Ambient Air Pollution Is Associated With Increased Risk of Hospital Cardiac Readmissions of Myocardial Infarction Survivors in Five European Cities
Stephanie von KlotFrom the Institute of Epidemiology (S.v.K., A.P., H.L.) and the Institute of Health Economics and Health Care Management (A.H.), GSF–National Research Center for Environment and Health, Neuherberg, Germany; Department of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, Finland; Department of Occupational and Environmental Health (T.B., N.B.), Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, Sweden;Annette PetersFrom the Institute of Epidemiology (S.v.K., A.P., H.L.) and the Institute of Health Economics and Health Care Management (A.H.), GSF–National Research Center for Environment and Health, Neuherberg, Germany; Department of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, Finland; Department of Occupational and Environmental Health (T.B., N.B.), Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, Sweden;Pasi P. AaltoFrom the Institute of Epidemiology (S.v.K., A.P., H.L.) and the Institute of Health Economics and Health Care Management (A.H.), GSF–National Research Center for Environment and Health, Neuherberg, Germany; Department of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, Finland; Department of Occupational and Environmental Health (T.B., N.B.), Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, Sweden;Tom BellanderFrom the Institute of Epidemiology (S.v.K., A.P., H.L.) and the Institute of Health Economics and Health Care Management (A.H.), GSF–National Research Center for Environment and Health, Neuherberg, Germany; Department of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, Finland; Department of Occupational and Environmental Health (T.B., N.B.), Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, Sweden;Niklas BerglindFrom the Institute of Epidemiology (S.v.K., A.P., H.L.) and the Institute of Health Economics and Health Care Management (A.H.), GSF–National Research Center for Environment and Health, Neuherberg, Germany; Department of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, Finland; Department of Occupational and Environmental Health (T.B., N.B.), Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, Sweden;Daniela D’IppolitiFrom the Institute of Epidemiology (S.v.K., A.P., H.L.) and the Institute of Health Economics and Health Care Management (A.H.), GSF–National Research Center for Environment and Health, Neuherberg, Germany; Department of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, Finland; Department of Occupational and Environmental Health (T.B., N.B.), Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, Sweden;Roberto ElosúaFrom the Institute of Epidemiology (S.v.K., A.P., H.L.) and the Institute of Health Economics and Health Care Management (A.H.), GSF–National Research Center for Environment and Health, Neuherberg, Germany; Department of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, Finland; Department of Occupational and Environmental Health (T.B., N.B.), Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, Sweden;Allmut HörmannFrom the Institute of Epidemiology (S.v.K., A.P., H.L.) and the Institute of Health Economics and Health Care Management (A.H.), GSF–National Research Center for Environment and Health, Neuherberg, Germany; Department of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, Finland; Department of Occupational and Environmental Health (T.B., N.B.), Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, Sweden;Markku KulmalaFrom the Institute of Epidemiology (S.v.K., A.P., H.L.) and the Institute of Health Economics and Health Care Management (A.H.), GSF–National Research Center for Environment and Health, Neuherberg, Germany; Department of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, Finland; Department of Occupational and Environmental Health (T.B., N.B.), Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, Sweden;Timo LankiFrom the Institute of Epidemiology (S.v.K., A.P., H.L.) and the Institute of Health Economics and Health Care Management (A.H.), GSF–National Research Center for Environment and Health, Neuherberg, Germany; Department of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, Finland; Department of Occupational and Environmental Health (T.B., N.B.), Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, Sweden;Hannelore LöwelFrom the Institute of Epidemiology (S.v.K., A.P., H.L.) and the Institute of Health Economics and Health Care Management (A.H.), GSF–National Research Center for Environment and Health, Neuherberg, Germany; Department of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, Finland; Department of Occupational and Environmental Health (T.B., N.B.), Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, Sweden;Juha PekkanenFrom the Institute of Epidemiology (S.v.K., A.P., H.L.) and the Institute of Health Economics and Health Care Management (A.H.), GSF–National Research Center for Environment and Health, Neuherberg, Germany; Department of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, Finland; Department of Occupational and Environmental Health (T.B., N.B.), Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, Sweden;Sally PicciottoFrom the Institute of Epidemiology (S.v.K., A.P., H.L.) and the Institute of Health Economics and Health Care Management (A.H.), GSF–National Research Center for Environment and Health, Neuherberg, Germany; Department of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, Finland; Department of Occupational and Environmental Health (T.B., N.B.), Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, Sweden;Jordi SunyerFrom the Institute of Epidemiology (S.v.K., A.P., H.L.) and the Institute of Health Economics and Health Care Management (A.H.), GSF–National Research Center for Environment and Health, Neuherberg, Germany; Department of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, Finland; Department of Occupational and Environmental Health (T.B., N.B.), Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, Sweden;Francesco ForastiereFrom the Institute of Epidemiology (S.v.K., A.P., H.L.) and the Institute of Health Economics and Health Care Management (A.H.), GSF–National Research Center for Environment and Health, Neuherberg, Germany; Department of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, Finland; Department of Occupational and Environmental Health (T.B., N.B.), Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, Sweden;
2005en
ABI
Annotatsiya
BACKGROUND: Ambient air pollution has been associated with increases in acute morbidity and mortality. The objective of this study was to evaluate the short-term effects of urban air pollution on cardiac hospital readmissions in survivors of myocardial infarction, a potentially susceptible subpopulation. METHODS AND RESULTS: In this European multicenter cohort study, 22,006 survivors of a first myocardial infarction were recruited in Augsburg, Germany; Barcelona, Spain; Helsinki, Finland; Rome, Italy; and Stockholm, Sweden, from 1992 to 2000. Hospital readmissions were recorded in 1992 to 2001. Ambient nitrogen dioxide, carbon monoxide, ozone, and mass of particles <10 microm (PM10) were measured. Particle number concentrations were estimated as a proxy for ultrafine particles. Short-term effects of air pollution on hospital readmissions for myocardial infarction, angina pectoris, and cardiac causes (myocardial infarction, angina pectoris, dysrhythmia, or heart failure) were studied in city-specific Poisson regression analyses with subsequent pooling. During follow-up, 6655 cardiac readmissions were observed. Cardiac readmissions increased in association with same-day concentrations of PM10 (rate ratio [RR] 1.021, 95% CI 1.004 to 1.039) per 10 microg/m3) and estimated particle number concentrations (RR 1.026 [95% CI 1.005 to 1.048] per 10,000 particles/cm3). Effects of similar strength were observed for carbon monoxide (RR 1.014 [95% CI 1.001 to 1.026] per 200 microg/m3 [0.172 ppm]), nitrogen dioxide (RR 1.032 [95% CI 1.013 to 1.051] per 8 microg/m3 [4.16 ppb]), and ozone (RR 1.026 [95% CI 1.001 to 1.051] per 15 microg/m3 [7.5 ppb]). Pooled effect estimates for angina pectoris and myocardial infarction readmissions were comparable. CONCLUSIONS: The results suggest that ambient air pollution is associated with increased risk of hospital cardiac readmissions of myocardial infarction survivors in 5 European cities.
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