Skip to main content
SpringerLink
Log in

Geospatial patterns of hospitalization rates for stroke with comorbid hypertension in relation to environmental sources of persistent organic pollutants: results from a 12-year population-based study

  • Research Article
  • Published:
Environmental Science and Pollution Research Aims and scope Submit manuscript

Abstract

Purpose

Recent evidence indicates that exposure to persistent organic pollutants (POPs) is emerging as an important risk factor for atherosclerosis-related diseases, including stroke. Hypertension (HTN) is a major risk factor for stroke, and some studies suggest that exposure to POPs is also a risk factor for HTN. We hypothesized that POPs increase the environmental burden of stroke with comorbid HTN.

Methods

A population-based study of hospitalization rates for stroke with comorbid HTN in populations presumably exposed to POPs, based on the zip code of residence, was conducted. Data on hospitalizations for stroke with comorbid HTN were obtained from the New York Statewide Planning and Research Cooperative System for 1993–2004. Relative risks, with 95% confidence intervals (RR, 95% CI), of hospitalization were estimated by multiple Poisson regression analysis.

Results

RR of hospitalization for stroke with comorbid HTN was 13.4% higher in populations residing in zip codes containing or abutting environmental sources of POPs (RR = 1.134; 95% CI, 1.036–1.241; p = 0.006). Also, hospitalization rates were significantly higher in males than in females (RR = 1.397; 95% CI, 1.357–1.437; p < 0.001), in African Americans than in Caucasians (RR = 3.902; 95% CI, 3.617–4.208; p < 0.001), and in older age groups (p for trend < 0.001). These statistically significant findings of the effect of demographic factors are highly consistent with the current knowledge of stroke and serve as indirect quality indicators for our model.

Conclusions

Results of our study support the hypothesis that exposure to POPs increases the environmental burden of both stroke and HTN.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

CI:

Confidence interval

HTN:

Hypertension

PCBs:

Polychlorinated biphenyls

POPs:

Persistent organic pollutants

RR:

Relative risk

SES:

Socio-economic status

References

  • Anonymous (1997) ICD-9-CM: International classification of diseases, 9th revision, clinical modification. PMIC, Practice Management Information Corp, Los Angeles

    Google Scholar 

  • Aschengrau A, Seage GR (2008) Essentials of epidemiology in public health. Jones and Bartlett, Sudbury

    Google Scholar 

  • Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, Kirby A, Sourjina T, Peto R, Collins R, Simes R (2005) Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90, 056 participants in 14 randomised trials of statins. Lancet 366:1267–1278

    Article  CAS  Google Scholar 

  • Bejot Y, Benatru I, Rouaud O, Fromont A, Besancenot JP, Moreau T, Giroud M (2007) Epidemiology of stroke in Europe: geographic and environmental differences. J Neurol Sci 262:85–88

    Article  Google Scholar 

  • Bevan S, Porteous L, Sitzer M, Markus HS (2005) Phosphodiesterase 4D gene, ischemic stroke, and asymptomatic carotid atherosclerosis. Stroke 36:949–953

    Article  CAS  Google Scholar 

  • Bonita R, Duncan J, Truelsen T, Jackson RT, Beaglehole R (1999) Passive smoking as well as active smoking increases the risk of acute stroke. Tob Control 8:156–160

    Article  CAS  Google Scholar 

  • Brewster DW, Bombick DW, Matsumura F (1988) Rabbit serum hypertriglyceridemia after administration of 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin (TCDD). J Toxicol Environ Health 25:495–507

    Article  CAS  Google Scholar 

  • Chen CJ, Hsueh YM, Lai MS, Shyu MP, Chen SY, Wu MM, Kuo TL, Tai TY (1995) Increased prevalence of hypertension and long-term arsenic exposure. Hypertension 25:53–60

    Google Scholar 

  • Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ (2003) The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 289:2560–2572

    Article  CAS  Google Scholar 

  • Dalton TP, Kerzee JK, Wang B, Miller M, Dieter MZ, Lorenz JN, Shertzer HG, Nerbert DW, Puga A (2001) Dioxin exposure is an environmental risk factor for ischemic heart disease. Cardiovasc Toxicol 1:285–298

    Article  CAS  Google Scholar 

  • DeCaprio AP, Johnson GW, Tarbell AM, Carpenter DO, Chiarenzelli JR, Morse GS, Santiago-Rivera AL, Schymura MJ (2005) Polychlorinated biphenyl (PCB) exposure assessment by multivariate statistical analysis of serum congener profiles in an adult Native American population. Environ Res 98:284–302

    Article  CAS  Google Scholar 

  • Evans GW, Kantrowitz E (2002) Socioeconomic status and health: the potential role of environmental risk exposure. Annu Rev Public Health 23:303–331

    Article  Google Scholar 

  • Faber DR, Krieg EJ (2002) Unequal exposure to ecological hazards: environmental injustices in the Commonwealth of Massachusetts. Environ Health Perspect 110(Suppl 2):277–288

    Google Scholar 

  • Feigin VL, Lawes CM, Bennett DA, Anderson CS (2003) Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2:43–53

    Article  Google Scholar 

  • Fisher BE (1999) Most unwanted: persistent organic pollutants. Environ Health Perspect 107:A18–23

    Article  CAS  Google Scholar 

  • Goldstein LB, Adams R, Alberts MJ, Appel LJ, Brass LM, Bushnell CD, Culebras A, DeGraba TJ, Gorelick PB, Guyton JR, Hart RG, Howard G, Kelly-Hayes M, Nixon JV, Sacco RL (2006) Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 113:e873–923

    Article  Google Scholar 

  • Goncharov A, Haase RF, Santiago-Rivera A, Morse G, McCaffrey RJ, Rej R, Carpenter DO (2008) High serum PCBs are associated with elevation of serum lipids and cardiovascular disease in a Native American population. Environ Res 106:226–239

    Article  CAS  Google Scholar 

  • Goncharov A, Bloom M, Pavuk M, Birman I, Carpenter DO (2010) Blood pressure and hypertension in relation to levels of serum polychlorinated biphenyls in residents of Anniston, Alabama. J Hypertens 28:2053–2060

    CAS  Google Scholar 

  • Ha MH, Lee DH, Jacobs DR (2007) Association between serum concentrations of persistent organic pollutants and self-reported cardiovascular disease prevalence: results from the National Health and Nutrition Examination Survey, 1999–2002. Environ Health Perspect 115:1204–1209

    Article  CAS  Google Scholar 

  • Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, Thomas D (2004) Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 363:1491–1502

    Article  CAS  Google Scholar 

  • Hankey GJ (2006) Potential new risk factors for ischemic stroke: what is their potential? Stroke 37:2181–2188

    Article  Google Scholar 

  • Huang X, Lessner L, Carpenter DO (2006) Exposure to persistent organic pollutants and hypertensive disease. Environ Res 102:101–106

    Article  CAS  Google Scholar 

  • Jokinen MP, Walker NJ, Brix AE, Sells DM, Haseman JK, Nyska A (2003) Increase in cardiovascular pathology in female Sprague-Dawley rats following chronic treatment with 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin and 3, 3′, 4, 4′, 5-pentachlorobiphenyl. Cardiovasc Toxicol 3:299–310

    Article  CAS  Google Scholar 

  • Jones KC, de Voogt P (1999) Persistent organic pollutants (POPs): state of the science. Environ Pollut 100:209–221

    Article  CAS  Google Scholar 

  • Kang HK, Dalager NA, Needham LL, Patterson DG Jr, Lees PS, Yates K, Matanoski GM (2006) Health status of army chemical corps Vietnam veterans who sprayed defoliant in Vietnam. Am J Ind Med 49:875–884

    Article  CAS  Google Scholar 

  • Kreiss K, Zack MM, Kimbrough RD, Needham LL, Smrek AL, Jones BT (1981) Association of blood pressure and polychlorinated biphenyl levels. JAMA 245:2505–2509

    Article  CAS  Google Scholar 

  • Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV (2005) Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: the public health disparities geocoding project. Am J Public Health 95:312–323

    Article  Google Scholar 

  • Kung HC, Hoyert DL, Xu JQ, Murphy SL (2008) Deaths: final data for 2005. Natl Vital Stat Rep 56:1–121

    Google Scholar 

  • Lawes CM, Bennett DA, Feigin VL, Rodgers A (2004a) Blood pressure and stroke: an overview of published reviews. Stroke 35:776–785

    Article  Google Scholar 

  • Lawes CM, Parag V, Bennett DA, Suh I, Lam TH, Whitlock G, Barzi F, Woodward M (2004b) Blood glucose and risk of cardiovascular disease in the Asia Pacific region. Diab Care 27:2836–2842

    Article  CAS  Google Scholar 

  • Lind PM, Orberg J, Edlund UB, Sjoblom L, Lind L (2004) The dioxin-like pollutant PCB 126 (3, 3′, 4, 4′, 5-pentachlorobiphenyl) affects risk factors for cardiovascular disease in female rats. Toxicol Lett 150:293–299

    Article  CAS  Google Scholar 

  • Lloyd-Jones D et al (2010) Heart disease and stroke statistics—2010 update. A report from the American heart association. Circulation 121:e1–e170

    Article  Google Scholar 

  • Mathers CD, Lopez AD, Murray CJL (2006) The burden of disease and mortality by condition: data, methods, and results for 2001. In: Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL (eds) Global burden of disease and risk factors. The World Bank and Oxford University Press, New York, pp 45–240

    Google Scholar 

  • Matsusue K, Ishii Y, Ariyoshi N, Oguri K (1997) A highly toxic PCB produces unusual changes in the fatty acid composition of rat liver. Toxicol Lett 91:99–104

    Article  CAS  Google Scholar 

  • Mocarelli P (2001) Seveso: a teaching story. Chemosphere 43:391–402

    Article  CAS  Google Scholar 

  • National Institutes of Health (2006) Incidence and prevalence: 2006 chart book on cardiovascular and lung diseases. National Heart, Lung, and Blood Institute, Bethesda

    Google Scholar 

  • Neal B, MacMahon S, Chapman N (2000) Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood pressure lowering treatment trialists’ collaboration. Lancet 356:1955–1964

    Article  CAS  Google Scholar 

  • Pelclova D, Fenclova Z, Preiss J, Prochazka B, Spacil J, Dubska Z, Okrouhlik B, Lukas E, Urban P (2002) Lipid metabolism and neuropsychological follow-up study of workers exposed to 2, 3, 7, 8-tetrachlordibenzo-p-dioxin. Int Arch Occup Environ Health 75(Suppl):S60–66

    CAS  Google Scholar 

  • Pelclova D, Urban P, Preiss J, Lukas E, Fenclova Z, Navratil T, Dubska Z, Senholdova Z (2006) Adverse health effects in humans exposed to 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin (TCDD). Rev Environ Health 21:119–138

    CAS  Google Scholar 

  • Prüss-Üstün A, Corvalán C, World Health Organization (2006) Preventing disease through healthy environments: towards an estimate of the environmental burden of disease. World Health Organization, Geneva

    Google Scholar 

  • Qureshi AI, Ezzeddine MA, Nasar A, Suri MF, Kirmani JF, Hussein HM, Divani AA, Reddi AS (2007) Prevalence of elevated blood pressure in 563, 704 adult patients with stroke presenting to the ED in the United States. Am J Emerg Med 25:32–38

    Article  Google Scholar 

  • Rodgers H, Greenaway J, Davies T, Wood R, Steen N, Thomson R (2004) Risk factors for first-ever stroke in older people in the north East of England: a population-based study. Stroke 35:7–11

    Article  Google Scholar 

  • Rogers RG, Hummer RA, Nam CB (2000) Living and dying in the USA: behavioral, health, and social differentials of adult mortality. Academic, San Diego

    Google Scholar 

  • Rosamond WD, Folsom AR, Chambless LE, Wang CH, McGovern PG, Howard G, Copper LS, Shahar E (1999) Stroke incidence and survival among middle-aged adults: 9-year follow-up of the Atherosclerosis Risk in Communities (ARIC) cohort. Stroke 30:736–743

    CAS  Google Scholar 

  • Rothman KJ, Greenland S, Lash TL (2008) Modern epidemiology. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  • Sacco RL, Benjamin EJ, Broderick JP, Dyken M, Easton JD, Feinberg WM, Goldstein LB, Gorelick PB, Howard G, Kittner SJ, Manolio TA, Whisnant JP, Wolf PA (1997) Risk factors. Prevention and rehabilitation of stroke. American heart association prevention conference. Stroke 28:1507–1517

    CAS  Google Scholar 

  • Schiller CM, Adcock CM, Moore RA, Walden R (1985) Effect of 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin (TCDD) and fasting on body weight and lipid parameters in rats. Toxicol Appl Pharmacol 81:356–361

    Article  CAS  Google Scholar 

  • Sergeev AV, Carpenter DO (2005) Hospitalization rates for coronary heart disease in relation to residence near areas contaminated with persistent organic pollutants and other pollutants. Environ Health Perspect 113:756–761

    Article  CAS  Google Scholar 

  • Shcherbatykh I, Huang X, Lessner L, Carpenter DO (2005) Hazardous waste sites and stroke in New York State. Environ Health 4:18

    Article  Google Scholar 

  • Sirivarasai J, Kaojarern S, Wananukul W, Deechakwan W, Srisomerarn P (2004) Non-occupational lead and cadmium exposure and blood pressure in Thai men. Asia Pac J Public Health 16:133–137

    CAS  Google Scholar 

  • Vazquez G, Suri MF, Lakshminarayan K, Memon MZ, Ezzeddine M, Qureshi AI (2008) Prevalence of elevated blood pressure in adult patients presenting to the emergency department. J Vasc Interv Neurol 1:46–49

    Google Scholar 

  • Wang TJ, Massaro JM, Levy D, Vasan RS, Wolf PA, D’Agostino RB, Larson MG, Kannel WB, Benjamin EJ (2003) A risk score for predicting stroke or death in individuals with new-onset atrial fibrillation in the community: the Framingham heart study. JAMA 290:1049–1056

    Article  Google Scholar 

  • Whisnant JP (1997) Modeling of risk factors for ischemic stroke. The Willis Lecture. Stroke 28:1840–1844

    CAS  Google Scholar 

  • Willmot M, Leonardi-Bee J, Bath PM (2004) High blood pressure in acute stroke and subsequent outcome: a systematic review. Hypertension 43:18–24

    Article  CAS  Google Scholar 

  • World Health Organization (2006) Almost a quarter of all disease caused by environmental exposure (News Release, 16 June 2006). Available at: http://www.who.int/mediacentre/news/releases/2006/pr32/en/index.html. Accessed 23 August 2010

Download references

Acknowledgements

This project was supported by Ohio University Research Challenge funding (A.V.S.) and a grant from the Fogarty International Center, National Institutes of Health (TW000636, to D.O.C.), with additional support from the Institute for Health and the Environment (D.O.C.). We thank R. Huang for help with the demographics data. The authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Social and Public Health, Ohio University, Grover Center W343, Athens, OH, 45701, USA

    Alexander V. Sergeev

  2. Institute for Health and the Environment, University at Albany, Rensselaer, NY, USA

    David O. Carpenter

Authors
  1. Alexander V. Sergeev
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David O. Carpenter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander V. Sergeev.

Additional information

Responsible editor: Markus Hecker

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sergeev, A.V., Carpenter, D.O. Geospatial patterns of hospitalization rates for stroke with comorbid hypertension in relation to environmental sources of persistent organic pollutants: results from a 12-year population-based study. Environ Sci Pollut Res 18, 576–585 (2011). https://doi.org/10.1007/s11356-010-0399-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11356-010-0399-7

Keywords

Search

Navigation