The Air Quality Health Index as a predictor of emergency department visits for ischemic stroke in Edmonton, Canada

The Air Quality Health Index (AQHI) is an aggregate measure of outdoor air quality. We investigated associations between the AQHI and emergency department (ED) visits for acute ischemic stroke to validate the AQHI as a predictor of risk of morbidity from stroke. ED visits in Edmonton, Canada between 1998 and 2002 were linked to hourly AQHI values and concentrations of carbon monoxide (CO), nitrogen dioxide (NO2), ozone, particulate matter with aerodynamic diameter less than 2.5 and 10 μm, and sulfur dioxide. A time-stratified case-crossover analysis was employed, and measures of association were adjusted for temperature and relative humidity. The AQHI, NO2 and CO were positively associated with the number of ED visits for ischemic stroke during April–September, and associations were strongest for persons 75 years of age and older. In this age range, the odds ratios (95% confidence intervals) for an interquartile range increase of AQHI in 1–24 h, 25–48 h, and 1–72 h lag periods were 1.23 (1.08–1.40), 1.15 (1.01–1.31), and 1.30 (1.10–1.54), respectively. Significant positive associations were also observed for NO2 and CO. Our finding that ED visits for stroke were significantly associated with the AQHI suggests that the AQHI may be a valid communication tool for air pollution morbidity effects related to stroke.