Long-term ambient hydrocarbons exposure and incidence of ischemic stroke

Autoři: Han-Wei Zhang aff001;  Victor C. Kok aff004;  Shu-Chun Chuang aff006;  Chun-Hung Tseng aff007;  Chin-Teng Lin aff008;  Tsai-Chung Li aff011;  Fung-Chang Sung aff013;  Chi Pang Wen aff014;  Chao A. Hsiung aff014;  Chung Y. Hsu aff015
Působiště autorů: Ph.D. Program for Aging, China Medical University, Taichung, Taiwan aff001;  Department of Electrical and Computer Engineering, Institute of Electrical Control Engineering, National Chiao Tung University, Hsinchu, Taiwan aff002;  Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan aff003;  Disease Informatics Research Group, Asia University Taiwan, Taichung, Taiwan aff004;  Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan aff005;  Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan aff006;  Department of Neurology, China Medical University Hospital, and School of Medicine, China Medical University, Taichung, Taiwan aff007;  Brain Research Center, National Chiao Tung University, Hsinchu, Taiwan aff008;  Department of Electrical and Computer Engineering, Institute of Electrical Control Engineering, National Chiao Tung University, Hsinchu, Taiwan aff009;  Centre for Artificial Intelligence School of Software, Faculty of Engineering & IT, University of Technology Sydney Broadway 2007, Sydney, New South Wales, Australia aff010;  Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan aff011;  Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan aff012;  Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan aff013;  Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan aff014;  Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan aff015
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0225363


Exposure to air pollutants is known to have adverse effects on human health; however, little is known about the association between hydrocarbons in air and an ischemic stroke (IS) event. We investigated whether long-term exposure to airborne hydrocarbons, including volatile organic compounds, increased IS risk. This retrospective cohort study included 283,666 people aged 40 years or older in Taiwan. Cox proportional hazards regression analysis was used to fit single- and multiple-pollutant models for two targeted pollutants, total hydrocarbons (THC) and nonmethane hydrocarbons (NMHC), and estimated the risk of IS. Before controlling for multiple pollutants, hazard ratios (HRs) of IS with 95% confidence intervals for the overall population were 2.69 (2.64–2.74) at 0.16-ppm increase in THC and 1.62 (1.59–1.66) at 0.11-ppm increase in NMHC. For the multiple-pollutant models controlling for PM2.5, the adjusted HR was 3.64 (3.56–3.72) for THC and 2.21 (2.16–2.26) for NMHC. Our findings suggest that long-term exposure to THC and NMHC may be a risk factor for IS development.

Klíčová slova:

Air pollution – Hydrocarbons – Inflammatory diseases – Insurance – Ischemic stroke – Particulates – Pollutants – stroke


1. Kraft S. Cerebrovascular disease: Causes, symptoms, and treatment. Medical News Today. 2017. [Cited 2018 August 13]. Available from: https://www.medicalnewstoday.com/articles/184601.php.

2. Mayo Foundation for Medical Education and Research (MFMER). Stroke: symptoms and causes. 2018. [Cited 2018 August 13]. Available from: https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113

3. Hsieh FI, Chiou HY. Stroke: morbidity, risk factors, and care in Taiwan. J Stroke. 2014;16: 59–64. doi: 10.5853/jos.2014.16.2.59 24949310

4. Lelieveld J, Evans JS, Fnais M, Giannadaki D, Pozzer A. The contribution of outdoor air pollution sources to premature mortality on a global scale. Nature. 2015;525: 367. doi: 10.1038/nature15371 26381985

5. Chien TY, Ting HW, Chan CL, Yang NP, Pan RH, Lai KR, et al. Does the short-term effect of air pollution influence the incidence of spontaneous intracerebral hemorrhage in different patient groups? Big data analysis in Taiwan. Int J Environ Res Public Health. 2017;14.

6. Guo S, Yang F, Tan J, Duan J. Nonmethane Hydrocarbons In Ambient Air Of Hazy And Normal Days in Foshan, South China. Environ Eng Sci. 2012;29: 262–269. doi: 10.1089/ees.2010.0421 22493559

7. Mo Z, Shao M, Wang W, Liu Y, Wang M, Lu S. Characterization of non-methane hydrocarbons and their sources in an industrialized coastal city, Yangtze River Delta, China. Sci Total Environ. 2017;593–594: 641–653. doi: 10.1016/j.scitotenv.2017.03.123 28363178

8. Wang M, Shao M, Chen W, Lu S, Liu Y, Yuan B, et al. Trends of non-methane hydrocarbons (nmhc) emissions in Beijing during 2002–2013. Atmos Chem Phys. 2015;15: 1489–1502.

9. Taiwan Environmental Protection Administration Executive Yuan; 2000. [Cited 2018 Aug 13]. [Internet]. Available from: https://www.epa.gov.tw/mp.asp?mp=epaen

10. Jung CR, Lin YT, Hwang BF. Ozone, particulate matter, and newly diagnosed Alzheimer's disease: a population-based cohort study in Taiwan. J Alzheimers Dis. 2015;44: 573–584. doi: 10.3233/JAD-140855 25310992

11. Barletta B, Meinardi S, Rowland FS, Chan CY, Wang X, Zou S, et al. Volatile organic compounds in 43 Chinese cities. Atmospheric Environ. 2005;39: 5979–5990.

12. Ogawa H, Li T. Volatile organic compounds in exhaust gas from diesel engines under various operating conditions. Intl J Engine Res. 2011;12: 30–40.

13. Zhang HW, Lin CW, Kok VC, Tseng CH, Lin YP, Li TC, et al. Incidence of retinal vein occlusion with long-term exposure to ambient air pollution. PLoS One. 2019;14: e0222895. doi: 10.1371/journal.pone.0222895 31550294

14. National Health Insurance Research Database (NHIRD). Introduction to the National Health Insurance Research Database. [Cited 2018 Aug 18]. [Internet]. Available at: http://nhird.nhri.org.tw/en/index.html

15. Sherman RE, Anderson SA, Dal Pan GJ, Gray GW, Gross T, Hunter NL, et al. Real-world evidence—what is it and what can it tell us? N Engl J Med. 2016;375: 2293–2297. doi: 10.1056/NEJMsb1609216 27959688

16. Framework of Taiwan’s Sustainable Energy Policy, Bureau of Energy Ministry of Economic Affairs (R.O.C.) Taiwan. [Cited 2018 May 9]. [Internet]. Available from: https://www.moeaboe.gov.tw/ECW/english/content/Content.aspx?menu_id=1524

17. Environment Resource Dataset, Environmental Protection Administration Executive Yuan (R.O.C.) Taiwan. [Cited 2018 Aug 13]. [Internet]. Available from: https://erdb.epa.gov.tw/ENG/

18. Taiwan Air Quality Monitoring Network in Taiwan Environmental Protection Administration Executive Yuan (R.O.C.) Taiwan. [Cited 2018 Aug 13]. [Internet]. Available from http://taqm.epa.gov.tw/taqm/en/PsiMap.aspx

19. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45: 613–619. doi: 10.1016/0895-4356(92)90133-8 1607900

20. Zhang R, Liu G, Jiang Y, Li G, Pan Y, Wang Y, et al. Acute effects of particulate air pollution on ischemic stroke and hemorrhagic stroke mortality. Front Neurol. 2018;9: 827. doi: 10.3389/fneur.2018.00827 30333790

21. Chen R, Wang C, Meng X, Chen H, Thach TQ, Wong CM, et al. Both low and high temperature may increase the risk of stroke mortality. Neurology. 2013;81: 1064–1070. doi: 10.1212/WNL.0b013e3182a4a43c 23946311

22. Lin YK, Chang CK, Wang YC, Ho TJ. Acute and prolonged adverse effects of temperature on mortality from cardiovascular diseases. PLoS One. 2013;8: e82678. doi: 10.1371/journal.pone.0082678 24349335

23. Mohammad TM, Ali A, Alireza M, Abbas K, Kazem N, Mir SY. Ambient temperature and cardiovascular mortality: a systematic review and meta-analysis. PeerJ. 2017;5: e3574. doi: 10.7717/peerj.3574 28791197

24. Chen R, Zhang Y, Yang C, Zhao Z, Xu X, Kan H. Acute effect of ambient air pollution on stroke mortality in the China air pollution and health effects study. Stroke. 2013;44: 954–960. doi: 10.1161/STROKEAHA.111.673442 23391765

25. Tong L, Li K, Zhou Q. Season, sex and age as modifiers in the association of psychosis morbidity with air pollutants: A rising problem in a Chinese metropolis. Sci Total Environ. 2016;541: 928–933. doi: 10.1016/j.scitotenv.2015.09.066 26457738

26. Wellenius GA, Burger MR, Coull BA, Schwartz J, Suh HH, Koutrakis P, et al. Ambient air pollution and the risk of acute ischemic stroke. Arch Intern Med. 2012;172: 229–234. doi: 10.1001/archinternmed.2011.732 22332153

27. Miller KA, Siscovick DS, Sheppard L, Shepherd K, Sullivan JH, Anderson GL, et al. Long-term exposure to air pollution and incidence of cardiovascular events in women. N Engl J Med. 2007;356: 447–458. doi: 10.1056/NEJMoa054409 17267905

28. Qiu H, Sun S, Tsang H, Wong CM, Lee RS, Schooling CM, et al. Fine particulate matter exposure and incidence of stroke: A cohort study in Hong Kong. Neurology. 2017;88: 1709–1717. doi: 10.1212/WNL.0000000000003903 28363975

29. Andersen ZJ, Olsen TS, Andersen KK, Loft S, Ketzel M, Raaschou-Nielsen O. Association between short-term exposure to ultrafine particles and hospital admissions for stroke in Copenhagen, Denmark. Eur Heart J. 2010;31: 2034–2040. doi: 10.1093/eurheartj/ehq188 20538735

30. Montresor-Lopez JA, Yanosky JD, Mittleman MA, Sapkota A, He X, Hibbert JD, et al. Short-term exposure to ambient ozone and stroke hospital admission: A case-crossover analysis. J Expo Sci Environ Epidemiol. 2016;26: 162–166. doi: 10.1038/jes.2015.48 26329139

31. Yu Y, Dong H, Yao S, Ji M, Yao X, Zhang Z. Protective effects of ambient ozone on incidence and outcomes of ischemic stroke in Changzhou, China: A time-series study. Int J Environ Res Public Health. 2017;14: 1610.

32. Clavo B, Suarez G, Aguilar Y, Gutierrez D, Ponce P, Cubero A, et al. Brain ischemia and hypometabolism treated by ozone therapy. Forsch Komplementmed. 2011;18: 283–287. doi: 10.1159/000333795 22105041

33. Henrotin JB, Zeller M, Lorgis L, Cottin Y, Giroud M, Béjot Y. Evidence of the role of short-term exposure to ozone on ischaemic cerebral and cardiac events: The Dijon Vascular Project (DIVA). Heart. 2010;96: 1990–1996. doi: 10.1136/hrt.2010.200337 20702540

34. Männistö T, Mendola P, Laughon Grantz K, Leishear K, Sundaram R, Sherman S, et al. Acute and recent air pollution exposure and cardiovascular events at labour and delivery. Heart. 2015;101: 1491–1498. doi: 10.1136/heartjnl-2014-307366 26105036

35. Lisabeth LD, Escobar JD, Dvonch JT, Sánchez BN, Majersik JJ, Brown DL, et al. Ambient air pollution and risk for ischemic stroke and transient ischemic attack. Ann Neurol. 2008;64: 53–59. doi: 10.1002/ana.21403 18508356

36. Jin R, Liu L, Zhang S, Nanda A, Li G. Role of inflammation and its mediators in acute ischemic stroke. J Cardiovasc Transl Res. 2013;6: 834–851. doi: 10.1007/s12265-013-9508-6 24006091

37. Hou J, Yin W, Li P, Hu C, Zhang Y, Wang X, et al. Seasonal modification of the associations of exposure to polycyclic aromatic hydrocarbons or phthalates of cellular aging. Ecotoxicol Environ Saf. 2019;182: 109384. doi: 10.1016/j.ecoenv.2019.109384 31272023

38. Alhamdow A, Lindh C, Albin M, Gustavsson P, Tinnerberg H, Broberg K. Cardiovascular disease-related serum proteins in workers occupationally exposed to polycyclic aromatic hydrocarbons. Toxicol Sci. 2019 [Epub ahead of print].

39. Ferguson KK, McElrath TF, Pace GG, Weller D, Zeng L, Pennathur S, et al. Urinary polycyclic aromatic hydrocarbon metabolite associations with biomarkers of inflammation, angiogenesis, and oxidative stress in pregnant women. Environ Sci Technol. 2017;51: 4652–4660. doi: 10.1021/acs.est.7b01252 28306249

40. Yorifuji T, Kashima S, Tsuda T, Ishikawa-Takata K, Ohta T, Tsuruta KI, et al. Long-term exposure to traffic-related air pollution and the risk of death from hemorrhagic stroke and lung cancer in Shizuoka, Japan. Sci Total Environ. 2013;443: 397–402. doi: 10.1016/j.scitotenv.2012.10.088 23208275

41. Hong YC, Lee JT, Kim H, Ha EH, Schwartz J, Christiani DC. Christiani. Effects of air pollutants on acute stroke mortality. Environ Health Perspect. 2002;110: 187–191. doi: 10.1289/ehp.02110187 11836148

42. Chung JW, Bang OY, Ahn K, Park SS, Park TH, Kim JG, et al. Air pollution is associated with ischemic stroke via cardiogenic embolism. Stroke. 2017;48: 17–23. doi: 10.1161/STROKEAHA.116.015428 27899751

43. Vivanco-Hidalgo RM, Wellenius G, Basagaña X, Cirach M, González AG, de Ceballos P, et al. Short-term exposure to traffic-related air pollution and ischemic stroke onset in Barcelona, Spain. Environ Res. 2018;162: 160–165. doi: 10.1016/j.envres.2017.12.024 29310044

44. Béjot Y, Reis J, Giroud M, Feigin V. A review of epidemiological research on stroke and dementia and exposure to air pollution. Int J Stroke. 2018:1747493018772800.

45. Lee JT, Chung WT, Lin JD, Peng GS, Muo CH, Lin CC, et al. Increased risk of stroke after septicaemia: a population-based longitudinal study in Taiwan. PLoS One. 2014;9: e89386. doi: 10.1371/journal.pone.0089386 24586739

46. Yang WY, Melgarejo JD, Thijs L, Zhang ZY, Boggia J, Wei FF, et al. Association of office and ambulatory blood pressure with mortality and cardiovascular outcomes. JAMA. 2019;322: 409–420. doi: 10.1001/jama.2019.9811 31386134

47. Zhu Y, Lu JM, Yu ZB, Li D, Wu MY, Shen P, et al. Intra-individual variability of total cholesterol is associated with cardiovascular disease mortality: a cohort study. Nutr Metab Cardiovasc Dis. 2019;S0939-4753: 30272–30278.

48. Deng Y, Chen Z, Hu L, Xu Z, Hu J, Ma J, et al. Decreased egfr is associated with ischemic stroke in patients with dilated cardiomyopathy. Clin Appl Thromb Hemost. 2019;25: 1076029619866909. doi: 10.1177/1076029619866909 31373212

49. Hirel C, Berton L, Preda C, Richard O, Lambert Y, Pico F. Air pollution and humidity as triggering factors for stroke. Results of a 12-year analysis in the West Paris area. Rev Neurol (Paris). 2019;S0035–3787: 30462-X.

Článek vyšel v časopise


2019 Číslo 12
Nejčtenější tento týden