{
  "abstract": "Background While associations between exposure to air pollution and the prevalence of acute ischaemic stroke (AIS) have been investigated, only a few studies have reported the relationship between air pollution and stroke severity. This study aimed to assess the impact of air pollution on AIS severity based on hourly monitoring data and a stroke-specific registry from 2017 to 2021 in Shanghai.Methods Hourly concentrations of particulate matter (PM 2.5 and PM10), O3, SO2, CO and NO2 were monitored from 2017 to 2021. A conditional logistic regression model and a Quasi-Poisson model, both coupled with a distributed lag non-linear model and a time-stratified case-crossover design, were used to evaluate a cohort of 106 623 AIS events documented within the Shanghai Stroke Service registry correspondingly. Counterfactual analyses were applied to reveal the potential reducible fractions (PRFs) of air pollution on baseline National Institute of Health Stroke Scale (NIHSS).Results Conditional logistic regression model suggested that PM 2.5 (excessive risk (ER) 2.31% (95% CI 1.32% to 3.32%), p<0.001), PM10 (ER 2.60% (95% CI 1.97% to 3.23%), p<0.001) and SO2 (ER 4.53% (95% CI 3.37% to 5.70%), p<0.001) have the most significant effects on increased baseline NIHSS score, which remained robust in the two-pollutant model. Counterfactual analysis based on a conditional logistic regression model revealed PRFs (PM2.5 1.77% (95% CI 0.86% to 2.68%), p<0.001; PM10 1.01% (95% CI 0.28% to 1.73%), p<0.001 and SO2 4.04% (95% CI 3.04% to 5.03%), p<0.001). Quasi-Poisson analysis showed similar results.Conclusions Short-term exposure to ambient air pollution, particularly PM 2.5, PM10 and SO2, was shown to increase AIS severity. This finding underscored the need for targeted emission controls and stroke prevention strategies.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging in Medicine, Huashan Hospital, Fudan University, Shanghai, China"
      ],
      "name": "Nan Cao"
    },
    {
      "affiliations": [
        "Department of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging in Medicine, Huashan Hospital, Fudan University, Shanghai, China"
      ],
      "name": "Lan Hong"
    },
    {
      "affiliations": [
        "Department of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging in Medicine, Huashan Hospital, Fudan University, Shanghai, China"
      ],
      "name": "Kun Fang"
    },
    {
      "affiliations": [
        "School of Environmental and Chemical Engineering, Shanghai University, Shanghai, China"
      ],
      "name": "Jialiang Feng"
    },
    {
      "affiliations": [
        "Shanghai Environmental Monitoring Center, Shanghai, China"
      ],
      "name": "Ming Hu"
    },
    {
      "affiliations": [
        "Shanghai Environmental Monitoring Center, Shanghai, China"
      ],
      "name": "Cheng Huang"
    },
    {
      "affiliations": [
        "Shanghai Academy of Environmental Sciences, Shanghai, China"
      ],
      "name": "Qingyan Fu"
    },
    {
      "affiliations": [
        "Department of NCD Surveillance, Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China"
      ],
      "name": "Yang Zheng"
    },
    {
      "affiliations": [
        "Department of NCD Surveillance, Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China"
      ],
      "name": "Qundi Yang"
    },
    {
      "affiliations": [
        "Department of NCD Surveillance, Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China"
      ],
      "name": "Yuzhuo Wang"
    },
    {
      "affiliations": [
        "School of Environmental and Chemical Engineering, Shanghai University, Shanghai, China"
      ],
      "name": "Yuankai Xie"
    },
    {
      "affiliations": [
        "School of Environmental and Chemical Engineering, Shanghai University, Shanghai, China"
      ],
      "name": "Shunyao Wang"
    },
    {
      "affiliations": [
        "Department of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging in Medicine, Huashan Hospital, Fudan University, Shanghai, China"
      ],
      "name": "Xin Cheng"
    },
    {
      "affiliations": [
        "Department of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging in Medicine, Huashan Hospital, Fudan University, Shanghai, China"
      ],
      "name": "Qiang Dong"
    }
  ],
  "title": "Short-term exposure to outdoor air pollution significantly associated with severity of acute ischaemic stroke: evidence from the 4S registry",
  "uid": "ecc63a99-523d-5c15-be0c-6fdaedf3f1e3"
}