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Emergency hospital admissions for cardiovascular diseases and ambient levels of carbon monoxide: results for 126 United States urban counties, 1999-2005.

ABSTRACT: Evidence on risk of cardiovascular disease (CVD) hospitalization associated with short-term exposure to outdoor carbon monoxide (CO), an air pollutant primarily generated by traffic, is inconsistent across studies. Uncertainties remain on the degree to which associations are attributable to other traffic pollutants and whether effects persist at low levels.We conducted a multisite time-series study to estimate risk of CVD hospitalization associated with short-term CO exposure in 126 US urban counties during 1999-2005 for >9.3 million Medicare enrollees aged > or =65 years. We considered models with adjustment by other traffic-related pollutants: NO2, fine particulate matter (with aerodynamic diameter < or =2.5 microm), and elemental carbon. We found a positive and statistically significant association between same-day CO and increased risk of hospitalization for multiple CVD outcomes (ischemic heart disease, heart rhythm disturbances, heart failure, cerebrovascular disease, total CVD). The association remained positive and statistically significant but was attenuated with copollutant adjustment, especially NO2. A 1-ppm increase in same-day daily 1-hour maximum CO was associated with a 0.96% (95% posterior interval, 0.79%, 1.12%) increase in risk of CVD admissions. With same-day NO(2) adjustment, this estimate was 0.55% (0.36%, 0.74%). The risk persisted at low CO levels <1 ppm.We found evidence of an association between short-term exposure to ambient CO and risk of CVD hospitalizations, even at levels well below current US health-based regulatory standards. This evidence indicates that exposure to current CO levels may still pose a public health threat, particularly for persons with CVD.

SUBMITTER: Bell ML

PROVIDER: S-EPMC2777712 | biostudies-literature | 2009 Sep

REPOSITORIES: biostudies-literature

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Emergency hospital admissions for cardiovascular diseases and ambient levels of carbon monoxide: results for 126 United States urban counties, 1999-2005.

Bell Michelle L ML Peng Roger D RD Dominici Francesca F Samet Jonathan M JM

Circulation 20090831 11

<h4>Background</h4>Evidence on risk of cardiovascular disease (CVD) hospitalization associated with short-term exposure to outdoor carbon monoxide (CO), an air pollutant primarily generated by traffic, is inconsistent across studies. Uncertainties remain on the degree to which associations are attributable to other traffic pollutants and whether effects persist at low levels.<h4>Methods and results</h4>We conducted a multisite time-series study to estimate risk of CVD hospitalization associated ...[more]

PMID: 19720933

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Project description:BackgroundBlack carbon (BC) is a ubiquitous component of particulate matter (PM) emitted from combustion-related sources and is associated with a number of health outcomes.ObjectivesWe conducted a systematic review to evaluate the potential for cardiovascular morbidity and mortality following exposure to ambient BC, or the related component elemental carbon (EC), in the context of what is already known about the associations between exposure to fine particulate matter (PM2.5) and cardiovascular health outcomes.Data sourcesWe conducted a stepwise systematic literature search of the PubMed database and employed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting our results.Study eligibility criteriaStudies meeting inclusion criteria (i.e., include a quantitative measurement of BC or EC used to characterize exposure and an effect estimate of the association of the exposure metric with ED visits, hospital admissions, or mortality due to cardiovascular disease) were evaluated for risk of bias in study design and results.Study appraisal and synthesis methodsRisk of bias evaluations assess some aspects of internal validity of study findings based on study design, conduct, and reporting and identify potential issues related to confounding or other biases.ResultsThe results of our systematic review demonstrate similar results for BC or EC and PM2.5; that is, a generally modest, positive association of each pollutant measurement with cardiovascular emergency department visits, hospital admissions, and mortality. There is no clear evidence that health risks are greater for either BC or EC when compared to one another, or when either is compared to PM2.5.LimitationsWe were unable to adequately evaluate the role of copollutant confounding or differential spatial heterogeneity for BC or EC compared to PM2.5.Conclusions and implications of key findingsOverall, the evidence at present indicates that BC or EC is consistently associated with cardiovascular morbidity and mortality but is not sufficient to conclude that BC or EC is independently associated with these effects rather than being an indicator for PM2.5 mass.Systematic review registration numberNot available.

Dataset Information

Emergency hospital admissions for cardiovascular diseases and ambient levels of carbon monoxide: results for 126 United States urban counties, 1999-2005.

Publications

Emergency hospital admissions for cardiovascular diseases and ambient levels of carbon monoxide: results for 126 United States urban counties, 1999-2005.

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