Temporal Heterogeneity of Short-Term Effects of Particulate Matter on Stroke Outpatients in Seven Major Cities of the Republic of Korea

Although particulate matter (PM) is a major risk factor for stroke, its effects on hospital outpatients admitted for stroke have not been documented in Korea. In addition, recent studies have reported that the effects of PM10 on circulatory mortality changed over time. We aimed to estimate the effects of PM10 on stroke and their temporal heterogeneity in seven major cities of Korea during the period 2002-2015. The study period was divided into five years of moving time windows, and city-specific PM10 effects on ischemic and hemorrhagic stroke outpatients were calculated. We pooled the estimates using meta-analysis and plotted them into a sequence to identify their temporal trends. A 10 mu g/m(3) increase of PM10 was significantly associated with increments in hospital outpatients admitted for ischemic stroke (0.24%, 95% CI: 0.04%, 0.44%), but not for hemorrhagic stroke (0.33%, 95% CI: -0.06%, 0.73%). Effect estimates for strokes increased during the period 2003-2013 but decreased after. For the first time, we have estimated the effects of PM10 on hospital outpatients admitted for stroke in Korea. The observed temporal trend in PM10 effects was similar to patterns of circulatory mortality, suggesting that the temporal heterogeneity in PM10 effects might be due to systematic causes rather than random fluctuations.