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Original research
Short-term associations between ambient air pollution and stroke hospitalisations: time-series study in Shenzhen, China
  1. Yanfang Guo1,
  2. Xiufang Xie2,
  3. Lin Lei3,
  4. Haibin Zhou3,
  5. Shizhou Deng2,
  6. Ying Xu1,
  7. Zheng Liu1,
  8. Junzhe Bao2,4,5,6,
  9. Ji Peng3,
  10. Cunrui Huang2,4,5,6
  1. 1Department of Non-Communicable Disease Control and Prevention, Bao'an District Hospital for Chronic Diseases Prevention and Cure, Shenzhen, China
  2. 2School of Public Health, Sun Yat-sen University, Guangzhou, China
  3. 3Department of Non-Communicable Disease Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
  4. 4Shanghai Typhoon Institute, China Meteorological Administration, Shanghai, China
  5. 5Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China
  6. 6School of Public Health, Zhengzhou University, Zhengzhou, China
  1. Correspondence to Dr. Junzhe Bao; baojzh3{at}; Dr. Ji Peng; pengji126{at}


Objective To investigate the association between ambient air pollution and stroke morbidity in different subgroups and seasons.

Methods We performed a time-series analysis based on generalised linear models to study the short-term exposure–response relationships between air pollution and stroke hospitalisations, and conducted subgroup analyses to identify possible sensitive populations.

Results For every 10 µg/m3 increase in the concentration of air pollutants, across lag 0–3 days, the relative risk of stroke hospitalisation was 1.029 (95% CI 1.013 to 1.045) for PM2.5, 1.054 (95% CI 1.031 to 1.077) for NO2 and 1.012 (95% CI 1.002 to 1.022) for O3. Subgroup analyses showed that statistically significant associations were found in both men and women, middle-aged and older populations, and both cerebral infarction and intracerebral haemorrhage. The seasonal analyses showed that statistically significant associations were found only in the winter.

Conclusions Our study indicates that short-term exposure to PM2.5, NO2 and O3 may induce stroke morbidity, and the government should take actions to mitigate air pollution and protect sensitive populations.

  • epidemiology
  • public health
  • stroke medicine

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  • YG and XX contributed equally.

  • Contributors The study was conceived and designed by JB, JP and YG; XX and YG conducted statistical analysis and drafted the manuscript; LL, HZ, and SD contributed to data collection and processing; YX and ZL helped in study management and the interpretation of the results; JB, JP and CH reviewed the manuscript for important intellectual content. All authors read and approved the final version.

  • Funding This study was supported by grants from National Key R&D Program of China (2018YFA0606200), Shenzhen Science and Technology Project (grant number JCYJ20170303104937484), Sanming Project of Medicine in Shenzhen (grant number SZSM201911015) and China Postdoctoral Science Foundation (grant number 2017M612827).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The institutional review board at the School of Public Health, Sun Yat-sen University, approved the study protocol (number 2019-029) with a waiver of informed consent. Data were analysed at the aggregate level. All patients were anonymous, and no patient privacy were revealed.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No additional data are available.

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