Associations between short-term exposure to ambient air pollution and emergency department visits for cardiovascular diseases in thirteen U.S. cities Restricted; Files & ToC

Abstract

Objective

This study aimed to estimate the association between short-term exposures to ambient air pollutants and emergency department (ED) visits for cardiovascular diseases (CVD) in 13 cities in the United States during the period 2005-2014.

Methods

Daily counts of ED visits data were obtained from hospital associations or health departments from 9 US states. Daily air pollution and meteorological data were retrieved from data fusion products. Quasi-Poisson log-linear regression models were adopted to analyze the association between same-day exposures to six air pollutants (NO2, SO2, O3, CO, PM2.5, PM10) and ED visits for l CVD, adjusted for temporal trends and meteorology. Co-diagnosis of diabetes was inspected as a potential effect modifier.

Results

For all CVD ED visits, we found positive associations for CO (RR = 1.002, 95% CI = [1.001, 1.003]), PM2.5 (1.001, [1.000, 1.002]), and SO2 (1.001, [1.000, 1.002]) per interquartile range (IQR) increase in same-day pollutant concentration. An IQR increase in NO2 was associated with increased risk in ED visits for ischemic heart disease (1.005, [1.001, 1.008]) and congestive heart failure (1.006, [1.001, 1.010]). Moreover, we found evidence of increased risks among patients with diabetes for several pollutants. For example, among diabetes patients, ED visits for all circulatory diseases were associated with PM10 (1.004, [1.001, 1.006]), PM2.5 (1.004, [1.002, 1.006]), and SO2 (1.002, [1.000, 1.003]), while associations among non-diabetes patients were weaker or null. Diabetes also increased the risk of ischemic heart disease ED visits associated with NO2 (1.008, [1.003, 1.013]), as well as risk for acute myocardial infarction ED visits with NO2 (1.020, [1.004, 1.036]) and SO2 (1.007, [1.001, 1.014]) concentrations. However, diabetes showed a protective effect on the increase of O3 to congestive heart failure ED visits (0.994, [0.988, 0.999]).

Conclusions

We found adverse effects of short-term ambient air pollutants on ED visits for cardiovascular diseases, and that diabetes mellitus may increase patients’ vulnerability toward certain air pollutants.

Table of Contents

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About this Master's Thesis

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School	Rollins School of Public Health
Department	Biostatistics
Subfield / Discipline	Public Health Informatics - MSPH
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Environmental Health
Keyword	Ambient air pollution Cardiovascular disease Emergency department visits
Committee Chair / Thesis Advisor	Howard H. Chang, Emory University
Committee Members	Stefanie Ebelt, Emory University

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