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Age disparities in stroke quality of care and delivery of health services.

https://arctichealth.org/en/permalink/ahliterature149008
Source
Stroke. 2009 Oct;40(10):3328-35
Publication Type
Article
Date
Oct-2009
Author
Gustavo Saposnik
Sandra E Black
Antoine Hakim
Jiming Fang
Jack V Tu
Moira K Kapral
Author Affiliation
Stroke Research Unit, Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. saposnikg@smh.toronto.on.ca
Source
Stroke. 2009 Oct;40(10):3328-35
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Aging - physiology - psychology
Atrial Fibrillation - drug therapy - prevention & control
Cohort Studies
Cost of Illness
Deglutition Disorders - diagnosis - prevention & control - therapy
Emergency Medical Services - standards - statistics & numerical data - trends
Female
Health Policy
Health Services - economics
Hospital Units - standards - statistics & numerical data - trends
Hospitalization - economics
Humans
Longevity
Male
Middle Aged
Mortality - trends
Ontario
Outcome Assessment (Health Care) - economics
Patient Discharge - economics
Pneumonia - epidemiology
Prospective Studies
Quality of Health Care - statistics & numerical data - trends
Quality of Life
Severity of Illness Index
Stroke - complications - mortality - therapy
Thrombolytic Therapy - statistics & numerical data - trends
Warfarin - therapeutic use
Abstract
Limited information is available on the effect of age on stroke management and care delivery. Our aim was to determine whether access to stroke care, delivery of health services, and clinical outcomes after stroke are affected by age.
This was a prospective cohort study of patients with acute ischemic stroke in the province of Ontario, Canada, admitted to stroke centers participating in the Registry of the Canadian Stroke Network between July 1, 2003 and March 31, 2005. Primary outcomes were the following selected indicators of quality stroke care: (1) use of thrombolysis; (2) dysphagia screening; (3) admission to a stroke unit; (4) carotid imaging; (5) antithrombotic therapy; and (6) warfarin for atrial fibrillation at discharge. Secondary outcomes were risk-adjusted stroke fatality, discharge disposition, pneumonia, and length of hospital stay.
Among 3631 patients with ischemic stroke, 1219 (33.6%) were older than 80 years. There were no significant differences in stroke care delivery by age group. Stroke fatality increased with age, with a 30-day risk adjusted fatality of 7.1%, 6.5%, 8.8%, and 14.8% for those aged 59 or younger, 60 to 69, 70 to 79, and 80 years or older, respectively. Those aged older than 80 years had a longer length of hospitalization, increased risk of pneumonia, and higher disability at discharge compared to those younger than 80. This group was also less likely to be discharged home.
In the context of a province-wide coordinated stroke care system, stroke care delivery was similar across all age groups with the exception of slightly lower rates of investigations in the very elderly. Increasing age was associated with stroke severity and stroke case-fatality.
PubMed ID
19696418 View in PubMed
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Association between weekend hospital presentation and stroke fatality.

https://arctichealth.org/en/permalink/ahliterature139618
Source
Neurology. 2010 Nov 2;75(18):1589-96
Publication Type
Article
Date
Nov-2-2010
Author
Jiming Fang
Gustavo Saposnik
Frank L Silver
Moira K Kapral
Author Affiliation
Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, Canada.
Source
Neurology. 2010 Nov 2;75(18):1589-96
Date
Nov-2-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada - epidemiology
Cohort Studies
Female
Holidays
Hospital Mortality
Humans
Male
Middle Aged
Outcome Assessment (Health Care) - statistics & numerical data
Patient Admission - statistics & numerical data
Personnel Staffing and Scheduling
Stroke - epidemiology - mortality - therapy
Time Factors
Abstract
Previous studies have found higher stroke case fatality in patients admitted to the hospital on weekends compared to weekdays, but the reasons for this association are not known.
This was a cohort study using data from the Registry of the Canadian Stroke Network. We included consecutive patients with acute stroke or TIA seen in the emergency department or admitted to the hospital at 11 stroke centers in Ontario, Canada, between July 1, 2003, and March 30, 2008 (n = 20,657). We compared in-hospital stroke care and 7-day all-cause stroke case fatality rates between patients seen on weekends and weekdays, with adjustment for stroke severity and other baseline factors.
Overall rates of hospital presentation were lower on weekends compared to weekdays, with lower rates of weekend presentation among individuals with minor stroke and TIA compared to those with more severe strokes. Stroke care, including admission to a stroke unit, neuroimaging, and dysphagia screening, was similar in those treated on weekends and weekdays. All-cause 7-day fatality rates were higher in patients seen on weekends compared to weekdays (8.1% vs 7.0%), even after adjustment for age, sex, stroke severity, and comorbid conditions (adjusted hazard ratio 1.12, 95% confidence interval 1.00 to 1.25).
Stroke fatality is higher with weekend compared to weekday admission, even after adjustment for case mix.
Notes
Comment In: Neurology. 2011 Aug 16;77(7):700-1; author reply 70121844529
PubMed ID
21041782 View in PubMed
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Association of statins and statin discontinuation with poor outcome and survival after intracerebral hemorrhage.

https://arctichealth.org/en/permalink/ahliterature125905
Source
Stroke. 2012 Jun;43(6):1518-23
Publication Type
Article
Date
Jun-2012
Author
Dar Dowlatshahi
Andrew M Demchuk
Jiming Fang
Moira K Kapral
Mukul Sharma
Eric E Smith
Author Affiliation
Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada. ddowlat@ottawahospital.on.ca
Source
Stroke. 2012 Jun;43(6):1518-23
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Aged
Canada - epidemiology
Cerebral Hemorrhage - drug therapy - mortality
Disease-Free Survival
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage
Male
Prospective Studies
Registries
Stroke - drug therapy - mortality
Survival Rate
Time Factors
Abstract
Studies suggest a protective role for statins after intracerebral hemorrhage, but many failed to assess statin discontinuation, did not include postdischarge outcomes, or did not account for withdrawal of care. We studied the relationship between preintracerebral hemorrhage statin use and in-hospital statin discontinuation on stroke severity and 30-day mortality.
We analyzed data from the Registry of the Canadian Stroke Network and determined the adjusted ORs for statin use and outcomes, controlling for stroke severity and other covariates.
We analyzed 2466 consecutive patients with intracerebral hemorrhage from 2003 to 2008: median age was 71 years, 53.6% were male, and 30-day mortality rate was 36.5%. Overall, 537 (21.7%) were taking statins before presentation. Compared with nonusers, statin users were less likely to have severe strokes on presentation (54.7% versus 63.3%) but had similar rates of poor outcome (70% versus 67%) and 30-day mortality (36% versus 37%). Statins were discontinued on admission in 158 of 537 (29.4%); these patients were more likely to have severe stroke (65% versus 27%, P
PubMed ID
22442172 View in PubMed
Less detail

Bone density and structure in healthy postmenopausal women treated with exemestane for the primary prevention of breast cancer: a nested substudy of the MAP.3 randomised controlled trial.

https://arctichealth.org/en/permalink/ahliterature127170
Source
Lancet Oncol. 2012 Mar;13(3):275-84
Publication Type
Article
Date
Mar-2012
Author
Angela M Cheung
Lianne Tile
Savannah Cardew
Sandhya Pruthi
John Robbins
George Tomlinson
Moira K Kapral
Sundeep Khosla
Sharmila Majumdar
Marta Erlandson
Judy Scher
Hanxian Hu
Alice Demaras
Lavina Lickley
Louise Bordeleau
Christine Elser
James Ingle
Harriet Richardson
Paul E Goss
Author Affiliation
University Health Network, University of Toronto, Toronto, ON, Canada. angela.cheung@uhn.ca
Source
Lancet Oncol. 2012 Mar;13(3):275-84
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon
Androstadienes - adverse effects
Anticarcinogenic Agents - adverse effects
Aromatase Inhibitors - adverse effects
Bone Density - drug effects
Bone and Bones - drug effects - radiography
Breast Neoplasms - prevention & control
Calcium - administration & dosage
Canada
Chi-Square Distribution
Dietary Supplements
Double-Blind Method
Female
Femur Neck - drug effects - radiography
Hip Joint - drug effects - radiography
Humans
Lumbar Vertebrae - drug effects - radiography
Middle Aged
Osteoporosis - chemically induced - radiography
Patient Selection
Placebos
Postmenopause
Primary prevention - methods
Risk assessment
Risk factors
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
United States
Vitamin D - administration & dosage
Abstract
Exemestane can prevent breast cancer in postmenopausal women. Because of potential widespread use, we examined the safety of exemestane on bone health.
In this nested safety substudy of the MAP.3 trial (a randomised, placebo-controlled, double-blind trial of exemestane 25 mg a day for the primary prevention of breast cancer), we included postmenopausal women from five centres who were eligible to participate in MAP.3, not osteoporotic, not receiving drugs for bone-related disorders, with baseline lumbar spine, total hip, and femoral neck T-scores above -2·0. The primary endpoint was percent change from baseline to 2 years in total volumetric bone mineral density (BMD) at the distal radius by high-resolution peripheral quantitative CT. The primary analysis was per protocol using a non-inferiority margin. This analysis was done earlier than originally planned because of the impending announcement of MAP.3 results and subsequent unmasking of patients to treatment assignment. This study is registered with ClinicalTrials.gov, number NCT01144468, and has been extended to 5 years of unmasked follow-up.
351 women (176 given exemestane, 175 given placebo; median age 61·3 years [IQR 59·2-64·9]) met our inclusion criteria and completed baseline assessment. At the time of clinical cutoff, 242 women had completed 2-year follow-up (124 given exemestane, 118 given placebo). From baseline to 2 years, the mean percent change in total volumetric BMD at the distal radius was -6·1% (95% CI -7·0 to -5·2) in the exemestane group and -1·8% (-2·4 to -1·2) in the placebo group (difference -4·3%, 95% CI -5·3 to -3·2; p
Notes
Comment In: Lancet Oncol. 2012 Mar;13(3):221-222318094
PubMed ID
22318095 View in PubMed
Less detail

Cost avoidance associated with optimal stroke care in Canada.

https://arctichealth.org/en/permalink/ahliterature124071
Source
Stroke. 2012 Aug;43(8):2198-206
Publication Type
Article
Date
Aug-2012
Author
Hans Krueger
Patrice Lindsay
Robert Cote
Moira K Kapral
Janusz Kaczorowski
Michael D Hill
Author Affiliation
School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. hans@krueger.ca
Source
Stroke. 2012 Aug;43(8):2198-206
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Aged
Brain Ischemia - complications - economics - epidemiology
Canada
Cerebral Hemorrhage - complications - economics - epidemiology
Cost Control - methods
Costs and Cost Analysis
Female
Humans
Length of Stay
Male
Middle Aged
Models, Economic
Models, Statistical
Quality-Adjusted Life Years
Registries
Stroke - economics - etiology - therapy
Treatment Outcome
Abstract
Evidence-based stroke care has been shown to improve patient outcomes and may reduce health system costs. Cost savings, however, are poorly quantified. This study assesses 4 aspects of stroke management (rapid assessment and treatment services, thrombolytic therapy, organized stroke units, and early home-supported discharge) and estimates the potential for cost avoidance in Canada if these services were provided in a comprehensive fashion.
Several independent data sources, including the Canadian Institute of Health Information Discharge Abstract Database, the 2008-2009 National Stroke Audit, and the Acute Cerebrovascular Syndrome Registry in the province of British Columbia, were used to assess the current status of stroke care in Canada. Evidence from the literature was used to estimate the effect of providing optimal stroke care on rates of acute care hospitalization, length of stay in hospital, discharge disposition (including death), changes in quality of life, and costs avoided.
Comprehensive and optimal stroke care in Canada would decrease the number of annual hospital episodes by 1062 (3.3%), the number of acute care days by 166 000 (25.9%), and the number of residential care days by 573 000 (12.8%). The number of deaths in the hospital would be reduced by 1061 (14.9%). Total avoidance of costs was estimated at $682 million annually ($307.4 million in direct costs, $374.3 million in indirect costs).
The costs of stroke care in Canada can be substantially reduced, at the same time as improving patient outcomes, with the greater use of known effective treatment modalities.
PubMed ID
22627985 View in PubMed
Less detail

Do all age groups benefit from organized inpatient stroke care?

https://arctichealth.org/en/permalink/ahliterature149394
Source
Stroke. 2009 Oct;40(10):3321-7
Publication Type
Article
Date
Oct-2009
Author
Gustavo Saposnik
Moira K Kapral
Shelagh B Coutts
Jiming Fang
Andrew M Demchuk
Michael D Hill
Author Affiliation
Stroke Research Unit, Division of Neurology, Department of Medicine, Stroke Outcome Research Canada, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. saposnikg@smh.toronto.on.ca
Source
Stroke. 2009 Oct;40(10):3321-7
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Age Distribution
Age Factors
Aged
Aged, 80 and over
Brain Ischemia - mortality - nursing - rehabilitation
Canada
Case-Control Studies
Cohort Studies
Cost of Illness
Emergency medical services
Female
Hospital Units - statistics & numerical data - trends
Humans
Inpatients - statistics & numerical data
Institutionalization
Length of Stay
Male
Middle Aged
National Health Programs
Outcome Assessment (Health Care)
Patient Care Team - statistics & numerical data - trends
Quality of Health Care - statistics & numerical data - trends
Risk Reduction Behavior
Stroke - mortality - nursing - therapy
Survival Rate
Treatment Outcome
Abstract
Organized inpatient stroke care consists of a multidisciplinary approach aimed at improving stroke outcomes. It is unclear whether elderly individuals benefit from these interventions to the same extent as younger patients. We sought to determine whether the reduction in mortality or institutionalization seen with organized stroke care was similar across all age groups.
This was a case-cohort study of patients with acute ischemic stroke seen between July 2003 and March 2005 and captured in the Registry of the Canadian Stroke Network. After stratifying by age category, we assessed for evidence of effect modification by age on the reduction in stroke fatality associated with stroke unit/organized care.
Among 3631 patients with ischemic stroke, stroke case-fatality at 30 days was lower for patients admitted to a stroke unit compared with those admitted to general medical wards (10.2% versus 14.8%; P80 years). Increasing levels of organized care were associated with lower stroke fatality or institutionalization. The beneficial effect of stroke units/organized care on survival was seen even after adjustment for multiple prognostic factors and after excluding patients on palliative approach. There was no evidence of effect modification by age in any analyses.
Stroke units and organized inpatient care reduce death or institutionalization with the same magnitude of effect across all age groups.
PubMed ID
19644068 View in PubMed
Less detail

Effect of a provincial system of stroke care delivery on stroke care and outcomes.

https://arctichealth.org/en/permalink/ahliterature113555
Source
CMAJ. 2013 Jul 9;185(10):E483-91
Publication Type
Article
Date
Jul-9-2013
Author
Moira K Kapral
Jiming Fang
Frank L Silver
Ruth Hall
Melissa Stamplecoski
Christina O'Callaghan
Jack V Tu
Author Affiliation
Department of Medicine, University of Toronto, Toronto, Ontario. moira.kapral@uhn.on.ca
Source
CMAJ. 2013 Jul 9;185(10):E483-91
Date
Jul-9-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada
Delivery of Health Care - methods
Emergency Medical Services - methods
Female
Hospitalization - statistics & numerical data
Humans
Ischemic Attack, Transient - mortality - therapy
Long-Term Care - methods
Male
Middle Aged
Ontario
Stroke - mortality - therapy
Young Adult
Abstract
Systems of stroke care delivery have been promoted as a means of improving the quality of stroke care, but little is known about their effectiveness. We assessed the effect of the Ontario Stroke System, a province-wide strategy of regionalized stroke care delivery, on stroke care and outcomes in Ontario, Canada.
We used population-based provincial administrative databases to identify all emergency department visits and hospital admissions for acute stroke and transient ischemic attack from Jan. 1, 2001, to Dec. 31, 2010. Using piecewise regression analyses, we assessed the effect of the full implementation of the Ontario Stroke System in 2005 on the proportion of patients who received care at stroke centres, and on rates of discharge to long-term care facilities and 30-day mortality after stroke.
We included 243 287 visits by patients with acute stroke or transient ischemic attack. The full implementation of the Ontario Stroke System in 2005 was associated with an increase in rates of care at stroke centres (before implementation: 40.0%; after implementation: 46.5%), decreased rates of discharge to long-term care facilities (before implementation: 16.9%; after implementation: 14.8%) and decreased 30-day mortality for hemorrhagic (before implementation: 38.3%; after implementation: 34.4%) and ischemic stroke (before implementation: 16.3%; after implementation: 15.7%). The system's implementation was also associated with marked increases in the proportion of patients who received neuroimaging, thrombolytic therapy, care in a stroke unit and antithrombotic therapy.
The implementation of an organized system of stroke care delivery was associated with improved processes of care and outcomes after stroke.
Notes
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PubMed ID
23713072 View in PubMed
Less detail

Effect of socioeconomic status on treatment and mortality after stroke.

https://arctichealth.org/en/permalink/ahliterature191996
Source
Stroke. 2002 Jan;33(1):268-73
Publication Type
Article
Date
Jan-2002
Author
Moira K Kapral
Hua Wang
Muhammad Mamdani
Jack V Tu
Author Affiliation
Institute for Clinical Evaluative Sciences, University Health Network University of Toronto, Ontario, Canada. moira.kapral@uhn.on.ca
Source
Stroke. 2002 Jan;33(1):268-73
Date
Jan-2002
Language
English
Publication Type
Article
Keywords
Aged
Canada
Cohort Studies
Endarterectomy, Carotid
Female
Health Services Accessibility
Humans
Length of Stay
Male
Social Class
Stroke - diagnosis - mortality - therapy
Survival Rate
Time Factors
Treatment Outcome
Abstract
Socioeconomic status is associated with increased mortality from ischemic heart disease. We undertook a study to determine whether a similar association exists between socioeconomic status and stroke mortality.
We linked hospital discharge abstracts and vital-status data for all patients with acute stroke admitted to hospitals in Ontario between April 1994 and March 1997. Socioeconomic status for each patient was inferred on the basis of median neighborhood income. We determined the risk of death at 30 days and 1 year; secondary analyses compared the use of medications, inpatient rehabilitation services, and carotid endarterectomy by socioeconomic status. We used multivariate analyses to adjust for age, sex, stroke type, comorbid conditions, and hospital and physician characteristics.
The study sample consisted of 38 945 patients. Each $10 000 increase in median neighborhood income was associated with a 9% reduction in the hazard of death at 30 days (adjusted hazard ratio 0.91, 95% CI 0.87 to 0.96) and a 5% reduction in the hazard of death at 1 year (adjusted hazard ratio 0.95, 95% CI 0.92 to 0.99). Patients in the lowest income quintile were less likely than those in the highest to receive in-hospital physiotherapy (58% versus 61%, P
Notes
Comment In: Stroke. 2002 Jan;33(1):274-511813694
PubMed ID
11779921 View in PubMed
Less detail

Escalating levels of access to in-hospital care and stroke mortality.

https://arctichealth.org/en/permalink/ahliterature156221
Source
Stroke. 2008 Sep;39(9):2522-30
Publication Type
Article
Date
Sep-2008
Author
Gustavo Saposnik
Jiming Fang
Martin O'Donnell
Vladimir Hachinski
Moira K Kapral
Michael D Hill
Author Affiliation
Stroke Research Unit, Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, M5C 1R6, Canada. saposnikg@smh.toronto.on.ca
Source
Stroke. 2008 Sep;39(9):2522-30
Date
Sep-2008
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada - epidemiology
Cohort Studies
Cost of Illness
Female
Health Services Accessibility - statistics & numerical data - trends
Hospitalization - statistics & numerical data
Humans
Male
Middle Aged
Outcome Assessment (Health Care) - methods
Patient Care Team - statistics & numerical data
Quality of Health Care - statistics & numerical data
Registries
Stroke - mortality - rehabilitation
Survival Rate - trends
Abstract
Organized stroke care is an integrated approach to managing stroke to improve stroke outcomes by ensuring that optimal treatment is offered. However, limited information is available comparing different levels of organized care. Our aim was to determine whether escalating levels of organized care can improve stroke outcomes.
Cohort study including patients with acute ischemic stroke between July 2003 and March 2005 in the Registry of the Canadian Stroke Network (RCSN). The RCSN is the largest clinical database of patients with acute stroke patients seen at selected acute care hospitals in Canada. As stroke unit admission does not automatically imply receipt of comprehensive care, we created the organized care index to represent different levels of access to organized care ranging from 0 to 3 as determined by the presence of occupational therapy/physiotherapy, stroke team assessment, and admission to a stroke unit. The primary end point was early stroke mortality. Secondary end points include 30-day and 1-year mortality.
Overall, 3631 ischemic stroke patients were admitted to 11 hospitals. Seven day stroke mortality was 6.9% (249/3631), 30-day stroke mortality was 12.6% (457/3631), and 1-year stroke mortality was 23.6% (856/3631). Risk-adjusted 7-day mortality was 2.0%, 3.2%, 7.8%, and 22.5% for organized care index of 3, 2, 1, and 0. Higher level of care was associated with lower adjusted mortality (for organized care index 3, OR 0.03, 95% CI 0.02 to 0.07 for 7-day mortality; OR 0.09, 95% CI 0.05 to 0.17 for 30-day mortality; and OR 0.40, 95% CI 0.25 to 0.64 for 1-year mortality).
Higher level of access to care was associated with lower stroke mortality rates. Establishing a well-organized and multidisciplinary system of stroke care will help improve the quality of service delivered and reduce the burden of stroke.
Notes
Comment In: Stroke. 2008 Nov;39(11):e18618802201
PubMed ID
18617667 View in PubMed
Less detail

Fine particulate air pollution (PM2.5) and the risk of acute ischemic stroke.

https://arctichealth.org/en/permalink/ahliterature136235
Source
Epidemiology. 2011 May;22(3):422-31
Publication Type
Article
Date
May-2011
Author
Martin J O'Donnell
Jiming Fang
Murray A Mittleman
Moira K Kapral
Gregory A Wellenius
Author Affiliation
National University of Ireland, Galway, Ireland. odonnm@mcmaster.ca
Source
Epidemiology. 2011 May;22(3):422-31
Date
May-2011
Language
English
Publication Type
Article
Keywords
Acute Disease
Age Distribution
Aged
Aged, 80 and over
Brain Ischemia - chemically induced - epidemiology
Cohort Studies
Confidence Intervals
Environmental Exposure - adverse effects
Female
Humans
Ischemic Attack, Transient - chemically induced - epidemiology
Logistic Models
Male
Middle Aged
Odds Ratio
Ontario - epidemiology
Particulate Matter - adverse effects
Prognosis
Registries
Risk assessment
Sex Distribution
Stroke - chemically induced - epidemiology
Survival Rate
Urban Population
Abstract
Short-term changes in levels of fine ambient particulate matter (PM2.5) may increase the risk of acute ischemic stroke; however, results from prior studies have been inconsistent. We examined this hypothesis using data from a multicenter prospective stroke registry.
We analyzed data from 9202 patients hospitalized with acute ischemic stroke, having a documented date and time of stroke onset, and residing within 50 km of a PM2.5 monitor in 8 cities in Ontario, Canada. We evaluated the risk of ischemic stroke onset associated with PM2.5 in each city using a time-stratified case-crossover design, matching on day of week and time of day. We then combined these city-specific estimates using random-effects meta-analysis techniques. We examined whether the effects of PM2.5 differed across strata defined by patient characteristics and ischemic stroke etiology.
Overall, PM2.5 was associated with a -0.7% change in ischemic stroke risk per 10-µg/m increase in PM2.5 (95% confidence interval = -6.3% to 5.1%). These overall negative results were robust to a number of sensitivity analyses. Among patients with diabetes mellitus, PM2.5 was associated with an 11% increase in ischemic stroke risk (1% to 22%). The association between PM2.5 and ischemic stroke risk varied according to stroke etiology, with the strongest associations observed for strokes due to large-artery atherosclerosis and small-vessel occlusion.
These results do not support the hypothesis that short-term increases in PM2.5 levels are associated with ischemic stroke risk overall. However, specific patient subgroups may be at increased risk of particulate-related ischemic strokes.
Notes
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PubMed ID
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