Associations between residential exposure to fine particulate matter and days spent in hospital for heart failure patients

Abstract

TPS 681: Short-term health effects of air pollutants 1, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Background: Heart failure (HF) is a severe form of cardiovascular disease which is increasing in prevalence. Mortality risks from elevlated ambient fine particulate matter (PM2.5) exposure are well characaterized for HF patients, but few studies have examined morbidity risks in the HF community. In particular, measures such as the days spent in hospital, which may correlate with quality of life and healthcare costs, have yet to be explored. Methods: Using the EPA CARES resource, we examined associations between annual average PM2.5 exposure (assessed at the primary residence at the time of initial HF diagnosis) and the total visits, number of emergency plus inpatient visits, and total days spent in hospital for 24,798 North Carolina resident HF patients (559,664 total visits, 7.7% inpatient or emergency) who resided <30 km from a PM2.5 monitor. The observation period was 7/1/2004 to 12/31/2016. Models were adjusted for age at diagnosis, sex, race, and socioeconomic status indicators extracted from the 2000 census. We used a quasipoisson model to model the total visits and inpatient plus emergency visits and a linear model for the log-transformed total days spent in hospital. Results: The average PM2.5 exposure was 10.2 µg/m3 (interquartile range 8.4-11.4 µg/m3). A 1 µg/m3 increase in PM2.5 exposure was associated with a 19% increase (95% confidence interval [CI] = 18-19%) in the total number of visits, an 11% increase (CI = 11-12%) in the number of inpatient and emergency visits, and a 4.4% increase (CI = 3.7-5.2%) in the total days spent in hospital. Conclusions: Elevated PM2.5 exposure is a significant morbidity risk factor for HF patients. Increases in the number of hospital visits and the days spent in hospital are likely related to quality of life as well as healthcare costs for HF patients. This abstract does not necessarily represent EPA policy.