Long-term exposure to traffic-related air pollution and stroke: A systematic review and meta-analysis

P Haddad; M Kutlar Joss; J Weuve; D Vienneau; R Atkinson; J Brook; H Chang; F Forastiere; G Hoek; R Kappeler; F Lurmann; S Sagiv; E Samoli; A Smargiassi; A Szpiro; A P Patton; H Boogaard; B Hoffmann

doi:10.1016/j.ijheh.2022.114079

Long-term exposure to traffic-related air pollution and stroke: A systematic review and meta-analysis

Int J Hyg Environ Health. 2023 Jan:247:114079. doi: 10.1016/j.ijheh.2022.114079. Epub 2022 Nov 26.

Authors

P Haddad¹, M Kutlar Joss², J Weuve³, D Vienneau⁴, R Atkinson⁵, J Brook⁶, H Chang⁷, F Forastiere⁸, G Hoek⁹, R Kappeler⁴, F Lurmann¹⁰, S Sagiv¹¹, E Samoli¹², A Smargiassi¹³, A Szpiro¹⁴, A P Patton¹⁵, H Boogaard¹⁵, B Hoffmann¹⁶

Affiliations

¹ Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany. Electronic address: pascale.haddad@med.uni-duesseldorf.de.
² Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany; Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
³ Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA.
⁴ Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
⁵ Epidemiology, Population Health Research Institute and MRC-PHE Centre for Environment and Health, St. George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
⁶ Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON M5T 3M7, Canada.
⁷ Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
⁸ School of Public Health, Faculty of Medicine, Imperial College, Level 2, Faculty Building South Kensington Campus, London, SW7 2AZ, UK.
⁹ Institute for Risk Assessment Sciences, Environmental Epidemiology, Utrecht University, Yalelaan 1, 3584 CL, Utrecht, the Netherlands.
¹⁰ Sonoma Technology, Inc, 1450 N McDowell Blvd #200, Petaluma, CA, 94954, USA.
¹¹ Center for Environmental Research and Children's Health, Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way, Berkeley, CA, 94704, USA.
¹² Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athina, 115 27, Greece.
¹³ Department of Environmental and Occupational Health, School of Public Health, University of Montreal, 7101 Park Ave, Montreal, Quebec, H3N 1X9, Canada.
¹⁴ Department of Biostatistics, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351617, Seattle, WA, 98195-1617, USA.
¹⁵ Health Effects Institute, 75 Federal suite UNIT 1400, Boston, MA, 02110, USA.
¹⁶ Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.

PMID: 36446272
DOI: 10.1016/j.ijheh.2022.114079

Abstract

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 PM_2.5, 0.98 (0.92; 1.05) per 10 μg/m³ NO₂ and 0.99 (0.94; 1.04) per 20 μg/m³ NO_x 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.

Keywords: Confidence assessment; Long-term exposure; Stroke; Systematic review; Traffic related air pollution; meta-Analysis.

Publication types

Meta-Analysis
Systematic Review
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, Non-U.S. Gov't

MeSH terms

Air Pollution* / adverse effects
Cardiovascular Diseases*
Databases, Factual
Humans
Stroke* / epidemiology
Traffic-Related Pollution*