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Acute effects of outdoor air pollution on emergency department visits due to five clinical subtypes of coronary heart diseases in shanghai, china.

ABSTRACT: Air pollution can be a contributing cause to the development and exacerbation of coronary heart disease (CHD), but there is little knowledge about the acute effects of air pollution on different clinical subtypes of CHD.We conducted a time-series study to investigate the association of air pollution (particulate matter with an aerodynamic diameter < 10 µm [PM10], sulfur dioxide [SO2], and nitrogen dioxide [NO2]) on emergency department (ED) visits due to five different subtypes of CHD in Shanghai, China, from 2010 to 2012. We applied an over-dispersed Poisson generalized addictive model to analyze the associations after controlling for the seasonality, day of the week, and weather conditions.We identified a total of 47 523 ED visits for CHD. A 10-µg/m(3) increase in the present-day concentrations of PM10, SO2, and NO2 was associated with respective increases of 1.10% (95% confidence interval [CI] 0.33%-1.87%), 0.90% (95% CI -0.14%-1.93%), and 1.44% (95% CI 0.63%-2.26%) for total ED visits for CHD. These associations varied greatly by clinical type, with strong effects on sudden cardiac death, moderate effects on acute myocardial infarction and angina, weak effects on ischemic cardiomyopathy, and no effect on occult CHD. The associations were stronger among people aged 65 years or more than in younger individuals and in the cool season versus the warm one.Outdoor air pollution may have different effects of air pollution on 5 subtypes of CHD. Our results might be useful for the primary prevention of various subtypes of CHD exacerbated by air pollution.

SUBMITTER: Xie J

PROVIDER: S-EPMC4213219 | biostudies-other | 2014

REPOSITORIES: biostudies-other

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Acute effects of outdoor air pollution on emergency department visits due to five clinical subtypes of coronary heart diseases in shanghai, china.

Xie Juan J He Mingzhen M Zhu Weiying W

Journal of epidemiology 20140705 6

<h4>Background</h4>Air pollution can be a contributing cause to the development and exacerbation of coronary heart disease (CHD), but there is little knowledge about the acute effects of air pollution on different clinical subtypes of CHD.<h4>Methods</h4>We conducted a time-series study to investigate the association of air pollution (particulate matter with an aerodynamic diameter < 10 µm [PM10], sulfur dioxide [SO2], and nitrogen dioxide [NO2]) on emergency department (ED) visits due to five d ...[more]

PMID: 24998952

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Project description:BackgroundRelatively few studies have been conducted of the association between air pollution and emergency department (ED) visits, and most of these have been based on a small number of visits, for a limited number of health conditions and pollutants, and only daily measures of exposure and response.MethodsA time-series analysis was conducted on nearly 400,000 ED visits to 14 hospitals in seven Canadian cities during the 1990 s and early 2000s. Associations were examined between carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), sulfur dioxide (SO2), and particulate matter (PM 10 and PM2.5), and visits for angina/myocardial infarction, heart failure, dysrhythmia/conduction disturbance, asthma, chronic obstructive pulmonary disease (COPD), and respiratory infections. Daily and 3-hourly visit counts were modeled as quasi-Poisson and analyses controlled for effects of temporal cycles, weather, day of week and holidays.Results24-hour average concentrations of CO and NO2 lag 0 days exhibited the most consistent associations with cardiac conditions (2.1% (95% CI, 0.0-4.2%) and 2.6% (95% CI, 0.2-5.0%) increase in visits for myocardial infarction/angina per 0.7 ppm CO and 18.4 ppb NO2 respectively; 3.8% (95% CI, 0.7-6.9%) and 4.7% (95% CI, 1.2-8.4%) increase in visits for heart failure). Ozone (lag 2 days) was most consistently associated with respiratory visits (3.2% (95% CI, 0.3-6.2%), and 3.7% (95% CI, -0.5-7.9%) increases in asthma and COPD visits respectively per 18.4 ppb). Associations tended to be of greater magnitude during the warm season (April - September). In particular, the associations of PM 10 and PM2.5 with asthma visits were respectively nearly three- and over fourfold larger vs. all year analyses (14.4% increase in visits, 95% CI, 0.2-30.7, per 20.6 microg/m3 PM 10 and 7.6% increase in visits, 95% CI, 5.1-10.1, per 8.2 microg/m3 PM2.5). No consistent associations were observed between three hour average pollutant concentrations and same-day three hour averages of ED visits.ConclusionIn this large multicenter analysis, daily average concentrations of CO and NO2 exhibited the most consistent associations with ED visits for cardiac conditions, while ozone exhibited the most consistent associations with visits for respiratory conditions. PM 10 and PM2.5 were strongly associated with asthma visits during the warm season.

Project description:Various temporal metrics of daily pollution levels have been used to examine the relationships between air pollutants and acute health outcomes. However, daily metrics of the same pollutant have rarely been systematically compared within a study. In this analysis, we describe the variability of effect estimates attributable to the use of different temporal metrics of daily pollution levels. We obtained hourly measurements of ambient particulate matter (PM?.?), carbon monoxide (CO), nitrogen dioxide (NO?), and ozone (O?) from air monitoring networks in 20-county Atlanta for the time period 1993-2004. For each pollutant, we created (1) a daily 1-h maximum; (2) a 24-h average; (3) a commute average; (4) a daytime average; (5) a nighttime average; and (6) a daily 8-h maximum (only for O?). Using Poisson generalized linear models, we examined associations between daily counts of respiratory emergency department visits and the previous day's pollutant metrics. Variability was greatest across O? metrics, with the 8-h maximum, 1-h maximum, and daytime metrics yielding strong positive associations and the nighttime O? metric yielding a negative association (likely reflecting confounding by air pollutants oxidized by O?). With the exception of daytime metric, all of the CO and NO? metrics were positively associated with respiratory emergency department visits. Differences in observed associations with respiratory emergency room visits among temporal metrics of the same pollutant were influenced by the diurnal patterns of the pollutant, spatial representativeness of the metrics, and correlation between each metric and copollutant concentrations. Overall, the use of metrics based on the US National Ambient Air Quality Standards (for example, the use of a daily 8-h maximum O? as opposed to a 24-h average metric) was supported by this analysis. Comparative analysis of temporal metrics also provided insight into underlying relationships between specific air pollutants and respiratory health.

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Acute effects of outdoor air pollution on emergency department visits due to five clinical subtypes of coronary heart diseases in shanghai, china.

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Acute effects of outdoor air pollution on emergency department visits due to five clinical subtypes of coronary heart diseases in shanghai, china.

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