reviewed to understand the current research gaps. For this systematic search, Web of Science and PubMed were used to obtain 247 articles. Systematic review of these studies revealed that PM2.5 and other air pollutants have been found to be associated with increased mortality and morbidity due to respiratory, cardiovascular, cerebrovascular disorders and diabetes. However, most of the total studies (~ 69%) were carried out in the high-income countries (HICs) despite the fact that PM2.5 concentrations are higher in the LMICs (annual mean exposure (2011–2017) of 48.42 µg/m3) and lower in the HICs (annual mean exposure (2011–2017) of 20.02 µg/m3). Therefore, the exposure response functions for mortality estimates associated with PM2.5 and developed using the exposure data from the HICs will not have predictive value in the LMICs. Furthermore, very few studies relate chemical components and source apportionment of PM2.5 to the associated toxicity. More studies on morbidity and mortality associated with PM2.5 and its components are needed in LMICs for better estimation of the overall risks.

Health Effects Associated with PM2.5: a Systematic Review

Europe experienced excess mortality from February through June, 2020 due to the COVID-19 pandemic, with more COVID-19-associated deaths in males compared to females. However, a difference in excess mortality among females compared to among males may be a more general phenomenon, and should be investigated in none-COVID-19 situations as well. Based on death counts from Eurostat, separate excess mortalities were estimated for each of the sexes using the EuroMOMO model. Sex-differential excess mortality were expressed as differences in excess mortality incidence rates between the sexes. A general relation between sex-differential and overall excess mortality both during the COVID-19 pandemic and in preceding seasons were investigated. Data from 27 European countries were included, covering the seasons 2016/17 to 2019/20. In periods with increased excess mortality, excess was consistently highest among males. From February through May 2020 male excess mortality was 52.7 (95% PI: 56.29; 49.05) deaths per 100,000 person years higher than for females. Increased male excess mortality compared to female was also observed in the seasons 2016/17 to 2018/19. We found a linear relation between sex-differences in excess mortality and overall excess mortality, i.e., 40 additional deaths among males per 100 excess deaths per 100,000 population. This corresponds to an overall female/male mortality incidence ratio of 0.7. In situations with overall excess mortality, excess mortality increases more for males than females. We suggest that the sex-differences observed during the COVID-19 pandemic reflects a general sex-disparity in excess mortality.

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Sex-differences in COVID-19 associated excess mortality is not exceptional for the COVID-19 pandemic.

Few studies investigating associations between fine particulate air pollution and hemorrhagic stroke have considered subtypes. Additionally, less is known about the modification of such association by factors measured at the individual level. We aimed to investigate the risk of fatal intracerebral hemorrhage (ICH) incidence in case of PM2.5 (particles ≤ 2.5 μm in aerodynamic diameter) exposure. Data on incidence of fatal ICH from 1 June 2012 to 31 May 2014 were extracted from the acute stroke mortality database in Shanghai Municipal Center for Disease Control and Prevention (SCDC). We used the time-stratified case-crossover approach to assess the association between daily concentrations of PM2.5 and fatal ICH incidence in Shanghai, China. A total of 5286 fatal ICH cases occurred during our study period. The averaged concentration of PM2.5 was 77.45 μg/m3. The incidence of fatal ICH was significantly associated with PM2.5 concentration. Substantial differences were observed among subjects with diabetes compared with those without; following the increase of PM2.5 in lag2, the OR (95% CI) for subjects with diabetes was 1.26 (1.09–1.46) versus 1.05 (0.98–1.12) for those without. We did not find evidence of effect modification by hypertension and cigarette smoking. Fatal ICH incidence was associated with PM2.5 exposure. Our results also suggested that diabetes may increase the risk for ICH incidence in relation to PM2.5.

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Association between incidence of fatal intracerebral hemorrhagic stroke and fine particulate air pollution.

Age- and sex-specific excess mortality associated with influenza in Shanghai, China, 2010-2015.

The invention relates to a system and method for realizing the healthy life expectancy calculation analysis function based on health medical big data. The system includes a health medical big data subsystem used for collecting and integrating the health care data, a healthy life expectancy analysis database management subsystem which is used for establishing a database management subsystem for estimating healthy life expectancy based on the health care data collected and integrated by the health care big data subsystem and is connected with the health care big data subsystem, and a healthy life expectancy measurement analysis model subsystem which is used for measuring the healthy life expectancy and is connected with the healthy life expectancy analysis database management subsystem. Thesystem is advantaged in that unified and standardized automatic measurement and intelligent analysis are provided for Shanghai's healthy life expectancy measurement.

System and method for realizing healthy life expectancy calculation analysis function based on health medical big data

The invention relates to a health and medical service big data-based health life expectancy application support information system and method. The system comprises an infrastructure layer subsystem, adata resource layer subsystem, and an application layer subsystem; the infrastructure layer subsystem is used for installing hardware and software equipment required for the system; the data resourcelayer subsystem is connected with the infrastructure layer subsystem and is used for collecting and storing data and constructing a healthy life expectancy main body data warehouse; and the application layer subsystem is connected with the infrastructure layer subsystem and the data resource layer subsystem and is used for calculating, analyzing and displaying the data. With the above structure adopted, a unified and standardized automatic measurement and intelligent analysis system can be provided for the measurement of healthy life expectancies in Shanghai, so that medical and health information resources related to healthy life expectancies can be effectively grasped and managed, and a foundation can be laid for the thorough utilization of medical and health information resources.

Bo Fang

Papers

Association between incidence of fatal intracerebral hemorrhagic stroke and fine particulate air pollution.

Age- and sex-specific excess mortality associated with influenza in Shanghai, China, 2010-2015.

System and method for realizing healthy life expectancy calculation analysis function based on health medical big data

Health and medical service big data-based health life expectancy application support information system and method