Ambient air pollution is associated with increased risk of hospital cardiac readmissions of myocardial infarction survivors in five European cities.

Abstract

BACKGROUND:

Ambient air pollution has been associated with increases in acute morbidity and mortality. The objective of this study was to evaluate the short-term effects of urban air pollution on cardiac hospital readmissions in survivors of myocardial infarction, a potentially susceptible subpopulation.

METHODS AND RESULTS:

In this European multicenter cohort study, 22,006 survivors of a first myocardial infarction were recruited in Augsburg, Germany; Barcelona, Spain; Helsinki, Finland; Rome, Italy; and Stockholm, Sweden, from 1992 to 2000. Hospital readmissions were recorded in 1992 to 2001. Ambient nitrogen dioxide, carbon monoxide, ozone, and mass of particles <10 microm (PM10) were measured. Particle number concentrations were estimated as a proxy for ultrafine particles. Short-term effects of air pollution on hospital readmissions for myocardial infarction, angina pectoris, and cardiac causes (myocardial infarction, angina pectoris, dysrhythmia, or heart failure) were studied in city-specific Poisson regression analyses with subsequent pooling. During follow-up, 6655 cardiac readmissions were observed. Cardiac readmissions increased in association with same-day concentrations of PM10 (rate ratio [RR] 1.021, 95% CI 1.004 to 1.039) per 10 microg/m3) and estimated particle number concentrations (RR 1.026 [95% CI 1.005 to 1.048] per 10,000 particles/cm3). Effects of similar strength were observed for carbon monoxide (RR 1.014 [95% CI 1.001 to 1.026] per 200 microg/m3 [0.172 ppm]), nitrogen dioxide (RR 1.032 [95% CI 1.013 to 1.051] per 8 microg/m3 [4.16 ppb]), and ozone (RR 1.026 [95% CI 1.001 to 1.051] per 15 microg/m3 [7.5 ppb]). Pooled effect estimates for angina pectoris and myocardial infarction readmissions were comparable.

CONCLUSIONS:

The results suggest that ambient air pollution is associated with increased risk of hospital cardiac readmissions of myocardial infarction survivors in 5 European cities.

• Authors: Stephanie von Klot, Annette Peters, Pasi Aalto, Tom Bellander, Niklas Berglind, Daniela D'Ippoliti, Roberto Elosua, Allmut Hörmann, Markku Kulmala, Timo Lanki, Hannelore Löwel, Juha Pekkanen, Sally Picciotto, Jordi Sunyer, Francesco Forastiere, Health Effects of Particles on Susceptible Subpopulations (HEAPSS) Study Group
• Journal: Circulation (Circulation) Vol. 112 Issue 20 Pg. 3073-9 (Nov 15 2005) ISSN: 1524-4539 [Electronic] United States
• PMID: 16286602 (Publication Type: Historical Article, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Air Pollutants
• Ozone
• Carbon Monoxide
• Nitrogen Dioxide

Topics

• Adult
• Air Pollutants (adverse effects)
• Angina Pectoris (epidemiology)
• Carbon Monoxide (adverse effects)
• Europe (epidemiology)
• History, 18th Century
• Humans
• Middle Aged
• Myocardial Infarction (epidemiology)
• Nitrogen Dioxide (adverse effects)
• Ozone (adverse effects, analysis)
• Patient Readmission (statistics & numerical data)
• Poisson Distribution
• Regression Analysis
• Risk Factors
• Survivors