{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T21:58:29Z","timestamp":1788991109507,"version":"build-2803163510"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Long-term exposure to air pollutants is associated with increased stroke incidence, morbidity, and mortality; however, research on the association of pollutant exposure with poststroke hospital readmissions is lacking.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>\n              We assessed associations between average annual carbon monoxide (CO), nitrogen dioxide (NO\n              <jats:sub>2<\/jats:sub>\n              ), ozone (O\n              <jats:sub>3<\/jats:sub>\n              ), particulate matter 2.5, and sulfur dioxide (SO\n              <jats:sub>2<\/jats:sub>\n              ) exposure and 30-day all-cause hospital readmission in US fee-for-service Medicare beneficiaries age \u226565 years hospitalized for ischemic stroke in 2014 to 2015. We fit Cox models to assess 30-day readmissions as a function of these pollutants, adjusted for patient and hospital characteristics and ambient temperature. Analyses were then stratified by treating hospital performance on the Centers for Medicare and Medicaid Services risk-standardized 30-day poststroke all-cause readmission measure to determine if the results were independent of performance: low (Centers for Medicare and Medicaid Services rate for hospital &lt;25th percentile of national rate), high (&gt;75th percentile), and intermediate (all others).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Of 448 148 patients with stroke, 12.5% were readmitted within 30 days. Except for tropospheric NO\n              <jats:sub>2<\/jats:sub>\n              (no national standard), average 2-year CO, O\n              <jats:sub>3<\/jats:sub>\n              , particulate matter 2.5, and SO\n              <jats:sub>2<\/jats:sub>\n              values were below national limits. Each one SD increase in average annual CO, NO\n              <jats:sub>2<\/jats:sub>\n              , particulate matter 2.5, and SO\n              <jats:sub>2<\/jats:sub>\n              exposure was associated with an adjusted 1.1% (95% CI, 0.4\u20131.9%), 3.6% (95% CI, 2.9%\u20134.4%), 1.2% (95% CI, 0.2%\u20132.3%), and 2.0% (95% CI, 1.1%\u20133.0%) increased risk of 30-day readmission, respectively, and O\n              <jats:sub>3<\/jats:sub>\n              with a 0.7% (95% CI, 0.0%\u20131.5%) decrease. Associations between long-term air pollutant exposure and increased readmissions persisted across hospital performance categories.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Long-term air pollutant exposure below national limits was associated with increased 30-day readmissions after stroke, regardless of hospital performance category. Whether air quality improvements lead to reductions in poststroke readmissions requires further research.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.122.042265","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T16:22:19Z","timestamp":1675354939000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Associations Between Long-Term Air Pollutant Exposure and 30-Day All-Cause Hospital Readmissions in US Patients With Stroke"],"prefix":"10.1161","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1735-6903","authenticated-orcid":true,"given":"Phoebe M.","family":"Tran","sequence":"first","affiliation":[{"name":"Department of Public Health, University of Tennessee, Knoxville (P.M.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua L.","family":"Warren","sequence":"additional","affiliation":[{"name":"Departments of Biostatistics (J.L.W.), Yale School of Public Health, New Haven, CT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9675-8913","authenticated-orcid":true,"given":"Erica C.","family":"Leifheit","sequence":"additional","affiliation":[{"name":"Chronic Disease Epidemiology (E.C.L., J.H.L.), Yale School of Public Health, New Haven, CT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7747-128X","authenticated-orcid":true,"given":"Larry B.","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Kentucky College of Medicine, Lexington (L.B.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5362-3875","authenticated-orcid":true,"given":"Judith H.","family":"Lichtman","sequence":"additional","affiliation":[{"name":"Chronic Disease Epidemiology (E.C.L., J.H.L.), Yale School of Public Health, New Haven, CT."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.050252"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.11760"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyz114"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.003165"},{"key":"e_1_3_3_6_2","unstructured":"Centers for Medicare & Medicaid Services. Fiscal Year (FY) 2022 Hospital Readmissions Reduction Program (HRRP). Accessed May 7 2022. https:\/\/qualitynet.cms.gov\/files\/6151e416edc606002200492d?filename=FY_2022_HRRP_FAQs_v2.pdf"},{"key":"e_1_3_3_7_2","unstructured":"Environmental Protection Agency. Air Data: Air Quality Data Collected at Outdoor Monitors Across the US. Accessed February 23 2022. https:\/\/www.epa.gov\/outdoor-air-quality-data"},{"key":"e_1_3_3_8_2","unstructured":"Enviromental Protection Agency. Technical Information about Fused Air Quality Surface Using Downscaling Tool: Metadata Description. Accessed February 23 2022. https:\/\/www.epa.gov\/sites\/production\/files\/2016-07\/documents\/data_fusion_meta_file_july_2016.pdf"},{"key":"e_1_3_3_9_2","unstructured":"National Aeronautics and Space Administration. OMI\/Aura NO2 Cloud-Screened Total and Tropospheric Column L3 Global Gridded 0.25 degree x 0.25 degree V3 (OMNO2d). Accessed February 23 2022. https:\/\/disc.gsfc.nasa.gov\/datasets\/OMNO2d_003\/summary"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2018.05.181"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.02.037"},{"key":"e_1_3_3_12_2","unstructured":"Northwest Alliance for Computational Science & Engineering. PRISM Climate Data. Accessed February 23 2022. https:\/\/prism.oregonstate.edu"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000007963"},{"key":"e_1_3_3_14_2","unstructured":"Enviromental Protection Agency. NAAQS Table. Accessed February 21 2022. https:\/\/www.epa.gov\/criteria-air-pollutants\/naaqs-table"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijheh.2015.09.003"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.019430"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2021.106715"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000930"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1038\/jes.2015.48"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.122.042265","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T15:03:27Z","timestamp":1715612607000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.122.042265"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4]]},"references-count":18,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,4]]}},"alternative-id":["10.1161\/STROKEAHA.122.042265"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.122.042265","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4]]},"assertion":[{"value":"2022-12-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-01","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}