Ambient air pollution and out-of-hospital cardiac arrest. Israel nation wide assessment

Abstract

IntroductionPrevious research suggested that an out-of-hospital cardiac arrest (OHCA) may be triggered by an exposure to ambient pollutants. ObjectiveWe investigated the link between OHCA and a short-term exposure to particulate matter (PM) and other pollutants, within extreme climate conditions in Israel and high PM. MethodsIn a case-crossover analysis, we analyzed all adult cases of OHCA in Israel during 2016–2017. The air-pollution and meteorology data were retrieved from the 132 monitoring stations. All associations at study were investigated using a lag-distributed regression and adjusted to temperature and humidity. ResultsThere were 12401 OHCA cases. Patients experiencing OHCA were likely to be exposed to elevated levels of pollutants, specifically, nitrogen dioxide (NO2) and particulate matter of size ≤2.5 μm (PM2.5) several hours prior to an event, although both at borderline significance, i.e. odds ratio (OR) = 1.20 (95%CI 0.96; 1.51) and OR = 1.15 (95%CI 0.84; 1.60), respectively. An exposure to NO2 was independently associated with OHCA among males (OR = 1.39, 95%CI 0.96; 2.01) and if occurred during the midweek (OR = 1.43, 95%CI 1.03; 1.97). The adverse effect of PM10 was more evident during a weekend (OR = 2.36, 95%CI 0.88; 6.28), as opposed to working days (OR = 0.81, 95%CI 0.45; 1.44). Analysis stratified by regions suggested a spatial variability in pollution associated with OHCA. ConclusionsShort-term exposure to high levels of pollution is adversely associated with OHCA independently of meteorological conditions. The magnitude of the effect is modified by patients' demography. Main findingShort-term exposure to high levels of pollution is adversely associated with OHCA. This effect is independent of temperature and humidity.