Association between air pollution exposure and coronary heart disease hospitalization in a humid sub-tropical region of China: A time-series study

Objective Emerging evidence has highlighted the possible links of environmental pollution with several cardiovascular diseases (CVDs). The current study aimed to explore the impact of short-term air pollution exposure on CHD hospitalization in Hefei. Methods Data about the daily number of CHD admissions (from 2014 to 2021) were retrieved from the First Affiliated Hospital of Anhui Medical University. Air pollutants and meteorological data were obtained from the China Environmental Monitoring Station and the China Meteorological Data Service Center, respectively. The correlation between air pollution and CHD hospitalization was assessed using distributed lag non-linear model (DLNM) and Poisson generalized linear regression. Results In the single-pollutant model, NO2, O3, and CO strongly correlated with CHD hospitalization rate. Specifically, exposure to NO2 (lag0, relative risk [RR]: 1.013, 95%CI: 1.002–1.024, per 10 μg/m3 increase) and CO (lag13, RR: 1.035, 95%CI: 1.001–1.071, per 1 μg/m3 increase) revealed a positive correlation with an increased rate of CHD hospitalization. Interestingly, O3 had a protective association with hospitalization of CHD (lag0, RR: 0.993, 95%CI: 0.988–0.999, per 10 μg/m3 increase). Similar results, to those of the single-pollutant model, were revealed following verification using two-pollutant models. Subgroup analyses indicated that young people, women, and people in hot seasons were more susceptible to NO2 exposure, while the elderly, women, and people in cold seasons were more susceptible to O3. Furthermore, the elderly were more susceptible to CO exposure. Conclusion Overall, exposure to NO2 and CO increases the rate of CHD hospitalization, but exposure to O3 shows a protective association with the rate of CHD hospitalization. Therefore, early preventive measures against air pollutants should be applied to protect vulnerable patients with CHD.

[1]  Lulu Lian,et al.  The short-term effects and burden of particle air pollution on hospitalization for coronary heart disease: a time-stratified case-crossover study in Sichuan, China , 2022, Environmental Health.

[2]  Zhiyong Yang,et al.  Correlation between air temperature, air pollutants, and the incidence of coronary heart disease in Liaoning Province, China: a retrospective, observational analysis. , 2021, Annals of Palliative Medicine.

[3]  F. Dominici,et al.  Air pollution and cardiovascular disease hospitalization – Are associations modified by greenness, temperature and humidity? , 2021, Environment international.

[4]  Jianqiang Du,et al.  Global burden of ischemic heart disease attributable to ambient PM2.5 pollution from 1990 to 2017. , 2021, Chemosphere.

[5]  Ji-yu Cao,et al.  Association between short-term exposure to ambient air pollutants and the risk of tuberculosis outpatient visits: A time-series study in Hefei, China. , 2020, Environmental research.

[6]  Mark R Miller.  Oxidative stress and the cardiovascular effects of air pollution , 2020, Free radical biology & medicine.

[7]  C. Kartsonaki,et al.  The association between high particulate matter pollution and daily cause-specific hospital admissions: a time-series study in Yichang, China , 2019, Environmental Science and Pollution Research.

[8]  C. Murray,et al.  Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 , 2019, The Lancet.

[9]  Furong Zhu,et al.  Associations of ambient PM2.5 and O3 with cardiovascular mortality: a time-series study in Hefei, China , 2019, International Journal of Biometeorology.

[10]  A. Peters,et al.  Temporal variations in the triggering of myocardial infarction by air temperature in Augsburg, Germany, 1987-2014. , 2019, European heart journal.

[11]  Francesca N. Delling,et al.  Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association , 2019, Circulation.

[12]  Yuming Guo,et al.  Effects of ambient carbon monoxide on daily hospitalizations for cardiovascular disease: a time-stratified case-crossover study of 460,938 cases in Beijing, China from 2013 to 2017 , 2018, Environmental Health.

[13]  A. Perillo,et al.  Particulate matter air pollution and respiratory impact on humans and animals , 2018, Environmental Science and Pollution Research.

[14]  R. Brook,et al.  Air Pollution and Cardiovascular Disease: JACC State-of-the-Art Review. , 2018, Journal of the American College of Cardiology.

[15]  Wenling Liu,et al.  Health Effects of Air Pollution in China , 2018, International journal of environmental research and public health.

[16]  Jonathan E. Thompson,et al.  Airborne Particulate Matter: Human Exposure and Health Effects , 2018, Journal of occupational and environmental medicine.

[17]  M. Delgado-Rodríguez,et al.  Systematic review and meta-analysis. , 2017, Medicina intensiva.

[18]  Y. Hernández-Matos,et al.  Medical ozone promotes Nrf2 phosphorylation reducing oxidative stress and pro-inflammatory cytokines in multiple sclerosis patients. , 2017, European journal of pharmacology.

[19]  Szu-Ying Chen,et al.  Particulate and gaseous pollutants on inflammation, thrombosis, and autonomic imbalance in subjects at risk for cardiovascular disease. , 2017, Environmental pollution.

[20]  D. Sorriento,et al.  The mechanisms of air pollution and particulate matter in cardiovascular diseases , 2017, Heart Failure Reviews.

[21]  E. Guerra,et al.  In vitro evaluation of wound healing and antimicrobial potential of ozone therapy. , 2017, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[22]  M. Gladwin,et al.  Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy , 2017, American journal of respiratory and critical care medicine.

[23]  S. Johansson,et al.  Mortality and morbidity trends after the first year in survivors of acute myocardial infarction: a systematic review , 2017, BMC Cardiovascular Disorders.

[24]  Erratum: Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy. , 2017, American journal of respiratory and critical care medicine.

[25]  U. Kodavanti.  Stretching the stress boundary: Linking air pollution health effects to a neurohormonal stress response. , 2016, Biochimica et biophysica acta.

[26]  Jaime E Mirowsky,et al.  Differential expression of pro-inflammatory and oxidative stress mediators induced by nitrogen dioxide and ozone in primary human bronchial epithelial cells , 2016, Inhalation toxicology.

[27]  Xiaochuan Pan,et al.  Disease burden of ischaemic heart disease from short-term outdoor air pollution exposure in Tianjin, 2002–2006 , 2016, European journal of preventive cardiology.

[28]  Jiang Lixin,et al.  Outline of the report on cardiovascular diseases in China, 2014. , 2016, European heart journal supplements : journal of the European Society of Cardiology.

[29]  D. Catelan,et al.  Air pollution exposure, cause-specific deaths and hospitalizations in a highly polluted Italian region. , 2016, Environmental research.

[30]  Ji Zhou,et al.  Acute Effects of Particulate Air Pollution on the Incidence of Coronary Heart Disease in Shanghai, China , 2016, PloS one.

[31]  D. Richardson,et al.  Air Pollution and Pulmonary Tuberculosis: A Nested Case–Control Study among Members of a Northern California Health Plan , 2016, Environmental health perspectives.

[32]  I. Oh,et al.  Recent Trends in Economic Burden of Acute Myocardial Infarction in South Korea , 2015, PloS one.

[33]  M. Biddle,et al.  A report from the American Heart Association Council on Cardiovascular and Stroke Nursing. , 2015, The Journal of cardiovascular nursing.

[34]  Antonio Gasparrini,et al.  Modeling exposure–lag–response associations with distributed lag non-linear models , 2013, Statistics in medicine.

[35]  David E Newby,et al.  Global association of air pollution and heart failure: a systematic review and meta-analysis , 2013, The Lancet.

[36]  K. Bhaskaran,et al.  Time series regression studies in environmental epidemiology , 2013, International journal of epidemiology.

[37]  Tjeerd P van Staa,et al.  Long-Term Exposure to Outdoor Air Pollution and Incidence of Cardiovascular Diseases , 2013, Epidemiology.

[38]  Bernadette A. Thomas,et al.  Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 , 2012, The Lancet.

[39]  Bernadette A. Thomas,et al.  Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 , 2012, The Lancet.

[40]  Eloi Marijon,et al.  Main air pollutants and myocardial infarction: a systematic review and meta-analysis. , 2012, JAMA.

[41]  N. Verberkmoes,et al.  Impact of temperature and atmospheric pressure on the incidence of major acute cardiovascular events , 2012, Netherlands Heart Journal.

[42]  E. Mohammadi,et al.  Barriers and facilitators related to the implementation of a physiological track and trigger system: A systematic review of the qualitative evidence , 2017, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[43]  A. Elvis,et al.  Ozone therapy: A clinical review , 2011, Journal of natural science, biology, and medicine.

[44]  A. Peters,et al.  Particulate Matter Air Pollution and Cardiovascular Disease: An Update to the Scientific Statement From the American Heart Association , 2010, Circulation.

[45]  A Gasparrini,et al.  Distributed lag non-linear models , 2010, Statistics in medicine.

[46]  S. Tanguy,et al.  Carbon monoxide pollution promotes cardiac remodeling and ventricular arrhythmia in healthy rats. , 2010, American journal of respiratory and critical care medicine.

[47]  A. Nel,et al.  Particulate matter and atherosclerosis: role of particle size, composition and oxidative stress , 2009, Particle and Fibre Toxicology.

[48]  T. Henry,et al.  Cardiovascular manifestations of moderate to severe carbon monoxide poisoning. , 2005, Journal of the American College of Cardiology.

[49]  J. Schwartz,et al.  Heart rate variability associated with particulate air pollution. , 1999, American heart journal.

[50]  G. Fraedrich,et al.  Juvenile recurrent respiratory papillomatosis: Still a mystery disease with difficult management , 2007, Head & neck.