Yixue xinzhi zazhi (Jun 2023)

Environmental risk factors for stroke in China: a systematic review

  • Li-Sha YU,
  • Xin-Liang LIU,
  • Kang SONG,
  • Rui WANG,
  • Fang-Yan GONG,
  • Liang FANG,
  • Yue WAN,
  • Lin ZHAO,
  • Hao LI

DOI
https://doi.org/10.12173/j.issn.1004-5511.202209017
Journal volume & issue
Vol. 33, no. 3
pp. 173 – 208

Abstract

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Objective The number of stroke patients has been increasing in China in recent years, but a comprehensive synthesis of the environmental risk factors on the development of stroke is yet to be conducted. The aim of this study is to determine the environmental risk factors for stroke, in order to provide evidence-based recommendations for health administration bodies to make relative policies and interventions.Methods We searched China National Knowledge Infrastructure, WanFang Database, VIP-Datebase, PubMed, Web of Science, and Scopus database to select articles published from January 2012 to May 2022. Articles were included if they examined the association between an environmental risk factor and stroke and were conducted in China. Descriptive analysis was made based on the categories and frequencies of the environmental risk factors, and narrative synthesis was made covering the association between environmental risk factors and stroke.Results Of 12,774 records obtained initially from searching databases, 215 articles were finally selected for our systematic review. There are 8 categories, including 43 environmental risk factors, of which 52.56% studied meteorological factors as the main environmental factor category, followed by air pollution (47.44%), and the most frequently reported indicators are air temperature (40.47%) and PM2.5 (28.37%). Among the meteorological factors, most of the studies involving air temperature suggest that it is the key factor influencing stroke and confirm that stroke and its subtypes are seasonal. Nearly half of the studies found that higher air pressure was associated with higher risk of stroke and its subtypes. For air pollution, this review found that higher levels of PM2.5, PM10, CO, NO2, O3 and SO2 are associated with greater risks. In addition, fuel exposure and passive smoking are also associated with the increased risk of stroke.Conclusion Environmental factors have a certain influence on the occurrence risk of stroke in Chinese people. Further studies are needed not only to evaluate these associations and elucidate the specific mechanisms involved, but also to explore potential health effects of more environmental factors on stroke.

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