Triggering of cardiovascular hospitalization by short-term increases in PM2.5 in New York adults: changes following Tier 3 vehicle introduction

Abstract

BACKGROUND and AIM: Previously, increased hospitalizations for cardiovascular disease (CVD) were associated with PM2.5 concentrations in New York State (NYS) adults from 2005-2016, with higher rates after air quality policies and a recession reduced PM2.5 concentrations (2014-2016), suggesting PM had become more toxic. Following introduction of Tier 3 light duty vehicles in 2017, which should produce less secondary organic carbon than previous vehicles likely making PM less toxic, we hypothesized that there would be a lower relative rate in 2017-2019 than 2014-2016. METHODS: From the SPARCS database (∼95% of hospital admissions in NYS), we included hospitalizations with a primary diagnosis of CVD from 2014-2019 to adults living within 15 miles of PM2.5 monitoring stations in Buffalo, Rochester, Albany, Bronx, Queens, and Manhattan. Using daily PM2.5 concentrations from these sites, a case-crossover design, and conditional-logistic regression, we separately estimated the rate of CVD hospitalizations associated with increased PM2.5 concentrations in 2014-2016 and 2017-2019. RESULTS: Interquartile range (IQR) increases in PM2.5 were associated with increased excess rates of ischemic heart disease hospitalizations in 2014-2016 (lag days 0-3: 2.0%, 95% CI = 0.9%, 3.2%), but not 2017-2019 (-0.8%, 95% CI = -2.3%, 0.6%). However, IQR increases in PM2.5 were associated with larger excess rates of heart failure hospitalizations in 2017-2019 (lag day 0: 4.4%; 95% CI = 1.3%, 7.7%) than 2014-2016 (1.1%; 95% CI = -0.1%, 2.2%), with a similar pattern for hypertension hospitalizations. CONCLUSIONS: We did not find consistent differences in rates of cause-specific CVD hospitalizations associated with increased PM2.5 concentrations in the previous 1-7 days in NYS adults, before and after Tier 3 vehicles were introduced. However, there may need to be more time for more Tier 3 vehicles to be in the vehicle fleet, and for greater retirement of the older more polluting vehicles. KEYWORDS: cardiovascular hospitalizations, air pollution, case-crossover