{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T08:43:28Z","timestamp":1782463408443,"version":"3.54.5"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T00:00:00Z","timestamp":1632700800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>The epidemiological evidence on relationships between air pollution, temperature, and stroke remains inconclusive. Limited evidence is available for the effect modification by apparent temperature, an indicator reflecting reactions to the thermal environment, on short-term associations between air pollution and hospital admissions for stroke. We used a generalized additive model with Poisson regression to estimate the relative risk (RR) of stroke admissions in Shanghai, China, between 2014 and 2016 associated with air pollutants, with subgroup analyses by age, sex, apparent temperature, and season. During the study period, changes in the daily number of stroke admissions per 10 \u03bcg\/m<jats:sup>3<\/jats:sup> increase in nitrogen dioxide (at lags 0, 1, 0\u20131, and 0\u20132) ranged from 1.05 (95% CI: 0.82%, 2.88%) to 2.24% (95% CI: 0.84%, 3.65%). For each 10 \u03bcg\/m<jats:sup>3<\/jats:sup> increase in sulfur dioxide concentrations at lags 1, 2, 0\u20131, and 0\u20132, the RR of daily stroke admissions increased by 3.34 (95% CI: 0.955%, 5.79%), 0.32 (95% CI: \u22121.97%, 2.67%), 3.33 (95% CI: 0.38%, 6.37%), and 2.86% (95% CI: \u22120.45%, 6.28%), respectively. The associations of same-day exposure to nitrogen dioxide with stroke admissions remained significant after adjustment for ozone levels. These associations were not modified by sex, age, apparent temperature, or season. More research is warranted to determine whether apparent temperature modifies the associations between air pollution and stroke admissions.<\/jats:p>","DOI":"10.3389\/fpubh.2021.716153","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T16:19:11Z","timestamp":1632759551000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Short-Term Association of Air Pollutant Levels and Hospital Admissions for Stroke and Effect Modification by Apparent Temperature: Evidence From Shanghai, China"],"prefix":"10.3389","volume":"9","author":[{"given":"Lvkan","family":"Weng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tienan","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongjia","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi-Jie","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,9,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","year":"2020","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2429","DOI":"10.1056\/NEJMoa1804492","article-title":"Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016","volume":"379","author":"Feigin","year":"2018","journal-title":"N Engl J Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1161\/CIRCULATIONAHA.116.025250","article-title":"Prevalence, incidence, and mortality of stroke in china results from a nationwide population-based survey of 480 687 adults","volume":"135","author":"Wang","year":"2017","journal-title":"Circulation"},{"key":"B4","doi-asserted-by":"publisher","first-page":"115743","DOI":"10.1016\/j.envpol.2020.115743","article-title":"Associations between short-term exposure to PM2 5 and stroke incidence and mortality in China: A case-crossover study and estimation of the burden","volume":"268","author":"Ban","year":"2021","journal-title":"Environ Pollut."},{"key":"B5","doi-asserted-by":"publisher","first-page":"136896","DOI":"10.1016\/j.scitotenv.2020.136896","article-title":"Ambient fine particulate matter and hospital admissions for ischemic and hemorrhagic strokes and transient ischemic attack in 248 Chinese cities","volume":"715","author":"Gu","year":"2020","journal-title":"Sci Total Environ."},{"key":"B6","doi-asserted-by":"publisher","first-page":"h1295","DOI":"10.1136\/bmj.h1295","article-title":"Short term exposure to air pollution and stroke: systematic review and meta-analysis","volume":"350","author":"Shah","year":"2015","journal-title":"BMJ."},{"key":"B7","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1136\/bmj.l879","article-title":"China's response to the rising stroke burden","volume":"364","author":"Li","year":"2019","journal-title":"BMJ-British Medical Journal."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e003437","DOI":"10.1161\/JAHA.116.003437","article-title":"Particulate matter and hospital admissions for stroke in Beijing, China: modification effects by ambient temperature","volume":"5","author":"Huang","year":"2016","journal-title":"J Am Heart Assoc"},{"key":"B9","doi-asserted-by":"publisher","first-page":"3734","DOI":"10.1161\/STROKEAHA.114.003130","article-title":"Ambient air pollution and stroke","volume":"45","author":"Ljungman","year":"2014","journal-title":"Stroke."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.1080\/15287394.2014.926801","article-title":"Relationship between hemorrhagic stroke hospitalization and exposure to fine particulate air pollution in Taipei, Taiwan","volume":"77","author":"Chiu","year":"2014","journal-title":"J Toxicol Environ Health A."},{"key":"B11","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1007\/s40726-019-00112-9","article-title":"Health effects of climate change through temperature and air pollution","volume":"5","author":"Lou","year":"2019","journal-title":"Current Pollution Reports."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1856","DOI":"10.3390\/ijerph15091856","article-title":"Synergistic effects of ambient temperature and air pollution on health in Europe: results from the PHASE project","volume":"15","author":"Analitis","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"B13","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1016\/j.neurol.2019.03.002","article-title":"Air pollution and humidity as triggering factors for stroke. Results of a 12-year analysis in the West Paris area","volume":"175","author":"Hirel","year":"2019","journal-title":"Rev Neurol (Paris)."},{"key":"B14","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1016\/j.scitotenv.2016.11.008","article-title":"Seasonal and temperature modifications of the association between fine particulate air pollution and cardiovascular hospitalization in New York state","volume":"578","author":"Hsu","year":"2017","journal-title":"Sci Total Environ."},{"key":"B15","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1016\/j.envint.2016.04.001","article-title":"The burden of stroke mortality attributable to cold and hot ambient temperatures: Epidemiological evidence from China","volume":"93","author":"Yang","year":"2016","journal-title":"Environ Int"},{"key":"B16","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1136\/jech-2014-203939","article-title":"Disentangling interactions between atmospheric pollution and weather","volume":"69","author":"Zanobetti","year":"2015","journal-title":"J Epidemiol Community Health."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.3390\/ijerph14091091","article-title":"Ambient air pollution and risk for ischemic stroke: a short-term exposure assessment in South China","volume":"14","author":"Guo","year":"2017","journal-title":"Int J Environ Res Public Health"},{"key":"B18","first-page":"1","article-title":"Norms of apparent temperature in Australia","volume":"43","author":"Steadman","year":"1994","journal-title":"Australian Meteorological Magazine."},{"key":"B19","unstructured":"2021"},{"key":"B20","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1080\/1943815X.2016.1150301","article-title":"Evolution and comparative assessment of ambient air quality standards in China","volume":"13","author":"Zhao","year":"2016","journal-title":"J Integr Environ Sci."},{"key":"B21","doi-asserted-by":"publisher","first-page":"e1002668","DOI":"10.1371\/journal.pmed.1002668","article-title":"Association between ambient air pollution and daily hospital admissions for ischemic stroke: A nationwide time-series analysis","volume":"15","author":"Tian","year":"2018","journal-title":"PLoS Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"e25101","DOI":"10.1371\/journal.pone.0025101","article-title":"Apparent temperature and air pollution vs. elderly population mortality in metro vancouver","volume":"6","author":"Krstic","year":"2011","journal-title":"PLoS ONE."},{"key":"B23","doi-asserted-by":"publisher","first-page":"139040","DOI":"10.1016\/j.scitotenv.2020.139040","article-title":"Short-term effect of apparent temperature on daily emergency visits for mental and behavioral disorders in Beijing, China: A time-series study","volume":"733","author":"Niu","year":"2020","journal-title":"Sci Total Environ."},{"key":"B24","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1164\/rccm.201609-1862OC","article-title":"Fine particulate air pollution and daily mortality. A nationwide analysis in 272 Chinese cities","volume":"196","author":"Chen","year":"2017","journal-title":"Am J Respir Crit Care Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1001\/jama.295.10.1127","article-title":"Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases","volume":"295","author":"Dominici","year":"2006","journal-title":"JAMA."},{"key":"B26","doi-asserted-by":"publisher","first-page":"6877","DOI":"10.1007\/s11356-020-10963-1","article-title":"Association between short-term exposure to ambient air pollution and hospital admissions for transient ischemic attacks in Beijing, China","volume":"28","author":"Zhang","year":"2021","journal-title":"Environ Sci Pollut Res Int."},{"key":"B27","doi-asserted-by":"publisher","first-page":"e12","DOI":"10.1016\/S2542-5196(17)30181-X","article-title":"Ambient carbon monoxide and cardiovascular mortality: a nationwide time-series analysis in 272 cities in China","volume":"2","author":"Liu","year":"2018","journal-title":"The Lancet Planetary Health."},{"key":"B28","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1136\/bmj.326.7382.219","article-title":"Statistics Notes - Interaction revisited: the difference between two estimates","volume":"326","author":"Altman","year":"2003","journal-title":"BMJ."},{"key":"B29","doi-asserted-by":"publisher","first-page":"189","DOI":"10.3390\/ijerph14020189","article-title":"Gaseous Air pollution and the risk for stroke admissions: a case-crossover study in Beijing, China","volume":"14","author":"Huang","year":"2017","journal-title":"Int J Environ Res Public Health"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1093\/ije\/dyz106","article-title":"Fine particulate air pollution and adult hospital admissions in 200 Chinese cities: a time-series analysis","volume":"48","author":"Tian","year":"2019","journal-title":"Int J Epidemiol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12940-019-0557-4","article-title":"Association between short-term exposure to air pollution and ischemic stroke onset: a time-stratified case-crossover analysis using a distributed lag nonlinear model in Shenzhen, China","volume":"19","author":"Wang","year":"2020","journal-title":"Environ Health."},{"key":"B32","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1016\/j.envpol.2017.06.057","article-title":"Association between ambient air pollution and hospitalization for ischemic and hemorrhagic stroke in China: A multicity case-crossover study","volume":"230","author":"Liu","year":"2017","journal-title":"Environ Pollut."},{"key":"B33","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/S0140-6736(10)60834-3","article-title":"Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study","volume":"376","author":"O'Donnell","year":"2010","journal-title":"Lancet."},{"key":"B34","doi-asserted-by":"publisher","first-page":"2068","DOI":"10.1001\/jama.2012.3488","article-title":"Association between changes in air pollution levels during the Beijing Olympics and biomarkers of inflammation and thrombosis in healthy young adults","volume":"307","author":"Rich","year":"2012","journal-title":"JAMA."},{"key":"B35","doi-asserted-by":"publisher","first-page":"3930","DOI":"10.1161\/CIRCULATIONAHA.105.588962","article-title":"Diesel exhaust inhalation causes vascular dysfunction and impaired endogenous fibrinolysis","volume":"112","author":"Mills","year":"2005","journal-title":"Circulation."},{"key":"B36","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1097\/EDE.0b013e31824523f0","article-title":"Air Pollution and Markers of Coagulation, Inflammation, and Endothelial Function: Associations and Epigene-environment Interactions in an Elderly Cohort","volume":"23","author":"Bind","year":"2012","journal-title":"Epidemiology."},{"key":"B37","doi-asserted-by":"publisher","first-page":"2405","DOI":"10.1182\/blood-2011-04-343111","article-title":"Thrombogenicity and cardiovascular effects of ambient air pollution","volume":"118","author":"Franchini","year":"2011","journal-title":"Blood."},{"key":"B38","doi-asserted-by":"publisher","first-page":"3043","DOI":"10.1093\/eurheartj\/ehn464","article-title":"Diesel exhaust inhalation increases thrombus formation in man\u2020","volume":"29","author":"Lucking","year":"2008","journal-title":"Eur Heart J."},{"key":"B39","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1016\/S0140-6736(16)00378-0","article-title":"Association between air pollution and coronary artery calcification within six metropolitan areas in the USA (the Multi-Ethnic Study of Atherosclerosis and Air Pollution): a longitudinal cohort study","volume":"388","author":"Kaufman","year":"2016","journal-title":"Lancet."},{"key":"B40","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1164\/rccm.200606-872OC","article-title":"Persistent endothelial dysfunction in humans after diesel exhaust inhalation","volume":"176","author":"T\u00f6rnqvist","year":"2007","journal-title":"Am J Respir Crit Care Med."},{"key":"B41","doi-asserted-by":"publisher","first-page":"2660","DOI":"10.1093\/eurheartj\/ehr195","article-title":"Combustion-derived nanoparticulate induces the adverse vascular effects of diesel exhaust inhalation","volume":"32","author":"Mills","year":"2011","journal-title":"Eur Heart J."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1721","DOI":"10.1161\/CIRCULATIONAHA.110.987263","article-title":"Particle traps prevent adverse vascular and prothrombotic effects of diesel engine exhaust inhalation in men","volume":"123","author":"Lucking","year":"2011","journal-title":"Circulation."},{"key":"B43","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s12199-021-00937-1","article-title":"Association between exposure to ambient air pollution and hospital admission, incidence, and mortality of stroke: an updated systematic review and meta-analysis of more than 23 million participants","volume":"26","author":"Niu","year":"2021","journal-title":"Environ Health Prev Med."},{"key":"B44","doi-asserted-by":"publisher","first-page":"2549","DOI":"10.1161\/01.STR.0000189687.78760.47","article-title":"Air pollution and hospital admissions for ischemic and hemorrhagic stroke among medicare beneficiaries","volume":"36","author":"Wellenius","year":"2005","journal-title":"Stroke."},{"key":"B45","doi-asserted-by":"publisher","first-page":"2052","DOI":"10.1161\/STROKEAHA.116.016482","article-title":"Ambient particulate matter concentrations and hospitalization for stroke in 26 Chinese cities:a case-crossover study","volume":"48","author":"Liu","year":"2017","journal-title":"Stroke."},{"key":"B46","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.1093\/eurheartj\/ehi835","article-title":"Urban air pollution and emergency admissions for cerebrovascular diseases in Taipei, Taiwan","volume":"27","author":"Chan","year":"2006","journal-title":"Eur Heart J."},{"key":"B47","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.scitotenv.2007.07.025","article-title":"Short term effects of air pollution on hospitalizations for cardiovascular diseases in eight French cities: The PSAS program","volume":"387","author":"Larrieu","year":"2007","journal-title":"Sci Total Environt."},{"key":"B48","doi-asserted-by":"publisher","first-page":"1018","DOI":"10.1289\/ehp.8674","article-title":"The effects of air pollution on hospitalizations for cardiovascular disease in elderly people in Australian and New Zealand cities","volume":"114","author":"Barnett","year":"2006","journal-title":"Environ Health Perspect."},{"key":"B49","doi-asserted-by":"publisher","first-page":"2612","DOI":"10.1161\/01.STR.0000095564.33543.64","article-title":"Evidence for an association between air pollution and daily stroke admissions in Kaohsiung, Taiwan","volume":"34","author":"Tsai","year":"2003","journal-title":"Stroke."},{"key":"B50","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1136\/oemed-2019-106301","article-title":"Short-term effects of outdoor air pollution on acute ischaemic stroke occurrence: a case-crossover study in Tianjin, China","volume":"77","author":"Qi","year":"2020","journal-title":"Occup Environ Med."},{"key":"B51","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1007\/s10654-006-9050-9","article-title":"Associations between outdoor air pollution and emergency department visits for stroke in Edmonton, Canada","volume":"21","author":"Villeneuve","year":"2006","journal-title":"Eur J Epidemiol."},{"key":"B52","doi-asserted-by":"publisher","first-page":"e61168","DOI":"10.1371\/journal.pone.0061168","article-title":"Estimation of short-term effects of air pollution on stroke hospital admissions in Wuhan, China","volume":"8","author":"Xiang","year":"2013","journal-title":"PLoS ONE."},{"key":"B53","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1016\/j.envres.2019.03.065","article-title":"A time series analysis of the relationship between apparent temperature, air pollutants and ischemic stroke in Madrid, Spain","volume":"173","author":"Roye","year":"2019","journal-title":"Environ Res."},{"key":"B54","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1093\/aje\/kwx295","article-title":"Examining the association between apparent temperature and mental health-related emergency room visits in California","volume":"187","author":"Basu","year":"2018","journal-title":"Am J Epidemiol."},{"key":"B55","doi-asserted-by":"publisher","first-page":"e566","DOI":"10.1016\/S2542-5196(20)30251-5","article-title":"Socioeconomic inequality in vulnerability to all-cause and cause-specific hospitalisation associated with temperature variability: a time-series study in 1814 Brazilian cities","volume":"4","author":"Xu","year":"2020","journal-title":"Lancet Planet Health."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.716153\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T16:19:15Z","timestamp":1632759555000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.716153\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,27]]},"references-count":55,"alternative-id":["10.3389\/fpubh.2021.716153"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2021.716153","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,27]]},"article-number":"716153"}}