Environmental Air Pollution and Acute Cerebrovascular Complications: An Ecologic Study in Tehran, Iran

Abstract

Background: In this study, we aimed to assess the association between air pollution and cerebrovascular complications in Tehran, one of the most air-polluted cities in the world, among different subgroups of patients with stroke in 2004.

Methods: In this ecologic study, we calculated the daily average levels of different air pollutants including CO, NOX, SO2, O3, and PM10 and also humidity and temperature on the day of stroke and 48 hours prior to stroke in 1 491 patients admitted with the diagnosis of stroke in eight referral hospitals in different areas of Tehran. Then, we evaluated the association between the rate of stroke admissions and the level of the selected pollutants, humidity, and temperature on the day of stroke and 48 hours prior to stroke among different subgroups of patients.

Results: There was no significant association between the sameday level of the pollutants and the rate of stroke admissions, but an association was seen for their level 48 hours before stroke. These associations differed among different subgroups of age, sex, history of underlying diseases, and type of stroke. Same-day temperature had a reverse association in patients with hemorrhagic stroke and in patients without a history of heart disease or previous stroke. A direct significant association was seen for humidity level 48 hours before stroke in patients with a history of heart disease.

Conclusions: It is inferred that air pollution has a direct association with the incidence of stroke and these association differs among different subgroups of patients. The results of this study are not time-dependant and can be generalized to different times and regions. Moreover, these results may be useful for environmental health policy makers.

Key words: Air pollution, cerebrovascular complications, CO, humidity, NOx, O3, PM , SO2, temperature, Tehran