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Abstract
Objectives To assess the association between traffic-related ambient air pollution and emergency hospital visits for cardiac arrest.
Design Case–crossover design was used with a lag time to 4 days.
Setting The Reykjavik capital area and the study population was the inhabitants 18 years and older identified by encrypted personal identification numbers and zip codes.
Participants and exposure Cases were those with emergency visits to Landspitali University Hospital during the period 2006–2017 and who were given the primary discharge diagnosis of cardiac arrest according to the International Classification of Diseases 10th edition (ICD-10) code I46. The pollutants were nitrogen dioxide (NO2), particulate matter with aerodynamic diameter less than 10 µm (PM10), particulate matter with aerodynamic diameter less than 2.5 µm (PM2.5) and sulfur dioxide (SO2) with adjustment for hydrogen sulfide (H2S), temperature and relative humidity.
Main outcome measure OR and 95% CIs per 10 µg/m3 increase in concentration of pollutants.
Results The 24-hour mean NO2 was 20.7 µg/m3, mean PM10 was 20.5 µg/m3, mean PM2.5 was 12.5 µg/m3 and mean SO2 was 2.5 µg/m3. PM10 level was positively associated with the number of emergency hospital visits (n=453) for cardiac arrest. Each 10 µg/m3 increase in PM10 was associated with increased risk of cardiac arrest (ICD-10: I46), OR 1.096 (95% CI 1.033 to 1.162) on lag 2, OR 1.118 (95% CI 1.031 to 1.212) on lag 0–2, OR 1.150 (95% CI 1.050 to 1.261) on lag 0–3 and OR 1.168 (95% CI 1.054 to 1.295) on lag 0–4. Significant associations were shown between exposure to PM10 on lag 2 and lag 0–2 and increased risk of cardiac arrest in the age, gender and season strata.
Conclusions A new endpoint was used for the first time in this study: cardiac arrest (ICD-10 code: I46) according to hospital discharge registry. Short-term increase in PM10 concentrations was associated with cardiac arrest. Future ecological studies of this type and their related discussions should perhaps concentrate more on precisely defined endpoints.
- epidemiology
- adult cardiology
- registries
Data availability statement
Data may be obtained from a third party and are not publicly available. The hospital data contain sensitive individual-level information which is not publicly available. It can be made available to researchers after obtaining approval of a formal application to the National Bioethics Committee and the Scientific Committee of LUH. The dataset of air pollution used and analysed during the current study is available from the corresponding author on reasonable request.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data may be obtained from a third party and are not publicly available. The hospital data contain sensitive individual-level information which is not publicly available. It can be made available to researchers after obtaining approval of a formal application to the National Bioethics Committee and the Scientific Committee of LUH. The dataset of air pollution used and analysed during the current study is available from the corresponding author on reasonable request.
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Footnotes
Contributors SH, RGF and VR designed the study. SH, RGF, BTE and VR planned the analysis. SH, GG and VR collected the data. SH, RGF and BTE analysed the data. VR wrote the first draft. SH, RGF, BTE, OSG, GG and VR read the manuscript, interpreted the conclusion and agreed on the final version. VR is responsible for the over all content.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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