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Short-term effects of air pollutants on hospitalization rate in patients with cardiovascular disease: a case-crossover study

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Abstract

Considering the increasing rate of hospitalization due to the symptoms intensification, and the increasing trend of air pollution, this study aimed to determine the relationship between the amount of air pollutants and the incidence of cardiovascular disease leading to hospitalization. This case-crossover study was carried out on the data of admitted patients with cardiovascular disease such as hypertension, ischemic heart disease, and cerebrovascular disease in Urmia during 2011–2016. Weather data about air pollutants (NO2, PM10, SO2, and CO) were obtained from the meteorological department of Urmia. The data were coded for each patient and matched with the meteorological data for statistical modeling. The data were analyzed through STATA version 14. Conditional logistic regression was used to estimate the effects of air pollutants on cardiovascular disease adjusted to air temperature, relative humidity, and air pollutants. The final analysis was performed on 43,424 patients with cardiovascular disease using code I10-I99 including ischemic heart disease, hypertension, and cerebrovascular disease adjusted to air temperature and relative humidity. Of all pollutants, CO with each increase 10 μg/m3 had a meaningful relationship with the incidence of cardiovascular hospitalization. By selecting the window of exposure, 1, 2, and 6 days before admission, lag 6 (6 days) was the best estimation for exposure time in the patients with cardiovascular patients (OR 1.0056, CI 1.0041–1.007), and in the patients with ischemic heart disease (OR 1.000055, CI 1.000036–1.000075) and in the patients with hypertension (OR 1.000076, CI 1.00002–1.000132). Regarding cerebrovascular disease, no statistically significant association was observed. The results showed that only CO was associated with an increased risk of admission in patients with cardiovascular disease, ischemic heart disease, and hypertension, and there was no clear evidence for pollution effects on cerebrovascular diseases.

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Data availability

Due to the fact that access to hospital data is subject to certain conditions and is not freely available to the public, so we went to Seyed Al-Shohada, Taleghani, and Imam Khomeini hospitals for access with the permission of the management. Weather data about air pollutants (NO2, PM10, SO2, and CO) were obtained from meteorological department of Urmia. I can provide you with all the raw data information that I have received from the mentioned sources immediately if needed. Sites that I visited with permission and was able to access raw data.

https://crdu.umsu.ac.ir/

https://sshohada.umsu.ac.ir/#

https://taleghani.umsu.ac.ir/index.aspx?fkeyid=&siteid=22&pageid=13267

https://ag.doe.ir/portal/home/

http://www.azmet.ir/

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Acknowledgments

This article was extracted from research project approved by Iran University of Medical Sciences in 2017 with ethical code IR.IUMS.REC 1396.32421. Also, the authors would like to thank the department of environment of West Azerbaijan Province as well as Imam Khomeini, Taleghani and Seyyid al-Shohada hospitals for preparing the basic information.

Author information

Authors and Affiliations

  1. Department of Epidemiology, School of Public Health, Iran of University of Medical Sciences, Tehran, Iran

    Leily Sokoty & Babak Hassanlouei

  2. Research Center for Environmental Health Technology, Radiation Biology Research Center, Department of Epidemiology, School of Public Health, Iran of University of Medical Sciences, Tehran, Iran

    Shahnaz Rimaz

  3. Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran

    Majid Kermani

  4. Biostatistics, School of Public Health, Preventive Medicine and Public Health Research Center, Iran University of Medical Science, Tehran, Iran

    Leila Janani

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  1. Leily Sokoty
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  4. Majid Kermani
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Contributions

LS: She analyzed and interpreted the patient data regarding the cardiovascular disease and the transplant.

ShR: She was a major contributor in writing the manuscript.

BH: He was a major contributor in writing the manuscript.

MK: He was a major contributor in writing the manuscript.

LJ: I analyzed and interpreted the patient data regarding the cardiovascular and am a major contributor in writing the manuscript.

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Leila Janani.

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Iran University of Medical Sciences (Tehran) was in charge of the role of the power supply institution in designing the study and collecting experiences and analyzing and interpreting the data and writing the manuscript.

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The authors declare that they have no conflict of interest.

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Responsible Editor: Lotfi Aleya

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What is “already known” in this topic:

Air pollution in Urmia, especially in the recent decade, has imposed serious problems on the society’s health. The results showed that CO was associated with high risk of admission in patients with cardiovascular disease, ischemic heart disease, and hypertension, but there was no clear evidence for pollution effects on cerebrovascular diseases.

What this article adds:

So far, no assessment has been done about the consequences of air pollution on the health of residents of Urmia during the last decade. This study used the WHO approach and STATA software. Air pollution impacts health, and thus, its assessment is highly important to help authorities and managers for making decision in this regard. Specialists should focus on air pollution to reduce it.

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Sokoty, L., Rimaz, S., Hassanlouei, B. et al. Short-term effects of air pollutants on hospitalization rate in patients with cardiovascular disease: a case-crossover study. Environ Sci Pollut Res 28, 26124–26131 (2021). https://doi.org/10.1007/s11356-021-12390-2

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  • DOI: https://doi.org/10.1007/s11356-021-12390-2

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