Associations between ambient air pollution and daily mortality among elderly persons in Montreal, Quebec.

BACKGROUND 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 65 years of age and older, for an additional 10 years (1990-2003) to assess whether these associations persisted and to investigate new health conditions. METHODS AND RESULTS 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 2.5 μm 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 (17.56 μg m(-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 2 months of death), airways disease, and diabetes and airways disease. CONCLUSIONS 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.

[1]  A. D. Diez Roux,et al.  Associations between Recent Exposure to Ambient Fine Particulate Matter and Blood Pressure in the Multi-Ethnic Study of Atherosclerosis (MESA) , 2008, Environmental health perspectives.

[2]  M P Wand,et al.  Generalized additive distributed lag models: quantifying mortality displacement. , 2000, Biostatistics.

[3]  Richard T Burnett,et al.  Shortness of breath at night and health status in congestive heart failure: effects of environmental conditions and health-related and dietary factors. , 2009, Environmental research.

[4]  Antonella Zanobetti,et al.  Cardiovascular Damage by Airborne Particles: Are Diabetics More Susceptible? , 2002, Epidemiology.

[5]  Michelle L. Bell,et al.  A Meta-Analysis of Time-Series Studies of Ozone and Mortality With Comparison to the National Morbidity, Mortality, and Air Pollution Study , 2005, Epidemiology.

[6]  D V Bates,et al.  Health indices of the adverse effects of air pollution: the question of coherence. , 1992, Environmental research.

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

[8]  J Schwartz,et al.  Are diabetics more susceptible to the health effects of airborne particles? , 2001, American journal of respiratory and critical care medicine.

[9]  P. Borne,et al.  Environmental determinants of blood pressure, arterial stiffness, and central hemodynamics , 2010, Journal of hypertension.

[10]  Chun-Yuh Yang,et al.  Air Pollution and Hospital Admissions for Congestive Heart Failure in a Tropical City: Kaohsiung, Taiwan , 2007, Inhalation toxicology.

[11]  J. Schwartz,et al.  Particulate air pollution and the rate of hospitalization for congestive heart failure among medicare beneficiaries in Pittsburgh, Pennsylvania. , 2005, American journal of epidemiology.

[12]  P. Vokonas,et al.  Medium-Term Exposure to Traffic-Related Air Pollution and Markers of Inflammation and Endothelial Function , 2011, Environmental health perspectives.

[13]  J. Schwartz,et al.  DIABETES ENHANCES VULNERABILITY TO PARTICULATE AIR POLLUTION-ASSOCIATED IMPAIRMENT IN VASCULAR REACTIVITY AND ENDOTHELIAL FUNCTION , 2004, Circulation.

[14]  J Schwartz,et al.  Ambient pollution and heart rate variability. , 2000, Circulation.

[15]  Richard L. Verrier,et al.  Association of Air Pollution with Increased Incidence of Ventricular Tachyarrhythmias Recorded by Implanted Cardioverter Defibrillators , 2005, Environmental health perspectives.

[16]  Thomas J. Smith,et al.  The Association Between Personal Measurements of Environmental Exposure to Particulates and Heart Rate Variability , 2002, Epidemiology.

[17]  Thomas J. Smith,et al.  Association of Heart Rate Variability With Occupational and Environmental Exposure to Particulate Air Pollution , 2001, Circulation.

[18]  J. Hartikainen,et al.  Effect of acute carbon monoxide exposure on heart rate variability in patients with coronary artery disease * , 2003, Clinical physiology and functional imaging.

[19]  D. Mannino,et al.  Air Pollution and Heart Rate Variability Among the Elderly in Mexico City , 2003, Epidemiology.

[20]  Richard T Burnett,et al.  A Review of Time-Series Studies Used to Evaluate the Short-Term Effects of Air Pollution on Human Health , 2003, Reviews on environmental health.

[21]  Richard T Burnett,et al.  Associations between ambient air pollution and daily mortality among persons with diabetes and cardiovascular disease. , 2006, Environmental research.

[22]  P. Saldiva,et al.  Cardiac arrhythmia emergency room visits and environmental air pollution in São Paulo, Brazil , 2008, Journal of Epidemiology & Community Health.

[23]  J C Bailar,et al.  Identification of persons with cardiorespiratory conditions who are at risk of dying from the acute effects of ambient air particles. , 2001, Environmental health perspectives.

[24]  F. Ruschitzka,et al.  Endothelin receptor antagonists in congestive heart failure: a new therapeutic principle for the future? , 2001, Journal of the American College of Cardiology.

[25]  E. Benjamin,et al.  Epidemiology and significance of atrial fibrillation. , 1999, The American journal of cardiology.

[26]  J Schwartz,et al.  What are people dying of on high air pollution days? , 1994, Environmental research.

[27]  Antonella Zanobetti,et al.  Ambient Pollution and Blood Pressure in Cardiac Rehabilitation Patients , 2004, Circulation.

[28]  A. Wheeler,et al.  Effects of Indoor, Outdoor, and Personal Exposure to Particulate Air Pollution on Cardiovascular Physiology and Systemic Mediators in Seniors , 2009, Journal of occupational and environmental medicine.

[29]  Francesca Dominici,et al.  Time-series analysis of air pollution and mortality: a statistical review. , 2004, Research report.

[30]  T. Bateson,et al.  Who is Sensitive to the Effects of Particulate Air Pollution on Mortality?: A Case-Crossover Analysis of Effect Modifiers , 2004, Epidemiology.

[31]  I. Adamson,et al.  Acute effects of inhaled urban particles and ozone: lung morphology, macrophage activity, and plasma endothelin-1. , 1998, The American journal of pathology.

[32]  J. Schwartz,et al.  The National Morbidity, Mortality, and Air Pollution Study. Part II: Morbidity and mortality from air pollution in the United States. , 2000, Research report.

[33]  Shirley Almon.  The Distributed Lag Between Capital Appropriations and Expenditures , 1965 .

[34]  J Schwartz,et al.  Air pollution and incidence of cardiac arrhythmia. , 2000, Epidemiology.

[35]  Richard T Burnett,et al.  Associations between ambient air pollution and daily mortality among persons with congestive heart failure. , 2003, Environmental research.

[36]  P. Paatero,et al.  A case-crossover analysis of out-of-hospital coronary deaths and air pollution in Rome, Italy. , 2005, American journal of respiratory and critical care medicine.

[37]  R. Burnett,et al.  Identifying subgroups of the general population that may be susceptible to short-term increases in particulate air pollution: a time-series study in Montreal, Quebec. , 2000, Research report.

[38]  Antonella Zanobetti,et al.  Air pollution and health: a European and North American approach (APHENA). , 2009, Research report.

[39]  M. Goldberg.  Particulate air pollution and daily mortality: who is at risk? , 1996, Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine.

[40]  R. Wyzga.  The effect of air pollution upon mortality: a consideration of distributed lag models. , 1978, Journal of the American Statistical Association.

[41]  T. Meade,et al.  Seasonal variations of plasma fibrinogen and factor VII activity in the elderly: winter infections and death from cardiovascular disease , 1994, The Lancet.

[42]  W. MacNee,et al.  Potential mechanisms of adverse pulmonary and cardiovascular effects of particulate air pollution (PM10). , 2001, International journal of hygiene and environmental health.

[43]  J. Schwartz,et al.  Are there sensitive subgroups for the effects of airborne particles? , 2000, Environmental health perspectives.

[44]  Ali S. Kamal,et al.  Insights Into the Mechanisms and Mediators of the Effects of Air Pollution Exposure on Blood Pressure and Vascular Function in Healthy Humans , 2009, Hypertension.

[45]  J Schwartz,et al.  The distributed lag between air pollution and daily deaths. , 2000, Epidemiology.

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

[47]  F. Dominici,et al.  Time-series studies of particulate matter. , 2004, Annual review of public health.

[48]  A. Peters,et al.  Particulate air pollution is associated with an acute phase response in men; results from the MONICA-Augsburg Study. , 2001, European heart journal.

[49]  J. Kaski,et al.  Increased plasma endothelin levels in angina patients with rapid coronary artery disease progression. , 2001, European heart journal.

[50]  Constantinos Sioutas,et al.  Controlled exposures of healthy and asthmatic volunteers to concentrated ambient particles in metropolitan Los Angeles. , 2003, Research report.

[51]  Daniel Krewski,et al.  Acute Effects of Ambient Particulate Matter on Mortality in Europe and North America: Results from the APHENA Study , 2008, Environmental health perspectives.

[52]  David C Christiani,et al.  The association of particulate air metal concentrations with heart rate variability. , 2002, Environmental health perspectives.

[53]  T. Nawrot,et al.  Air Pollution–Related Prothrombotic Changes in Persons with Diabetes , 2009, Environmental health perspectives.

[54]  Antonella Zanobetti,et al.  Reduction in Heart Rate Variability with Traffic and Air Pollution in Patients with Coronary Artery Disease , 2009, Environmental health perspectives.

[55]  J. Schwartz,et al.  Increased Risk of Paroxysmal Atrial Fibrillation Episodes Associated with Acute Increases in Ambient Air Pollution , 2005, Environmental health perspectives.

[56]  J C Bailar,et al.  The association between daily mortality and ambient air particle pollution in Montreal, Quebec. 1. Nonaccidental mortality. , 2001, Environmental research.

[57]  R. Burnett,et al.  Further interpretation of the acute effect of nitrogen dioxide observed in Canadian time-series studies , 2007, Journal of Exposure Science and Environmental Epidemiology.

[58]  R. Brook,et al.  Acute Blood Pressure Responses in Healthy Adults During Controlled Air Pollution Exposures , 2005, Environmental health perspectives.

[59]  I. Annesi-Maesano,et al.  Subpopulations at increased risk of adverse health outcomes from air pollution , 2003, European Respiratory Journal.

[60]  D. Liao,et al.  Particulate matter and heart rate variability among elderly retirees: the Baltimore 1998 PM study , 2001, Journal of Exposure Analysis and Environmental Epidemiology.

[61]  J Schwartz,et al.  Air pollution and inflammation in type 2 diabetes: a mechanism for susceptibility , 2006, Occupational and Environmental Medicine.

[62]  S. Chakrabarti,et al.  Endothelins in chronic diabetic complications. , 2003, Canadian journal of physiology and pharmacology.

[63]  Chun-Yuh Yang,et al.  Air Pollution and Emergency Room Visits for Arrhythmias: Are There Potentially Sensitive Groups? , 2009, Journal of toxicology and environmental health. Part A.

[64]  Yuming Guo,et al.  Gaseous air pollution and emergency hospital visits for hypertension in Beijing, China: a time-stratified case-crossover study , 2010, Environmental health : a global access science source.

[65]  J C Bailar,et al.  The association between daily mortality and ambient air particle pollution in Montreal, Quebec. 2. Cause-specific mortality. , 2001, Environmental research.

[66]  P. Saldiva,et al.  Effect of air pollution on diabetes and cardiovascular diseases in São Paulo, Brazil. , 2008, Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas.

[67]  Jonathan Thornburg,et al.  Differences in blood pressure and vascular responses associated with ambient fine particulate matter exposures measured at the personal versus community level , 2010, Occupational and Environmental Medicine.

[68]  L. Zhong,et al.  Acute mortality effects of carbon monoxide in the Pearl River Delta of China. , 2011, The Science of the total environment.

[69]  M. Hilton,et al.  The effect of sulphur dioxide exposure on indices of heart rate variability in normal and asthmatic adults. , 2001, The European respiratory journal.

[70]  A. Wheeler,et al.  Influence of Personal Exposure to Particulate Air Pollution on Cardiovascular Physiology and Biomarkers of Inflammation and Oxidative Stress in Subjects With Diabetes , 2007, Journal of occupational and environmental medicine.

[71]  Joel Schwartz,et al.  REVIEW OF EPIDEMIOLOGICAL EVIDENCE OF HEALTH EFFECTS OF PARTICULATE AIR POLLUTION , 1995 .

[72]  G. Pershagen,et al.  Effects of Ambient Air Pollution on Daily Mortality in a Cohort of Patients with Congestive Heart Failure , 2001, Epidemiology.

[73]  J. Schwartz,et al.  Association of ventricular arrhythmias detected by implantable cardioverter defibrillator and ambient air pollutants in the St Louis, Missouri metropolitan area , 2006, Occupational and Environmental Medicine.

[74]  J. Schwartz,et al.  Particulate air pollution and nonfatal cardiac events. Part II. Association of air pollution with confirmed arrhythmias recorded by implanted defibrillators. , 2005, Research report.

[75]  Xiaohui Xu,et al.  Fine particulate air pollution and daily mortality in Shenyang, China. , 2011, The Science of the total environment.

[76]  J. Schwartz,et al.  Ambient particulate air pollution and cardiac arrhythmia in a panel of older adults in Steubenville, Ohio , 2006, Occupational and Environmental Medicine.

[77]  W. Cascio,et al.  Elderly humans exposed to concentrated air pollution particles have decreased heart rate variability , 2003, European Respiratory Journal.

[78]  S. Iliceto,et al.  Individual exposure to particulate matter and the short-term arrhythmic and autonomic profiles in patients with myocardial infarction. , 2009, European heart journal.

[79]  A. Gasparrini,et al.  The short-term influence of temperature on daily mortality in the temperate climate of Montreal, Canada. , 2011, Environmental research.

[80]  Joel Schwartz,et al.  Diabetes, Obesity, and Hypertension May Enhance Associations between Air Pollution and Markers of Systemic Inflammation , 2006, Environmental health perspectives.

[81]  Annette Peters,et al.  Effects of air pollution on blood pressure: a population-based approach. , 2001, American journal of public health.

[82]  C. Tankersley,et al.  Air pollution and daily mortality: a hypothesis concerning the role of impaired homeostasis. , 2001, Environmental health perspectives.

[83]  Ben Armstrong,et al.  Models for the Relationship Between Ambient Temperature and Daily Mortality , 2006, Epidemiology.

[84]  R. Burnett,et al.  Inhalation toxicology of urban ambient particulate matter: acute cardiovascular effects in rats. , 2001, Research report.

[85]  R. D. Morris,et al.  Carbon monoxide and hospital admissions for congestive heart failure: evidence of an increased effect at low temperatures. , 1998, Environmental health perspectives.

[86]  F. Cassee,et al.  HEALTH EFFECTS AND TIME COURSE OF PARTICULATE MATTER ON THE CARDIOPULMONARY SYSTEM IN RATS WITH LUNG INFLAMMATION , 2002, Journal of toxicology and environmental health. Part A.