Abstract
Adverse impacts of air pollution on human health have been well documented in Spain; however, very few have been conducted in the Spanish region of Castilla-La Mancha (CLM). CLM is an extensive region with a low population density, little industrial production, and moderate air pollution level. The aim of the study was to assess the relationship between the risk of hospital admission for cardiovascular disease (CVD) and exposure to PM2.5, PM10, and NO2 in CLM during 2006–2015. Daily air pollution concentration, temperature, and relative humidity were monitored from the air quality monitoring stations in CLM. A time-series analysis with generalized linear model was used to examine the effects of air pollution on hospital admissions by controlling for long-term trend and other potential confounders. The effect modifications by sex and age (15–64; ≥ 65 years) were examined. Lagging exposure concept was used to analyze a possible latency period in cumulative exposure-pollution analyses. Relative risks (RR) of CVD admissions at the same day (lag 0) and to 7 days after exposure (lag 7) were calculated. Relative risks of CVD admissions (for an increase of 10 µg m−3 in concentration of air pollutant) were calculated. The elderly group (≥ 65 years) were the most susceptible group to the effect of air pollution, whereas the estimated effect by sex was significantly different depending on the age group. The potential utility of these results may help for syndromic surveillance during future similar air pollutant concentrations, where an increase in the use of health services among the vulnerable groups could be unexpected by the emergency department.
Highlights
Cardiovascular diseases (CVD), a class of disorders involving the heart and blood vessels, contribute to about onethird of deaths worldwide (WHO 2017)
A total of 109,974 cardiovascular hospital admissions derived from the emergency department were recorded in Castilla-La Mancha (CLM), from January 1, 2006, to December 31, 2015 (Table 1)
This study found in Spain, for the studied period 2001–2014, a daily annual average of 27.8 μg m−3 for PM10 and 11.3 μg m−3 for PM2.5, similar values to the concentrations measured in CLM in our study
Summary
Cardiovascular diseases (CVD), a class of disorders involving the heart and blood vessels, contribute to about onethird of deaths worldwide (WHO 2017). Patients with CVD share many risk factors such as obesity, Faculty of Environmental Sciences and Biochemistry, University of Castilla-La Mancha, Toledo, Spain. Faculty of Physiotherapy and Nursing of Toledo, University of Castilla-La Mancha, Toledo, Spain. The elderly population is the group who present the highest susceptibility in CVD risk factors (North et al 2012). Sex differences lead to discrepancies in CVD risk factors which may be attributed to sex hormones and their associated receptors (García et al 2016). Even though the individual risk estimates for exposure to air pollution are relatively small compared to the cardiovascular risk factors presented previously, since exposure to air pollution is ubiquitous, the overall population attributable risk and subsequent burden are significant (Nawrot et al 2011)
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