Abstract
The objective of the present study was to estimate the contribution of environmental pollutants to hospital admissions for cardiovascular disease. A time series ecological study was conducted on subjects aged over 60 years and living in São José dos Campos, Brazil, with a population near 700,000 inhabitants. Hospital admission data of public health patients (SUS) were obtained from DATASUS for the period between January 1, 2004 and December 31, 2006, according to the ICD-10 diagnoses I20 to I22 and I24. Particulate matter with less than 10 µm in aerodynamic diameter, sulfur dioxide and ozone were the pollutants examined, and the control variables were mean temperature and relative humidity. Data on pollutants were obtained from the São Paulo State Sanitary Agency. The generalized linear model Poisson regression with lags of up to 5 days was used. There were 1303 hospital admissions during the period. Exposure to particulate matter was significantly associated with hospitalization for cardiovascular disease 3 days after exposure (RR = 1.006; 95%CI = 1.000 to 1.010) and an increase of 16 µg/m(3) was associated with a 10% increase in risk of hospitalization; other pollutants were not associated with hospitalization. Thus, it was possible to identify the role of exposure to particulate matter as an environmental pollutant in hospitalization for cardiovascular disease in a medium-sized city in Southeastern Brazil.
Highlights
The incidence and prevalence of cardiovascular diseases have increased over the last decades and have become one of the main causes of death among adults [1,2]
As the effect of atmospheric pollution on ischemic heart disease (IHD) morbidity may be distributed along the time, the number of events on a single day may be due to the exposure to air pollution on this day but along the previous day, with no consensus in the literature about the lag days
The risks of admission and the percent increase (INC) of these risks were estimated according to the increase observed in the interquartile difference (IQD) of each pollutant, according to the expression INC = (RR - 1) x 100, where RR is defined as exp, where coeff is the pollutant coefficient obtained by the Poisson regression
Summary
The incidence and prevalence of cardiovascular diseases have increased over the last decades and have become one of the main causes of death among adults [1,2]. The association between air pollution and emergency room visits for ischemic cardiovascular disease has been demonstrated recently in São Paulo, Brazil. Other effects on the cardiovascular system such as arterial hypertension and alteration in the heart rate variability have been observed in São Paulo. The first involves changes in the modulation of the autonomic nervous system, as indicated by the observation of a decrease in heart rate variability in relation to the level of pollutants. Some diseases of the cardiovascular system, such as acute myocardial infarction and sudden death, are associated with alterations in the autonomic nervous system. Another possible mechanism is related to the increase in fibrinogen and circulating
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