Abstract
BackgroundAir pollutants have been associated with various adverse health effects, including increased rates of hospital admissions and emergency room visits. Although numerous time-series studies and case-crossover studies have estimated associations between day-to-day variation in pollutant levels and mortality/morbidity records, studies on geographic variations in emergency department use and the spatial effects in their associations with air pollution exposure are rare.MethodsWe focused on the elderly who visited emergency room for cardiovascular related disease (CVD) in 2011. Using spatially and temporally resolved multi-pollutant exposures, we investigated the effect of short-term exposures to ambient air pollution on emergency department utilization. We developed two statistical models with and without spatial random effects within a hierarchical Bayesian framework to capture the spatial heterogeneity and spatial autocorrelation remaining in emergency department utilization.ResultsAlthough the cardiovascular effect of spatially homogeneous pollutants, such as PM2.5 and ozone, was unchanged, we found the cardiovascular effect of NO_2 was pronounced after accounting for the spatially correlated structure in emergency department utilization. We also identified areas with high ED utilization for CVD among the elderly and assessed the uncertainty associated with risk estimates.ConclusionsWe assessed the short-term effect of multi-pollutants on cardiovascular risk of the elderly and demonstrated the use of community multiscale air quality model-derived spatially and temporally resolved multi-pollutant exposures to an epidemiological study. Our results indicate that NO_2 was significantly associated with the elevated ED utilization for CVD among the elderly.
Highlights
Air pollutants have been associated with various adverse health effects, including increased rates of hospital admissions and emergency room visits
Individuals age over 65 take the majority of the 2011 Emergency department (ED) utilization (46.0 %) compared to their demographic composition (15.8%) in this region
We explored the spatio-temporal variability of ED utilizations for cardiovascular related disease (CVD) in relation to the spatial variation of daily exposure to air pollutants, such as NO2, PM2.5 and ozone, at zip code units (Zips)
Summary
Air pollutants have been associated with various adverse health effects, including increased rates of hospital admissions and emergency room visits. The population-weighted spatial average of measurements from monitoring sites have been used in both time-series analysis and case-crossover studies to approximate city-wide or regional average ambient concentrations This approach is relevant as long as the spatial homogeneity assumption is met, but can lead to increased uncertainty and potential bias in their estimates of health risk when the spatiotemporal heterogeneity of pollutants is pronounced [20]. Environmental Protection Agency (EPA) released fine scale predictions of pollutant levels, which were obtained by fusing monitoring data with the CMAQ model outputs These spatially and temporally resolved pollutant surface estimates are subject to calibration bias and uncertainties [26,27,28], there is the potential of improving the quality of individual and population exposure to ambient pollution. The applications of CMAQ related air quality data to population-level epidemiological studies are still rare with a few exceptions [29, 30]
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