Cardiac arrhythmia emergency room visits and environmental air pollution in Sao Paulo, Brazil.

Pulmonary Division of Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Journal of epidemiology and community health (Impact Factor: 3.04). 04/2008; 62(3):267-72. DOI: 10.1136/jech.2006.058123
Source: PubMed

ABSTRACT Air-pollution exposure has been associated with increased cardiovascular hospital admissions and mortality in time-series studies. We evaluated the relation between air pollutants and emergency room (ER) visits because of cardiac arrhythmia in a cardiology hospital.
In a time-series study, we evaluated the association between the emergency room visits as a result of cardiac arrhythmia and daily variations in SO(2), CO, NO(2), O(3) and PM(10), from January 1998 to August 1999. The cases of arrhythmia were modelled using generalised linear Poisson regression models, controlling for seasonality (short-term and long-term trend), and weather.
Interquartile range increases in CO (1.5 ppm), NO(2) (49,5 microg/m(3)) and PM(10) (22.2 microg/m(3)) on the concurrent day were associated with increases of 12.3% (95% CI: 7.6% to 17.2%), 10.4% (95% CI: 5.2% to 15.9%) and 6.7% (95% CI: 1.2% to 12.4%) in arrhythmia ER visits, respectively. PM(10), CO and NO(2) effects were dose-dependent and gaseous pollutants had thresholds. Only CO effect resisted estimates in models with more than one pollutant.
Our results showed that air pollutant effects on arrhythmia are predominantly acute starting at concentrations below air quality standards, and the association with CO and NO(2) suggests a relevant role for pollution caused by cars.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Persons with underlying health conditions may be at higher risk for the short-term effects of air pollution. We have extended our original mortality time series study in Montreal, Quebec, among persons 65years of age and older, for an additional 10years (1990-2003) to assess whether these associations persisted and to investigate new health conditions. We created subgroups of subjects diagnosed with major health conditions one year before death using billing and prescription data from the Quebec Health Insurance Plan. We used parametric log-linear Poisson models within the distributed lag non-linear models framework, that were adjusted for long-term temporal trends and daily maximum temperature, for which we assessed associations with NO2, O3, CO, SO2, and particles with aerodynamic diameters 2.5μm in diameter or less (PM2.5). We found positive associations between daily non-accidental mortality and all air pollutants but O3 (e.g., for a cumulative effect over a 3-day lag, with a mean percent change (MPC) in daily mortality of 1.90% [95% confidence interval: 0.73, 3.08%] for an increase of the interquartile range (17.56μgm(-3)) of NO2). Positive associations were found amongst persons having cardiovascular disease (cumulative MPC for an increase equal to the interquartile range of NO2=2.67%), congestive heart failure (MPC=3.46%), atrial fibrillation (MPC=4.21%), diabetes (MPC=3.45%), and diabetes and cardiovascular disease (MPC=3.50%). Associations in the warm season were also found for acute and chronic coronary artery disease, hypertension, and cancer. There was no persuasive evidence to conclude that there were seasonal associations for cerebrovascular disease, acute lower respiratory disease (defined within 2months of death), airways disease, and diabetes and airways disease. These data indicate that individuals with certain health conditions, especially those with diabetes and cardiovascular disease, hypertension, atrial fibrillation, and cancer, may be susceptible to the short-term effects of air pollution.
    Science of The Total Environment 07/2013; 463-464C:931-942. · 3.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: High concentrations of various air pollutants have been associated with hospitalization due to development and exacerbation of cardiovascular diseases. We aimed to assess associations between airborne exposures by particulate matter as well as gaseous air pollutants and hospital admissions due to different cardiovascular disease groups in Santiago de Chile. The study was performed in the metropolitan area of Santiago de Chile during 2004-2007. We applied a time-stratified case-crossover analysis taking temporal variation, meteorological conditions and autocorrelation into account. We computed associations between daily ambient concentrations of carbon monoxide (CO), nitrogen dioxide (NO2), particulate matter (PM10 and PM2.5 - particulate matter with aerodynamic diameters less than 10 or 2.5μm, respectively) or ozone (O3) and hospital admissions for cardiovascular illnesses. We found for CO, NO2, PM10 and PM2.5 adverse relationships to cardiovascular admissions while effect strength and lag depended on the pollutant and on the disease group. By trend, in 1-pollutant models most adverse pollutants were NO2 and particulate matter (PM10 and PM2.5) followed by CO, while in 2-pollutant models effects of PM10 persisted in most cases whereas other effects weakened. In addition the strongest effects seemed to be immediate or with a delay of up to 2days. Adverse effects of ozone could not be detected. Our results provided evidence for adverse health effects of combined exposure to airborne pollutants. Different pollutants accounted for varying adverse effects within different cardiovascular disease groups. Taking case numbers and effect strength of all cardiovascular diseases into account, mitigation measures should address all pollutants but especially NO2, PM10, and CO.
    Science of The Total Environment 09/2014; 468-469:746-756. · 3.26 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Cardiac arrhythmias are cardiac rhythm disorders that comprise an important public health problem. Few prior studies have examined the association between ambient air pollution and arrhythmias in general populations in mainland China.Methods: We performed a time-series analysis to investigate the short-term association between air pollution (particulate matter with an aerodynamic diameter less than 10 µm [PM10], sulfur dioxide [SO2], and nitrogen dioxide [NO2]) and outpatient visits for arrhythmia in Shanghai, China. We applied the over-dispersed Poisson generalized additive model to analyze the associations after control for seasonality, day of the week, and weather conditions. We then stratified the analyses by age, gender, and season.Results: We identified a total of 56 940 outpatient visits for cardiac arrhythmia. A 10-µg/m(3) increase in the present-day concentrations of PM10, SO2, and NO2 corresponded to increases of 0.56% (95% CI 0.42%, 0.70%), 2.07% (95% CI 1.49%, 2.64%), and 2.90% (95% CI 2.53%, 3.27%), respectively, in outpatient arrhythmia visits. The associations were stronger in older people (aged ≥65 years) and in females. This study provides the first evidence that ambient air pollution is significantly associated with increased risk of cardiac arrhythmia in mainland China.Conclusions: Our analyses provide evidence that the current air pollution levels have an adverse effect on cardiovascular health and strengthened the rationale for further limiting air pollution levels in the city.
    Journal of epidemiology / Japan Epidemiological Association. 05/2014;