Abstract
The burden of five main air pollutants, including CO, O3, NO2, SO2, and PM2.5, on the emergency department visits (EDVs) during January 2016–December 2019 due to all cardiovascular diseases was assessed in Tehran by using a time-series model. The pollutants data were collected from Iran Department of Environment including 10 air pollution monitoring stations for the period of our study. Cumulative relative risk and attributable number/fraction were calculated for each pollutants by a Quasi-Poisson time-series regression and distributed lag non-linear model (DLNM). The maximum lag was set to 14 days because harvesting effect is more likely happened during few days. We used percentile 25 as reference value in order to calculate cumulative relative risk and attributable fraction. About 69,000 patients with cardiovascular symptoms have been admitted into the hospital during 4 years. The cumulative relative risk during the 14 days was 1.13 (1.01, 1.26), 1.15 (1.02, 1.29), and 1.08 (1.01, 1.18) for CO, NO2, and PM2.5, respectively. The numbers attributed to all values of CO were more than others; about 3800 EDVs were significantly attributed to CO, of which over 3000 were significantly attributed to high values of the pollutant. Low values of all pollutants were, not surprisingly, responsible for low number of EDVs. PM2.5, CO, and NO2 were responsible to considerable attributable number of EDVs. Our study emphasizes the need for local authorities to establish a program to reduce the air pollution in Tehran.
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Data Availability
The dataset analyzed during the current study are not publicly available due to ethical concerns but are available from the corresponding author on reasonable request.
References
Aboubakri O, Khanjani N, Jahani Y, Bakhtiari B (2020a) Thermal comfort and mortality in a dry region of Iran, Kerman; a 12-year time series analysis. Theor Appl Climatol 139:403–413
Aboubakri O, Khanjani N, Jahani Y, Bakhtiari B, Mesgari E (2020b) Projection of mortality attributed to heat and cold; the impact of climate change in a dry region of Iran. Kerman Sci Total Environ 728:138700
Allred EN et al (1989) Short-term effects of carbon monoxide exposure on the exercise performance of subjects with coronary artery disease. N Engl J Med 321:1426–1432
Amsalu E et al (2019) Short-term effect of ambient sulfur dioxide (SO2) on cause-specific cardiovascular hospital admission in Beijing, China: a time series study. Atmos Environ 208:74–81
Atkinson R, Kang S, Anderson H, Mills I, Walton H (2014) Epidemiological time series studies of PM2. 5 and daily mortality and hospital admissions: a systematic review and meta-analysis. Thorax 69:660–665
Beelen R, Raaschou-Nielsen O, Stafoggia M, Andersen ZJ, Weinmayr G, Hoffmann B, Wolf K, Samoli E, Fischer P, Nieuwenhuijsen M, Vineis P, Xun WW, Katsouyanni K, Dimakopoulou K, Oudin A, Forsberg B, Modig L, Havulinna AS, Lanki T, Turunen A, Oftedal B, Nystad W, Nafstad P, de Faire U, Pedersen NL, Östenson CG, Fratiglioni L, Penell J, Korek M, Pershagen G, Eriksen KT, Overvad K, Ellermann T, Eeftens M, Peeters PH, Meliefste K, Wang M, Bueno-de-Mesquita B, Sugiri D, Krämer U, Heinrich J, de Hoogh K, Key T, Peters A, Hampel R, Concin H, Nagel G, Ineichen A, Schaffner E, Probst-Hensch N, Künzli N, Schindler C, Schikowski T, Adam M, Phuleria H, Vilier A, Clavel-Chapelon F, Declercq C, Grioni S, Krogh V, Tsai MY, Ricceri F, Sacerdote C, Galassi C, Migliore E, Ranzi A, Cesaroni G, Badaloni C, Forastiere F, Tamayo I, Amiano P, Dorronsoro M, Katsoulis M, Trichopoulou A, Brunekreef B, Hoek G (2014) Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project. Lancet 383:785–795
Burnett R et al (2018) Global estimates of mortality associated with long-term exposure to outdoor fine particulate matter. Proc Natl Acad Sci 115:9592–9597
Chen F et al (2017) Attributable risk of ambient PM10 on daily mortality and years of life lost in Chengdu, China. Sci Total Environ 581:426–433
Chiu H-F, Weng Y-H, Chiu Y-W, Yang C-Y (2017) Short-term effects of ozone air pollution on hospital admissions for myocardial infarction: a time-stratified case-crossover study in Taipei. J Toxicol Environ Health A 80:251–257
Dehbi H-M et al (2017) Air pollution and cardiovascular mortality with over 25 years follow-up: A combined analysis of two British cohorts. Environ Int 99:275–281
Gasparrini A (2011) Distributed lag linear and non-linear models in R: the package dlnm. J Stat Softw 43:1
Halonen JI, Lanki T, Tiittanen P, Niemi JV, Loh M, Pekkanen J (2010) Ozone and cause-specific cardiorespiratory morbidity and mortality. J Epidemiol Community Health 64:814–820
Heger M, Sarraf M (2018) Air Pollution in Tehran: Health Costs, Sources, and Policies. Environment and Natural Resources Global Practice Discussion Paper; No. 6. World Bank, Washington, DC. © World Bank. https://openknowledge.worldbank.org/handle/10986/29909 License: CC BY 3.0 IGO
Hůnová I, Malý M, Řezáčová J, Braniš M (2013) Association between ambient ozone and health outcomes in Prague. Int Arch Occup Environ Health 86:89–97
Ito T, Suzuki T, Tamura K, Nezu T, Honda K, Kobayashi T (2008) Examination of mRNA expression in rat hearts and lungs for analysis of effects of exposure to concentrated ambient particles on cardiovascular function. Toxicology 243:271–283
Katsouyanni K, Touloumi G, Spix C, Schwartz J, Balducci F, Medina S, Rossi G, Wojtyniak B, Sunyer J, Bacharova L, Schouten JP, Ponka A, Anderson HR (1997) Short term effects of ambient sulphur dioxide and particulate matter on mortality in 12 European cities: results from time series data from the APHEA project. Bmj 314:1658–1663
Kobayashi Y, Santos JM, Mill JG, Júnior NCR, Andreão WL, Taciana TdA, Stuetz RM (2020) Mortality risks due to long-term ambient sulphur dioxide exposure: large variability of relative risk in the literature. Environ Sci Pollut Res 27:35908–35917
McKone TE, Ryan PB, Özkaynak H (2009) Exposure information in environmental health research: Current opportunities and future directions for particulate matter, ozone, and toxic air pollutants. J Expos Sci Environ Epidemiol 19:30–44
Metzger KB et al (2004) Ambient air pollution and cardiovascular emergency department visits. Epidemiology 15:46–56
Nakhlé MM, Farah W, Ziade N, Abboud M, Salameh D, Annesi-Maesano I (2015) Short-term relationships between emergency hospital admissions for respiratory and cardiovascular diseases and fine particulate air pollution in Beirut, Lebanon. Environ Monit Assess 187:196
Raza A, Dahlquist M, Lind T, Ljungman PL (2018) Susceptibility to short-term ozone exposure and cardiovascular and respiratory mortality by previous hospitalizations. Environ Health 17(37)
Samet JM, Dominici F, Curriero FC, Coursac I, Zeger SL (2000) Fine particulate air pollution and mortality in 20 US cities, 1987–1994. N Engl J Med 343:1742–1749
Schins RP, Lightbody JH, Borm PJ, Shi T, Donaldson K, Stone V (2004) Inflammatory effects of coarse and fine particulate matter in relation to chemical and biological constituents. Toxicol Appl Pharmacol 195:1–11
Schwartz J (2000) Harvesting and long term exposure effects in the relation between air pollution and mortality. Am J Epidemiol 151:440–448
Schwartz J et al (1996) Methodological issues in studies of air pollution and daily counts of deaths or hospital admissions. J Epidemiol Community Health 50:S3–S11
Shah AS et al (2013) Global association of air pollution and heart failure: a systematic review and meta-analysis. Lancet 382:1039–1048
Steenland K, Armstrong B (2006) An overview of methods for calculating the burden of disease due to specific risk factors. Epidemiology 17:512–519
Tian Y, Liu H, Liang T, Xiang X, Li M, Juan J, Song J, Cao Y, Wang X, Chen L, Wei C, Gao P, Hu Y (2018) Ambient air pollution and daily hospital admissions: a nationwide study in 218 Chinese cities. Environ Pollut 242:1042–1049
Tunnicliffe W, Hilton M, Harrison R, Ayres J (2001) The effect of sulphur dioxide exposure on indices of heart rate variability in normal and asthmatic adults. Eur Respir J 17:604–608
Wang Z, Peng J, Liu P, Duan Y, Huang S, Wen Y, Liao Y, Li H, Yan S, Cheng J, Yin P (2020) Association between short-term exposure to air pollution and ischemic stroke onset: a time-stratified case-crossover analysis using a distributed lag nonlinear model in Shenzhen, China. Environ Health 19:1–12
WHO (2018) Ambient (outdoor) air pollution. https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health. Accessed 1 Nov 2020
WHO (2019) Ten threats to global health in 2019. https://www.who.int/news-room/feature-stories/ten-threats-to-global-health-in-2019. Accessed 1 Nov 2020
Yang J, Yin P, Zhou M, Ou CQ, Guo Y, Gasparrini A, Liu Y, Yue Y, Gu S, Sang S, Luan G, Sun Q, Liu Q (2015) Cardiovascular mortality risk attributable to ambient temperature in China. Heart 101:1966–1972
Yazdi MD, Wang Y, Di Q, Zanobetti A, Schwartz J (2019) Long-term exposure to PM2. 5 and ozone and hospital admissions of Medicare participants in the Southeast USA. Environ Int 130:104879
Zhang Y, Ni H, Bai L, Cheng Q, Zhang H, Wang S, Xie M, Zhao D, Su H (2019) The short-term association between air pollution and childhood asthma hospital admissions in urban areas of Hefei City in China: a time-series study. Environ Res 169:510–516
Acknowledgements
The authors thank the Iran Meteorological Organization, Department of Environment, and Jamaran Hospital for providing the data for this study.
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M S: Conceptualization; Methodology; Software; Formal Analysis; Writing, Original Draft; Validation; Investigation; Supervision
H A: Resources; Data Curation; Writing, Review and Editing; Project Administration
M Hassan N: Visualization
Y A: Visualization
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The data from hospital was collected with no personal identification. The proposal for this study was approved by the Ethics Committee of Baqiyatallah University of Medical Sciences. Ethics code was IR.BMSU.BAQ.REC.1398.052.
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Sepandi, M., Akbari, H., Naseri, M.H. et al. Emergency hospital admissions for cardiovascular diseases attributed to air pollution in Tehran during 2016-2019. Environ Sci Pollut Res 28, 38426–38433 (2021). https://doi.org/10.1007/s11356-021-13377-9
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DOI: https://doi.org/10.1007/s11356-021-13377-9