Evaluation of the Sex-and-Age-Specific Effects of PM2.5 on Hospital Readmission in the Presence of the Competing Risk of Mortality in the Medicare Population of Utah 1999-2009

Effect of Air Pollution on Heart Failure: Systematic Review and Meta-Analysis

BACKGROUND

Heart failure (HF) poses a significant global disease burden. The current evidence on the impact of air pollution on HF remains inconsistent.

OBJECTIVES

We aimed to conduct a systematic review of the literature and meta-analysis to provide a more comprehensive and multiperspective assessment of the associations between short- and long-term air pollution exposure and HF from epidemiological evidences.

METHODS

Three databases were searched up to 31 August 2022 for studies investigating the association between air pollutants (PM 2.5 , PM 10 , NO 2 , SO 2 , CO, O 3 ) and HF hospitalization, incidence, or mortality. A random effects model was used to derive the risk estimations. Subgroup analysis was conducted by geographical location, age of participants, outcome, study design, covered area, the methods of exposure assessment, and the length of exposure window. Sensitivity analysis and adjustment for publication bias were performed to test the robustness of the results.

RESULTS

Of 100 studies covering 20 countries worldwide, 81 were for short-term and 19 were for long-term exposure. Almost all air pollutants were adversely associated with the risk of HF in both short- and long-term exposure studies. For short-term exposures, we found the risk of HF increased by 1.8% [relative risk ( RR ) = 1.018 , 95% confidence interval (CI): 1.011, 1.025] and 1.6% (RR = 1.016 , 95% CI: 1.011, 1.020) per 10 - μ g / m 3 increment of PM 2.5 and PM 10 , respectively. HF was also significantly associated with NO 2 , SO 2 , and CO, but not O 3 . Positive associations were stronger when exposure was considered over the previous 2 d (lag 0-1) rather than on the day of exposure only (lag 0). For long-term exposures, there were significant associations between several air pollutants and HF with RR (95% CI) of 1.748 (1.112, 2.747) per 10 - μ g / m 3 increment in PM 2.5 , 1.212 (1.010, 1.454) per 10 - μ g / m 3 increment in PM 10 , and 1.204 (1.069, 1.356) per 10 -ppb increment in NO 2 , respectively. The adverse associations of most pollutants with HF were greater in low- and middle-income countries than in high-income countries. Sensitivity analysis demonstrated the robustness of our results.

DISCUSSION

Available evidence highlighted adverse associations between air pollution and HF regardless of short- and long-term exposure. Air pollution is still a prevalent public health issue globally and sustained policies and actions are called for to reduce the burden of HF. https://doi.org/10.1289/EHP11506.

Multi-City Analysis of the Acute Effect of Polish Smog on Cause-Specific Mortality (EP-PARTICLES Study)

Polish smog is a specific type of air pollution present in Eastern Poland, which may cause particularly adverse cardiovascular effects. It is characterized primarily by high concentrations of particulate matter (PM) and different favorable conditions of formation. Our study aimed to assess whether PM and nitrogen dioxide (NO₂) have a short-term impact on mortality due to acute coronary syndrome (ACS) and ischemic stroke (IS). The study covered the years 2016-2020, a total of 6 million person-years from five main cities in Eastern Poland. To evaluate the association between air pollution and cause-specific mortality, a case-crossover study design with conditional logistic regression was used at days with LAG from 0 to 2. We recorded 87,990 all-cause deaths, including 9688 and 3776 deaths due to ACS and IS, respectively. A 10 μg/m³ increase in air pollutants was associated with an increase in mortality due to ACS (PM_2.5 OR = 1.029, 95%CI 1.011-1.047, p = 0.002; PM₁₀ OR = 1.015, 95%CI 1-1.029, p = 0.049) on LAG 0. On LAG 1 we recorded an increase in both IS (PM_2.5 OR = 1.03, 95%CI 1.001-1.058, p = 0.04) and ACS (PM_2.5 OR = 1.028, 95%CI 1.01-1.047, p = 0.003; PM₁₀ OR = 1.026, 95%CI 1.011-1.041, p = 0.001; NO₂ OR = 1.036, 95%CI 1.003-1.07, p = 0.04). There was a strong association between air pollution and cause-specific mortality in women (ACS: PM_2.5 OR = 1.032, 95%CI 1.006-1.058, p = 0.01; PM₁₀ OR = 1.028, 95%CI 1.008-1.05, p = 0.01) and elderly (ACS: PM_2.5 OR = 1.03, 95%CI 1.01-1.05, p = 0.003; PM₁₀ OR = 1.027, 95% CI 1.011-1.043, p < 0.001 and IS: PM_2.5 OR = 1.037, 95%CI 1.007-1.069, p = 0.01; PM₁₀ OR = 1.025, 95%CI 1.001-1.05, p = 0.04). The negative influence of PMs was observed on mortality due to ACS and IS. NO₂ was associated with only ACS-related mortality. The most vulnerable subgroups were women and the elderly.

Short-term PM2.5 exposure and early-readmission risk: a retrospective cohort study in North Carolina heart failure patients

BACKGROUND

Short-term changes in ambient fine particulate matter (PM_2.5) increase the risk for unplanned hospital readmissions. However, this association has not been fully evaluated for high-risk patients or examined to determine if the readmission risk differs based on time since discharge. Here we investigate the relation between ambient PM_2.5 and 30-day readmission risk in heart failure (HF) patients using daily time windows and examine how this risk varies with respect to time following discharge.

METHODS

We performed a retrospective cohort study of 17,674 patients with a recorded HF diagnosis between 2004 and 2016. The cohort was identified using the EPA CARES electronic health record resource. The association between ambient daily PM_2.5 (μg/m³) concentration and 30-day readmissions was evaluated using time-dependent Cox proportional hazard models. PM_2.5 associated readmission risk was examined throughout the 30-day readmission period and for early readmissions (1-3 days post-discharge). Models for 30-day readmissions included a parametric continuous function to estimate the daily PM_2.5 associated readmission hazard. Fine-resolution ambient PM_2.5 data were assigned to patient residential address and hazard ratios are expressed per 10 μg/m³ of PM_2.5. Secondary analyses examined potential effect modification based on the time after a HF diagnosis, urbanicity, medication prescription, comorbidities, and type of HF.

RESULTS

The hazard of a PM_2.5-related readmission within 3 days of discharge was 1.33 (95% CI 1.18-1.51). This PM_2.5 readmission hazard was slightly elevated in patients residing in non-urban areas (1.43, 95%CI 1.22-1.67) and for HF patients without a beta-blocker prescription prior to the readmission (1.35; 95% CI 1.19-1.53).

CONCLUSION

Our findings add to the evidence indicating substantial air quality-related health risks in individuals with underlying cardiovascular disease. Hospital readmissions are key metrics for patients and providers alike. As a potentially modifiable risk factor, air pollution-related interventions may be enacted that might assist in reducing costly and burdensome unplanned readmissions.

Association between long-term exposure to ambient air pollution and clinical outcomes among patients with heart failure: Findings from the China PEACE Prospective Heart Failure Study

BACKGROUND

The health effects of air pollution on heart failure (HF) patients have not been adequately studied.

OBJECTIVES

We assessed the associations between long-term air pollution exposure and prognosis in HF patients.

METHODS

HF patients were prospectively recruited from 52 hospitals throughout China between August 2016 and May 2018. The participants were followed up for 12 months after discharge from index hospitalization. Long-term air pollution was calculated as annual average level of air pollution before the date of the index hospitalization. Outcomes were defined as HF readmission, cardiovascular death, and composite events. Cox proportional hazards model was applied to quantify the associations between air pollution exposure and clinical outcomes.

RESULTS

Of 4866 patients included in the analysis, mean age was 65.2 ± 13.5 years, and 62.5% were male. During 1-year follow-up, 1577 (32.4%) participants were readmitted for HF and 550 (11.3%) died from cardiovascular disease. Though no associations between long-term air pollution and HF readmission in the overall participants, geographic and age heterogeneity in the long-term effects of air pollutants on HF readmission was observed. Air pollutants included PM_2.5 [HR (hazard ratio) = 1.146, 95% CI (confidence interval): 1.044, 1.259], PM₁₀ (HR = 1.120, 95% CI: 1.043, 1.203), SO₂ (HR = 1.808, 95% CI: 1.190, 2.747), and CO (HR = 3.596, 95% CI: 1.792, 7.218) were associated with higher risk of HF readmission in South China, but not in North China, where people spend less time outdoors and have limited indoor-outdoor ventilation. PM_2.5, PM_10, O₃, and CO among patients ≥ 65 years were found to be associated with higher risk of HF readmission. The effects on composite outcomes were broadly consistent with that of HF readmission. Cardiovascular death was not significantly associated with air pollution in the overall or subgroups.

DISCUSSION

Among HF patients who were older, living in South China, more HF readmissions occurred with higher long-term air pollution exposure. The findings suggest that the elderly patients and those living in South China should particularly enhance their personal protection against air pollution.

A survey of PM2.5 preventive behavioral intention and related factors among community elderly in Northern Taiwan

Population aging and air pollution are global concerns. The purpose of this study is to explore the relationship among particulate matter with a diameter of 2.5 μm or less (PM2.5) knowledge, PM2.5 preventive attitude, and PM2.5 preventive behavioral intention in the elderly.A cross-sectional survey design was applied in this study, including usage intention and snowball sampling. A total of 617 elderly people aged over 65 participated, and the collected data were quantitatively analyzed.The results showed that the mean score of PM2.5 knowledge of the elderly was 10.34 (79.53%) with the standard deviation (SD) of 3.42, the mean score of PM2.5 preventive attitude was 4.58 (91.60%) with SD of 0.49, and the mean score of PM2.5 preventive behavioral intention was 4.72 (94.40%) with SD of 0.40. Elderly people's characteristics regarding PM2.5 knowledge and PM2.5 preventive attitude explained 22% (adjusted R2 = 0.22, F = 30.44, P < .001) of the variance in PM2.5 preventive behavioral intention.It is concluded that we found no difference in PM2.5 knowledge, PM2.5 preventive attitude, or PM2.5 preventive behavioral intention among the elderly with or without chronic diseases. In our opinion, health education regarding the threat of PM2.5 to the health of the elderly should be strengthened, to enhance their knowledge, preventive attitude, and preventive behavioral intention of PM2.5.

[Air pollution and heart rhythm disturbance: A retrospective study]

INTRODUCTION

According to many studies, exposure to air pollution increases cardiovascular morbidity and mortality. It has also been shown that the frequency of heart rhythm disorders in Region wallonne is very high.

OBJECTIVES

The objective of this study is to test the hypothesis of a link between rhythm disorders measured by cardiac holters and data from devices measuring the concentration of air pollutants present in ambient air.

METHODOLOGY

The health data were obtained via the Erasme hospital's cardiology center. This is a retrospective data collection over the last 2 to 5 years. The environmental data are: PM2.5, PM10, NO2, O3 and temperature. The statistical models were based on "cross-case" analyses.

RESULTS

An association between PM10 and the number of ESAs was observed. An increase of 10μg/m³ of PM10 increases the number of ESAs by 20% (P=0.040). The number of ESAs increases with age (63% more ESAs when age increases by 10 years). A history of intervention also decreases the number of ESAs (-35%), the same phenomenon is observed for pacemaker wearers (-66%). The strongest association observed between NO2 and ESA with an OR of 1.37 (P=0.027) in the final model. No significant association was observed between the effects of air pollution and VPCs.

CONCLUSION

Our analyses resume the effects of the different pollutants on rhythm disorders, the effects adjusted for treatment and co-morbidities. They open the door to other more refined studies based on individual measurements.