Associations between ambient air pollution and prevalence of stroke and cardiovascular diseases in 33 Chinese communities Guang-Hui Dong a, b , Zhengmin (Min) Qian b, * , Jing Wang c , Weiqing Chen d , Wenjun Ma e , Edwin Trevathan b , Pamela K. Xaverius b , Richard DeClue b , Andrew Wiese b , Marvin Langston b , Miao-Miao Liu a , Da Wang a , Wan-Hui Ren f a Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province 110001, PR China b Department of Epidemiology, School of Public Health, Saint Louis University, Saint Louis, MO 63104, USA c Department of Biostatistics, School of Public Health, Saint Louis University, Saint Louis, MO 63104, USA d Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, PR China e Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 510300, PR China f Department of Ambient Air Pollution Monitor, Shenyang Environmental Monitoring Center, Shenyang, Liaoning Province 110014, PR China highlights  We found significant associations between PM 10 and SO 2 levels and stroke prevalence.  No significant associations between air pollutants and CVDs prevalence were found.  These associations were significant only in men, but not in women. article info Article history: Received 7 November 2012 Received in revised form 11 June 2013 Accepted 14 June 2013 Keywords: Stroke Cardiovascular diseases Ambient air pollution China abstract Inconsistent results have been reported that long-term exposure to ambient air pollution contributes to the increased prevalence of stroke and cardiovascular diseases (CVDs). In order to examine whether the exposure to ambient air pollution was associated with the prevalence of stroke and CVDs among people living in a heavy industrial province of northeast China, we conducted a cross-sectional study of 24,845 Chinese adults, ages 18e74 years old, from 33 communities in the 11 districts of the three Northeastern Chinese Cities during 2009. Three-year (2006e2008) average concentrations of particles with an aero- dynamic diameter 10 mm (PM 10 ), sulfur dioxide (SO 2 ), nitrogen dioxides (NO 2 ), and Ozone (O 3 ) were calculated from monitoring stations in each of the 11 districts. We used two-level logistic regressions models to examine the effects of yearly variations in exposure to each pollutant, controlling for important covariates. We found significant associations between PM 10 and SO 2 levels and stroke prev- alence after accounting for important covariates: the adjusted odds ratio for stroke increased by 1.16 (95% confidence interval [CI], 1.03e1.30) per 19 mgm 3 increase in PM 10 , and 1.14 (95%CI, 1.01e1.29) per 20 mgm 3 increase in SO 2 , respectively. When stratified analysis by gender, these associations were significant only in men, but not in women. In conclusion, this study shows the association between long- term exposure to PM 10 and SO 2 and increased stroke prevalence, and the associations were more apparent in men than in women. Ó 2013 Elsevier Ltd. All rights reserved. 1. Introduction Cardiovascular diseases (CVDs) account for the largest propor- tion of deaths in the world, causing more than 17 million deaths in 2008 (Mendis et al., 2011). Furthermore, what holds our concern is that, over the past two decades, deaths from CVDs have increased at a fast rate in low-and middle-income countries (Mendis et al., 2011). It has been suggested that this increase cannot be * Corresponding author. Department of Epidemiology, School of Public Health, Saint Louis University, Salus Center/Room 473, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA. Tel.: þ1 314 977 8158; fax: þ1 314 977 3234. E-mail address: zqian2@slu.edu (Z.(Min) Qian). Contents lists available at SciVerse ScienceDirect Atmospheric Environment journal homepage: www.elsevier.com/locate/atmosenv 1352-2310/$ e see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.atmosenv.2013.06.034 Atmospheric Environment 77 (2013) 968e973