The association between fine particulate air pollution and hospital emergency room visits for cardiovascular diseases in Beijing, China

doi:10.1016/j.scitotenv.2009.05.022

Science of The Total Environment

Volume 407, Issue 17, 15 August 2009, Pages 4826-4830

https://doi.org/10.1016/j.scitotenv.2009.05.022 Get rights and content

Abstract

Background

Because epidemiological studies have yielded different results, the association between exposure to fine particulate matter less than 2.5 μm in aerodynamic diameter (PM_2.5) and acute events of cardiovascular diseases (CVD) is unknown. Additionally, no research has been conducted to explore the association between PM_2.5 and hospital emergency room (ER) visits of cardiovascular diseases in Beijing, China.

Objective

To explore the association between PM_2.5 and the hospital ER visits in Beijing, China for CVD {(International Classification of Diseases, 10th vision (ICD-10): I00~I99)}.

Methods

We collected data for daily hospital ER visits for CVD from the Peking University Third Hospital, daily ambient PM_2.5 data from a fixed monitor site at Peking University, and data on the daily level of gaseous air pollutants {sulfur dioxide (SO₂) and nitrogen dioxide (NO₂)} from the Beijing Municipal Environmental Monitoring Center between June 1, 2004 and December 31, 2006. A time-stratified case–crossover design was used to evaluate associations between CVD health outcomes and ambient air pollutants.

Results

8377 hospital ER visits of CVD were collected in our study. After adjusting the temperature and the relative humidity, the associations for 10 μg/m³ increases in levels of PM_2.5, SO₂, or NO₂ and hospital ER visits for cardiovascular diseases were statistically significant with odds ratios (ORs) of 1.005{95% confidence interval (CI): 1.001–1.009}, 1.014(95% CI: 1.004–1.024), and 1.016(95% CI: 1.003–1.029), respectively.

Conclusion

These findings suggest that elevated levels of ambient air pollutants are associated with the increase in hospital ER visits for CVD in Beijing, China.

Introduction

In recent years, the results of many epidemiologic studies have suggested an association between ambient air pollution and morbidity and mortality of cardiovascular diseases (CVD) (Kan et al., 2008, Le Tertre et al., 2002, Wang et al., 2002). Researches have found the associations between short-term changes in ambient air pollution levels and hospital admission for CVD (Dominici et al., 2006, Zanobetti and Schwartz, 2005). There were also studies focusing on the association between air pollution and hospital emergency room (ER) visits for CVD (Peel et al., 2007, Szyszkowicz, 2008). Some studies conducted in the United States and European countries found that the increase of particulate matter less than 10 μm in aerodynamic diameter (PM₁₀) could induce the increase of myocardial infarction in the exposed population (Braga et al., 2001a, Mann et al., 2002).

Different results have been found for the association of fine particulate matter less than 2.5 μm in aerodynamic diameter (PM_2.5) and acute events of CVD thus a conclusion based on epidemiological evidences cannot be made. For example, while Peters et al. (2001) found that elevated risk of myocardial infarction was associated with higher concentration of PM_2.5 in the 1 to 3 h period just before the myocardial infarction in a hospital-based study, a study by Levy et al. (2001) did not find the association between daily PM_2.5 concentration and out of hospital cardiac arrest.

Some studies conducted in China have statistically significant results for the association of ambient PM₁₀ levels are with the mortality for CVD or respiratory diseases (Ren et al., 2007, Zhang et al., 2007), but there has been little research using hospital admissions, outpatient visits or hospital ER visits as the health outcomes, which may be more sensitive indicators for the effects of PM pollution. Especially there is no research on the association between PM_2.5 and ER visits for CVD. The aim of our study was to quantitatively analyze the effects of short-term exposure to PM_2.5 on cardiovascular events in the exposed population. These health records have been stored in the databases of the medical record department in the Peking University Third Hospital. To explore the effect of short-term exposure of air pollution on the CVD, the case–crossover design was conducted in Beijing, China.

Section snippets

Data collection for the hospital emergency room visits

Data on hospital ER visits were collected from the Peking University Third Hospital, which is located in northwest part of urban city of Beijing (Fig. 1). It is one of the top-level hospitals in Beijing, even in all China. Relevant information for each case of daily ER visits in the Emergency Department of the Hospital were collected, i.e. age, gender, identification number, occupation, diagnostic code, living address and primary diagnosis. We coded the data of daily ER visits according to the

Results

During the study period, there were a total of 8377 hospital ER visits for CVD in Peking University Third Hospital. The descriptive statistics for ER visits, air pollutants data, and weather condition are shown in Table 1. There was an average of 8.87 hospital ER visits per day for CVD over the study period. Daily average concentrations of SO₂, NO₂, and PM_2.5 air pollutants were 49.32 μg/m³, 68.25 μg/m³, and 121.58 μg/m³ respectively, Wherein the SO₂ and NO₂ air pollution were lower than the

Discussion

This is the first investigation of short-term effects of PM_2.5 air pollution on hospital ER visits for CVD performed in Beijing, China, where the PM_2.5 air pollution is more serious than United States and European countries. Daily average concentration of PM_2.5 was 121.58 μg/m³ in the research period, while the PM_2.5 concentration was lower in other studies which had similar research objectives and found bad health effect of PM_2.5 (Chan et al., 2006, Symons et al., 2006). Therefore, it is

Conclusion

In this case–crossover study, we found that ambient air pollution had a slight association with CVD in Beijing during June 1, 2004 to December 31, 2006. These findings suggest that elevated levels of ambient air pollutants are associated with the increase in hospital ER visits for CVD. Additionally, the findings can provide information about the health effects of air pollution in Beijing, China and may have implications for local environmental and social policies.

Acknowledgments

We thank Professor Duncan C. Thomas (University of Southern California) for his statistic guide, Dr. Terrence Lee (Johns Hopkins University) for his insightful comment, and the Medical Record Department of Peking University Third Hospital, Municipal Environmental Monitoring Center and Institute of Atmospheric Physics, Chinese Academy of Science for providing data.

Grant Information

This study is funded by the Deutsche Forschungsgemeinschaft Foundation (DFG, RA-2489/07) and the National Natural

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The association between fine particulate air pollution and hospital emergency room visits for cardiovascular diseases in Beijing, China

Abstract

Background

Objective

Methods

Results

Conclusion

Introduction

Section snippets

Data collection for the hospital emergency room visits

Results

Discussion

Conclusion

Acknowledgments

Environ Res

Toxicology

Am J Cardiol

Toxicol Appl Pharmacol

The effects of air pollution on hospitalizations for cardiovascular disease in elderly people in Australian and New Zealand cities

Environ Health Perspect

Hematological and hemorheological effects of air pollution

Arch Environ Health

Control for seasonal variation and time trend in case–crossover studies of acute effects of environmental exposures

Epidemiology

The lag structure between particulate air pollution and respiratory and cardiovascular deaths in 10 US cities

J Occup Environ Med

The time course of weather-related deaths

Epidemiology

Inhalation of fine particulate air pollution and ozone causes acute arterial vasoconstriction in healthy adults

Circulation

PM2.5 metal exposures and nocturnal heart rate variability: a panel study of boilermaker construction workers

Environ Health

Urban air pollution and emergency admissions for cerebrovascular diseases in Taipei, Taiwan

Eur Heart J

Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases

JAMA

Vascular function, inflammation, and variations in cardiac autonomic responses to particulate matter among welders

Am J Epidemiol

Association between the concentration of particulate matters and the hospital emergency room visits for circulatory diseases: a case–crossover study

Chin J Epidemiol

Season, sex, age, and education as modifiers of the effects of outdoor air pollution on daily mortality in Shanghai, China: The Public Health and Air Pollution in Asia (PAPA) Study

Environ Health Perspect

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J Epidemiol Community Health

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Environ Health Perspect

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Epidemiology

On the equivalence of case–crossover and time series methods in environmental epidemiology

Biostatistics

The case–crossover design: a method for studying transient effects on the risk of acute events

Am J Epidemiol

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Environ Health Perspect

Oxidation stress effects of SO2 and its systemic toxin

Chin Public Health

Oxidation damage of sulfur dioxide inhalation on erythrocytes of rats

J Environ Health

Effects of SO_2 derivatives on ion channels in acutely isolated rat neurons and cardiomyocytes

Asian J Ecotoxicol