{
  "abstract": "Background and purpose\n\nAmbient air pollution is an established risk factor for incident stroke, but whether post-discharge pollutant exposure influences stroke recurrence remains unclear. We investigated the association between post-discharge exposure to six ambient air pollutants and stroke recurrence after acute ischemic stroke.Methods\n\nWe analyzed 27,340 patients in the Clinical Research Collaboration for Stroke in Korea-National Institutes of Health nationwide multicenter registry (2014-2021). The 3-month post-discharge district-level mean concentrations of particulate matter ≤10 μm (PM10), ≤2.5 μm (PM2.5), nitrogen dioxide, sulfur dioxide (SO2), carbon monoxide, and ozone were estimated by inverse-distance-weighted interpolation. The primary outcome was stroke recurrence from 3 to 15 months post-discharge. Cause-specific Cox models with cluster-robust standard errors were used, treating death as a competing risk; non-linear dose-response was assessed by restricted cubic splines.Results\n\nDuring follow-up (median 364.8 days), 764 patients had recurrence and 542 died. Only SO2 showed a significant association with recurrence (P for overall association in the spline model= 0.024), with a graded dose-response; the non-linear (J-shaped) pattern did not reach significance (P for non-linearity=0.095), and quartile contrasts were individually non-significant (Q4 vs. Q1: hazard ratio 1.19, 95% confidence interval 0.94-1.50). The association was numerically stronger among older adults (≥75 years; P for interaction=0.051) and women (P for interaction=0.062). The highest SO2 concentrations were observed in harbor cities (Incheon, Ulsan, Busan). No significant associations were observed for the other five pollutants.Conclusions\n\nElevated post-discharge SO2 exposure was associated with increased stroke recurrence, with a graded dose-response, supporting consideration of ambient air quality in secondary stroke prevention.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurology, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea. gooday19@gmail.com.",
    "Department of Medical IT Engineering, College of Software Convergence, Soonchunhyang University, Asan, Korea.",
    "Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.",
    "Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.",
    "Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.",
    "Department of Neurology, Dong-A University Hospital, Busan, Korea.",
    "Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea.",
    "Department of Neurology, Uijeongbu Eulji Hospital, Eulji University School of Medicine, Uijeongbu, Korea.",
    "Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea.",
    "Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea.",
    "Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.",
    "Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea.",
    "Department of Neurology, Jeju National University Hospital, Jeju, Korea.",
    "Department of Neurology, Seoul Medical Center, Seoul, Korea.",
    "Department of Neurology, Ulsan University Hospital, Ulsan, Korea.",
    "Department of Neurology, Yeungnam University Medical Center, Daegu, Korea.",
    "Department of Neurology, Soonchunhyang University Seoul Hospital, Seoul, Korea.",
    "Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.",
    "Department of Neurology, Chung-Ang University Hospital, Seoul, Korea.",
    "Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea.",
    "Department of Biostatistics, Korea University, Seoul, Korea.",
    "Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. braindoc@snu.ac.kr."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 43,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Keon-Joo Lee"
    },
    {
      "affs": [
        1
      ],
      "name": "Jeongeun Hwang"
    },
    {
      "affs": [
        2
      ],
      "name": "Seong-Eun Kim"
    },
    {
      "affs": [
        2
      ],
      "name": "Beom Joon Kim"
    },
    {
      "affs": [
        2
      ],
      "name": "Moon-Ku Han"
    },
    {
      "affs": [
        3
      ],
      "name": "Hyunsoo Kim"
    },
    {
      "affs": [
        3
      ],
      "name": "Joon-Tae Kim"
    },
    {
      "affs": [
        3
      ],
      "name": "Kang-Ho Choi"
    },
    {
      "affs": [
        4
      ],
      "name": "Kyu Sun Yum"
    },
    {
      "affs": [
        4
      ],
      "name": "Dong-Ick Shin"
    },
    {
      "affs": [
        5
      ],
      "name": "Jae-Kwan Cha"
    },
    {
      "affs": [
        5
      ],
      "name": "Dae-Hyun Kim"
    },
    {
      "affs": [
        6
      ],
      "name": "Dong-Seok Gwak"
    },
    {
      "affs": [
        6
      ],
      "name": "Dong-Eog Kim"
    },
    {
      "affs": [
        7
      ],
      "name": "Jong-Moo Park"
    },
    {
      "affs": [
        8
      ],
      "name": "Kyusik Kang"
    },
    {
      "affs": [
        9
      ],
      "name": "Soo Joo Lee"
    },
    {
      "affs": [
        9
      ],
      "name": "Jae Guk Kim"
    },
    {
      "affs": [
        10
      ],
      "name": "Minwoo Lee"
    },
    {
      "affs": [
        10
      ],
      "name": "Mi-Sun Oh"
    },
    {
      "affs": [
        10
      ],
      "name": "Kyung-Ho Yu"
    },
    {
      "affs": [
        11
      ],
      "name": "Hong-Kyun Park"
    },
    {
      "affs": [
        11
      ],
      "name": "Keun-Sik Hong"
    },
    {
      "affs": [
        11
      ],
      "name": "Yong-Jin Cho"
    },
    {
      "affs": [
        12
      ],
      "name": "Joong-Goo Kim"
    },
    {
      "affs": [
        12
      ],
      "name": "Jay Chol Choi"
    },
    {
      "affs": [
        13
      ],
      "name": "Tai Hwan Park"
    },
    {
      "affs": [
        13
      ],
      "name": "Sang-Soon Park"
    },
    {
      "affs": [
        14
      ],
      "name": "Jee-Hyun Kwon"
    },
    {
      "affs": [
        14
      ],
      "name": "Wook-Joo Kim"
    },
    {
      "affs": [
        15
      ],
      "name": "Doo Hyuk Kwon"
    },
    {
      "affs": [
        15
      ],
      "name": "Jun Lee"
    },
    {
      "affs": [
        16
      ],
      "name": "Kyungbok Lee"
    },
    {
      "affs": [
        16
      ],
      "name": "Jeong-Yoon Lee"
    },
    {
      "affs": [
        17
      ],
      "name": "Sung Il Sohn"
    },
    {
      "affs": [
        17
      ],
      "name": "Jeong-Ho Hong"
    },
    {
      "affs": [
        18
      ],
      "name": "Kwang-Yeol Park"
    },
    {
      "affs": [
        18
      ],
      "name": "Hae-Bong Jeong"
    },
    {
      "affs": [
        19
      ],
      "name": "Chulho Kim"
    },
    {
      "affs": [
        19
      ],
      "name": "Sang-Hwa Lee"
    },
    {
      "affs": [
        20
      ],
      "name": "Juneyoung Lee"
    },
    {
      "affs": [
        21
      ],
      "name": "Hee-Joon Bae"
    },
    {
      "name": "CRCS-K-NIH Investigators"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/882s05mcqpzz0.bib",
  "cited_by": 0,
  "doi": "10.5853/jos.2026.03265",
  "fulltext_url": "https://europepmc.org/articles/PMC13678330",
  "id": "882s05mcqpzz0",
  "issns": [
    "2287-6391",
    "2287-6405"
  ],
  "landing_url": "https://europepmc.org/article/MED/42894454",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2307|Air Quality and Health Impacts"
    ]
  ],
  "openalex": "W7220656955",
  "pdf_url": "https://europepmc.org/articles/PMC13678330?pdf=render",
  "pmcid": "PMC13678330",
  "pmid": "42894454",
  "published": "2026-08-30",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/882s05mcqpzz0.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:41Z",
      "native_id": "MED:42894454",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42894454"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2307|Air Quality and Health Impacts",
      "subfield": "pharmacology-toxicology"
    }
  ],
  "title": "Post-Discharge Ambient Sulfur Dioxide Exposure and Stroke Recurrence After Acute Ischemic Stroke.",
  "title_text": "Post-Discharge Ambient Sulfur Dioxide Exposure and Stroke Recurrence After Acute Ischemic Stroke.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:41Z",
  "url": "https://research.draconitic.com/paper/882s05mcqpzz0",
  "venue": "Journal of stroke",
  "versions": []
}