Association between short-term exposure to ultrafine particles and hospital admissions for stroke in Copenhagen, Denmark

Aims The relevance of ultrafine particles (UFPs, particles <0.1 mu m diameter), the smallest fraction of ambient particulate matter, on stroke morbidity has not been documented. We studied the effects of short-term changes in exposure to these particles on stroke, separately for ischaemic and haemorrhagic strokes, mild and severe strokes, and ischaemic strokes with (likely embolic) and without (likely thrombotic) atrial fibrillation (AF). Methods and results We used a time-stratified case-crossover design to study the association between short-term exposure to UFPs, particulate matter <10 mu m in diameter (PM10), nitrogen oxides (NOx) and carbon monoxide (CO) (measured at single background station) and hospital admissions for stroke in Copenhagen (2003 - 2006). Of 7485 stroke admissions, 6798 were ischaemic and 687 haemorrhagic, 3485 mild, and 2248 severe. Of the ischaemic stroke cases, 1204 had AF and 5273 did not We found significant positive association with exposure to UFPs, NOx and CO, and ischaemic strokes, and UFPs and NOx and mild strokes, 4 days before admission. The strongest associations were with UFPs. Exposure to UFPs lead to a 21% increase in hospital admissions (per interquartile range of 5-day averages; 95% confidence interval 4-41%) for mild ischaemic stroke of without AF (likely thrombotic origin). Conclusion Our results indicate possible effects of traffic-related air pollution, mainly UFPs, on hospital admissions for ischaemic stroke, especially for mild ischaemic stroke of likely thrombotic origin (without AF). These are novel findings regarding the relevance of UFPs and the heterogeneous effect of air pollution on the severity and origin of stroke, and need confirmation by other data.