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Publisher's URL: http://dx.doi.org/10.1093/pubmed/fdr025
Background Active smoking is a recognized risk factor for stroke. We determined the evidence for an association with secondhand smoke exposure. Methods A systematic review was undertaken according to PRISMA guidelines. Random effects meta-analysis provided a pooled estimate of risk, and heterogeneity quantified using I2 values. Potential publication and study bias were assessed using a funnel plot and Egger's test. Meta-regression analyses were used to investigate sources of heterogeneity. Results The 20 eligible studies provided 35 estimates of risk derived from 885 307 participants, of whom 5894 (0.7%) suffered a stroke. The pooled estimate of risk was 1.25 (95% CI: 1.12–1.38) with no evidence of significant publication or small-study bias. There was moderate heterogeneity (I2 = 54.2%, P < 0.001) but no study characteristics were statistically significant in the meta-regression analysis. There was a non-linear dose relationship. The relative risk increased from 1.16 (95% CI: 1.06–1.27) for exposure to 5 cigarettes/day to 1.56 (95% CI: 1.25–1.96) for exposure to 40 cigarettes/day. Conclusions There is evidence of a strong, consistent and dose-dependent association between exposure to secondhand smoke and risk of stroke, suggestive of a causal relationship, with disproportionately high risk at low levels of exposure suggesting no safe lower limit of exposure.
|Glasgow Author(s) Enlighten ID:||Mackay, Dr Daniel and Pell, Professor Jill|
|Authors:||Oono, I. P., Mackay, D. F., and Pell, J. P.|
|College/School:||College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health|
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences
|Journal Name:||Journal of Public Health|
|Publisher:||Oxford University Press|
|Published Online:||21 March 2011|