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

This table of contents is under embargo until 06 January 2025

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

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
Parola chiave	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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