Published Online
on December 16, 2004

A more recent version of this article appeared on February 1, 2005

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Submitted on August 24, 2004
Revised on October 7, 2004
Accepted on October 26, 2004

Outdoor Air Pollution and Stroke in Sheffield, United Kingdom. A Small-Area Level Geographical Study

Ravi Maheswaran MD^*; Robert P. Haining PhD; Paul Brindley MSc; Jane Law PhD; Tim Pearson MSc; Peter R. Fryers MSc; Stephen Wise BSc; and Michael J. Campbell PhD

From the Public Health GIS Unit (R.M., T.P., P.R.F.), the Institute of Primary Care (M.J.C.), School of Health and Related Research; the Sheffield Center for Geographic Information and Spatial Analysis (P.B., S.W.), University of Sheffield; and the Department of Geography (R.P.H., J.L.), University of Cambridge, United Kingdom.

^* To whom correspondence should be addressed. E-mail: r.maheswaran{at}sheffield.ac.uk.

Background and Purpose--Current evidence suggests that stroke mortality and hospital admissions should be higher in areas with elevated levels of outdoor air pollution because of the combined acute and chronic exposure effects of air pollution. We examined this hypothesis using a small-area level ecological correlation study.

Methods--We used 1030 census enumeration districts as the unit of analysis and examined stroke deaths and hospital admissions from 1994 to 1998, with census denominator counts for people 45 years. Modeled air pollution data for particulate matter (PM₁₀), nitrogen oxides (NO_x), and carbon monoxide (CO) were interpolated to census enumeration districts. We adjusted for age, sex, socioeconomic deprivation, and smoking prevalence.

Results--The analysis was based on 2979 deaths, 5122 admissions, and a population of 199 682. After adjustment for potential confounders, stroke mortality was 37% (95% CI, 19 to 57), 33% (95% CI, 14 to 56), and 26% (95% CI, 10 to 46) higher in the highest, relative to the lowest, NO_x, PM₁₀, and CO quintile categories, respectively. Corresponding increases in risk for admissions were 13% (95% CI, 1 to 27), 13% (95% CI, -1 to 29), and 11% (95% CI, -1 to 25).

Conclusion--The results are consistent with an excess risk of stroke mortality and, to a lesser extent, hospital admissions in areas with high outdoor air pollution levels. If causality were assumed, 11% of stroke deaths would have been attributable to outdoor air pollution. Targeting policy interventions at high pollution areas may be a feasible option for stroke prevention.

Key words: air pollutants, environmental • cerebrovascular disorders • hospitalization • mortality

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