Dataset Information

Acute and chronic effects of particles on hospital admissions in New-England.

ABSTRACT:

Background

Many studies have reported significant associations between exposure to PM(2.5) and hospital admissions, but all have focused on the effects of short-term exposure. In addition all these studies have relied on a limited number of PM(2.5) monitors in their study regions, which introduces exposure error, and excludes rural and suburban populations from locations in which monitors are not available, reducing generalizability and potentially creating selection bias.

Methods

Using our novel prediction models for exposure combining land use regression with physical measurements (satellite aerosol optical depth) we investigated both the long and short term effects of PM(2.5) exposures on hospital admissions across New-England for all residents aged 65 and older. We performed separate Poisson regression analysis for each admission type: all respiratory, cardiovascular disease (CVD), stroke and diabetes. Daily admission counts in each zip code were regressed against long and short-term PM(2.5) exposure, temperature, socio-economic data and a spline of time to control for seasonal trends in baseline risk.

Results

We observed associations between both short-term and long-term exposure to PM(2.5) and hospitalization for all of the outcomes examined. In example, for respiratory diseases, for every 10-µg/m(3) increase in short-term PM(2.5) exposure there is a 0.70 percent increase in admissions (CI = 0.35 to 0.52) while concurrently for every 10-µg/m(3) increase in long-term PM(2.5) exposure there is a 4.22 percent increase in admissions (CI = 1.06 to 4.75).

Conclusions

As with mortality studies, chronic exposure to particles is associated with substantially larger increases in hospital admissions than acute exposure and both can be detected simultaneously using our exposure models.

SUBMITTER: Kloog I

PROVIDER: S-EPMC3328473 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

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Publications

Acute and chronic effects of particles on hospital admissions in New-England.

Kloog Itai I Coull Brent A BA Zanobetti Antonella A Koutrakis Petros P Schwartz Joel D JD

PloS one 20120417 4

<h4>Background</h4>Many studies have reported significant associations between exposure to PM(2.5) and hospital admissions, but all have focused on the effects of short-term exposure. In addition all these studies have relied on a limited number of PM(2.5) monitors in their study regions, which introduces exposure error, and excludes rural and suburban populations from locations in which monitors are not available, reducing generalizability and potentially creating selection bias.<h4>Methods</h4 ...[more]

PMID: 22529923

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Project description:BACKGROUND:Little information is available on how primary and comorbid acute myocardial infarction contribute to the mortality burden of acute myocardial infarction, the share of these deaths that occur during or after a hospital admission, and the reasons for hospital admission of those who died from acute myocardial infarction. Our aim was to fill in these gaps in the knowledge about deaths and hospital admissions due to acute myocardial infarction. METHODS:We used individually linked national hospital admission and mortality data for England from 2006 to 2010 to identify all primary and comorbid diagnoses of acute myocardial infarction during hospital stay and their associated fatality rates (during or within 28 days of being in hospital). Data were obtained from the UK Small Area Health Statistics Unit and supplied by the Health and Social Care Information Centre (now NHS Digital) and the Office of National Statistics. We calculated event rates (reported as per 100?000 population for relevant age and sex groups) and case-fatality rate for primary acute myocardial infarction diagnosed during the first physician encounter or during subsequent encounters, and acute myocardial infarction diagnosed only as a comorbidity. We also calculated what proportion of deaths from acute myocardial infarction occurred in people who had been in hospital on or within the 28 days preceding death, and whether acute myocardial infarction was one of the recorded diagnoses in such admissions. FINDINGS:Acute myocardial infarction was diagnosed in the first physician encounter in 307?496 (69%) of 446?744 admissions with a diagnosis of acute myocardial infarction, in the second or later physician encounter in 52?374 (12%) admissions, and recorded only as a comorbidity in 86?874 (19%) admissions. Patients with comorbid diagnoses of acute myocardial infarction had two to three times the case-fatality rate of patients in whom acute myocardial infarction was a primary diagnosis. 135?950 deaths were recorded as being caused by acute myocardial infarction as the underlying cause of death, of which 66?490 (49%) occurred in patients who were in hospital on the day of death or in the 28 days preceding death. AMI was the primary diagnosis in 32?695 (49%) of these 66?490 patients (27?678 [42%] diagnosed in the first physician encounter and 5017 [8%] in a second or subsequent encounter), was a comorbid diagnosis in 12?118 (18%), and was not mentioned at all in the remaining 21?677 (33%). The most common causes of admission in people who did not have an acute myocardial infarction diagnosis but went on to die of acute myocardial infarction as the underlying cause of death were other circulatory conditions (7566 [35%] of 21?677 deaths), symptomatic diagnoses including non-specific chest pain, dyspnoea and syncope (1368 [6%] deaths), and respiratory disorders (2662 [12%] deaths), mainly pneumonia and chronic obstructive airways disease. INTERPRETATION:As many acute myocardial infarction deaths occurring within 28 days of being in hospital follow a non-acute myocardial infarction admission as follow an acute myocardial infarction admission. These people are often diagnosed with other circulatory disorders or symptoms of circulatory disturbance. Further investigation is needed to establish whether there are symptoms and information that can be used to predict the risk of a fatal acute myocardial infarction in such patients, which can contribute to reducing the mortality burden of acute myocardial infarction. FUNDING:Wellcome Trust, Medical Research Council, Public Health England, National Institute for Health Research.

Dataset Information

Acute and chronic effects of particles on hospital admissions in New-England.

Background

Methods

Results

Conclusions

Publications

Acute and chronic effects of particles on hospital admissions in New-England.

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