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

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 mu m 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 mu g/m(3) of 2-day moving average concentrations of particulate matter <10 mu m in aerodynamic diameter, sulfur dioxide, and nitrogen dioxide corresponded to 0.54% (95% posterior intervals, 0.28-0.81), 0.88% (95% posterior intervals, 0.54-1.22), and 1.47% (95% posterior intervals, 0.88-2.06) increase of stroke mortality, respectively. The concentration-response curves indicated linear nonthreshold associations between air pollution and risk of stroke mortality. Conclusions-To our knowledge, this is the first multicity study in China, or even in other developing countries, to report the acute effect of air pollution on stroke mortality. Our results contribute to very limited data on the effect of air pollution on stroke for high-exposure settings typical in developing countries. (Stroke. 2013;44:954-960.)