Air pollution and cardiovascular mortality in Poland: a panel time-series analysis of 80 million person-years (EP-PARTICLES study)

Abstract

Abstract Introduction Air pollution is one of the leading environmental risk factors affecting the population worldwide. Studies so far mostly analysed urban and industrial areas excluding smaller towns and villages due to a lack of monitoring stations and recognition of these areas as potentially free from pollution. Our analysis focuses on Eastern Poland, one of the poorest regions of the EU, with a population of nearly 8 million people with almost half living in rural areas. We investigate the impact of "Polish smog" a new type of air pollution which - due to its composition and the conditions in which it is formed - is characterized by extremely adverse cardiovascular health effects. Purpose Analysis of the short and mid-term impact of air pollution on cardiovascular (CV) mortality. Methods We collected daily data on air pollution from the Voivodeship Inspectorate for Environmental Protection for the years 2010-2020 and used an algorithm developed in collaboration with the Department of Atmospheric and Climate Modeling at the Polish Academy of Sciences to model the average daily concentrations of pollutants in locations without available data. Causes of death with ICD-10 codes from I00 to I99 were extracted for analysis. We estimated county-specific associations of air pollution concentration with mortality using panel standard time-series with Poisson distribution regression models, adjusting for weather conditions, and short- and long-term trends in mortality. Odds ratios (ORs) with interquartile ranges (IQRs) were reported for each type of air pollutant and lag structure was analysed. Results We observed 831,246 deaths, including 377,344 due to CV diseases. The overall standardized death rate (SDR) was 533.3 cases/100,000 inhabitants/year, with an increasing trend over each year. The IQR increase in concentrations of PM2.5 (OR=1.034, 95%CI 1.029-1.04, P<0.001), benzo(a)pyrene (BaP) (OR=1.015, 95%CI 1.011-1.02; P<0.001), SO2 (OR=1.008, 95%CI 1.006-1.01; P<0.001), and NO2 (OR=1.013, 95%CI 1.01-1.016; P<0.001) were associated with an increase in CV mortality on the day of the exposure and this effect was persistent up to LAG6. The detrimental influence of pollutants was also observed in the mid-term [lag0-30 (BaP-OR=1.028, 95%CI 1.022-1.034; P<0.001), (PM2.5-OR=1.056, 95%CI 1.047-1.064; P<0.001), (SO2-OR=1.014, 95%CI 1.011-1.017; P<0.001), (NO2-OR=1.037, 95%CI 1.031-1.043; P<0.001)]. Conclusion The mortality rate due to CV diseases continues to rise. Our study highlights the negative impact of air pollution, both in the short and long term. Areas previously assumed to be free from pollution may actually be at high risk, emphasizing the need for careful monitoring of air quality. Further research should focus on identifying the most vulnerable areas and developing effective strategies to prevent the adverse health effects of air pollution on public health.