Association between short-term air pollution exposure and traumatic intracranial hemorrhage: pilot evidence from Taiwan

Kuo-Hsing Liao; Ta-Chien Chan; Chia-Chieh Wu; Wen-Cheng Huang; Chin-Wang Hsu; Hsiao-Chi Chuang; Bayu Satria Wiratama; Wen-Ta Chiu; Carlos Lam

doi:10.3389/fneur.2023.1087767

Association between short-term air pollution exposure and traumatic intracranial hemorrhage: pilot evidence from Taiwan

Front Neurol. 2023 May 10:14:1087767. doi: 10.3389/fneur.2023.1087767. eCollection 2023.

Authors

Kuo-Hsing Liao^{1

2

3

4}, Ta-Chien Chan^{5

6}, Chia-Chieh Wu^{7

8}, Wen-Cheng Huang^{8

9

10

11}, Chin-Wang Hsu^{8

9}, Hsiao-Chi Chuang^{12

13

14}, Bayu Satria Wiratama¹⁵, Wen-Ta Chiu^{16

17}, Carlos Lam^{7

8}

Affiliations

¹ Department of Neurosurgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
² Division of Critical Medicine, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
³ Department of Neurotraumatology and Intensive Care, Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.
⁴ Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁵ Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan.
⁶ Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁷ Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
⁸ Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁹ Emergency Department, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
¹⁰ Center for Education in Medical Simulation, Taipei Medical University, Taipei, Taiwan.
¹¹ Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
¹² School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.
¹³ Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
¹⁴ Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
¹⁵ Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
¹⁶ Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan.
¹⁷ AHMC Health System, Alhambra, CA, United States.

Abstract

Introduction: The detrimental effects of air pollution on the brain are well established. However, few studies have examined the effect of air pollution on traumatic brain injury (TBI). This pilot study evaluated the association between short-term air pollution exposure and traumatic intracranial hemorrhage (TIH).

Methods: Hospital data of patients with TBI following road traffic accidents were retrospectively collected from the electronic medical records at five trauma centers in Taiwan between 1 January and 31 December 2017. TIH was employed as an outcome measure. All road accident locations were geocoded, and air quality data were collected from the nearest monitoring stations. Air pollutants were entered into five multivariable models. A sensitivity analysis was performed on patients who are vulnerable to suffering TBI after road accidents, including motorcyclists, bicyclists, and pedestrians.

Results: Among 730 patients with TBI, 327 had TIH. The ages of ≥65 [odds ratio (OR), 3.24; 95% confidence interval (CI), 1.85-5.70], 45-64 (OR, 2.61; 95% CI, 1.64-4.15), and 25-44 (OR, 1.79; 95% CI, 1.13-2.84) years were identified as significant risk factors in the multivariable analysis. In the best-fit multivariable model, exposure to higher concentrations of particulate matter ≤ 2.5 μm in aerodynamic diameter (PM_2.5) was associated with an elevated TIH risk (OR, 1.50; 95% CI, 1.17-1.94). The concentration of nitrogen oxides (NO_X) did not increase the risk of TIH (OR, 0.45; 95% CI, 0.32-0.61). After categorizing the air pollution concentration according to quartile, the trend tests in the multivariate model showed that the concentrations of PM_2.5 and NO_X were significant (p = 0.017 and p < 0.001, respectively). There was a negative borderline significant association between temperature and TIH risk (OR, 0.75; 95% CI, 0.56-1.00, p = 0.05). Notably, the single-vehicle crash was a significant risk factor (OR, 2.11; 95% CI, 1.30-3.42) for TIH.

Discussion: High PM_2.5 concentrations and low temperatures are risk factors for TIH in patients with TBI. High NO_X concentrations are associated with a lower TIH risk.

Keywords: air pollution; fine particulate matter; geographic information system; road traffic accident; short-term exposure; traumatic intracranial hemorrhage.

Grants and funding

This research was jointly supported by grants from the Institute of Transportation, Ministry of Transportation and Communications, Executive Yuan, Taiwan (Grant Numbers: MOTC-IOT-104-SEB009 and MOTC-IOT-105-SEB010), Wan Fang Hospital, Taipei Medical University (Grant Number: 109-wf-swf-07), National Taipei University of Technology and Wan Fang Hospital, Taipei Medical University Joint Research Program (Grant Number: 112-wf-ntut-05), and the Injury Prevention and Disaster Medicine Research Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.