Cardiorespiratory Hospital Admissions Research Articles

Impact of elevated fine particulate matter (PM2.5) during landscape fire events on cardiorespiratory hospital admissions in Perth, Western Australia

BackgroundAustralia has experienced extreme fire weather in recent years. Information on the impact of fine particulate matter (PM2.5) from landscape fires (LFs) on cardiorespiratory hospital admissions is limited.MethodsWe conducted a...

Impact of ultrafine particles and total particle number concentration on five cause-specific hospital admission endpoints in three German cities

IntroductionNumerous studies have shown associations between daily concentrations of fine particles (e.g., particulate matter with an aerodynamic diameter ≤2.5 µm; PM2.5) and morbidity. However, evidence for ultrafine particles (UFP; particles with an aerodynamic diameter of 10–100 nm) remains conflicting. Therefore, we aimed to examine the short-term associations of UFP with five cause-specific hospital admission endpoints for Leipzig, Dresden, and Augsburg, Germany. Material and methodsWe obtained daily counts of (cause-specific) cardiorespiratory hospital admissions between 2010 and 2017. Daily average concentrations of UFP, total particle number (PNC; 10–800 nm), and black carbon (BC) were measured at six sites; PM2.5 and nitrogen dioxide (NO2) were obtained from monitoring networks. We assessed immediate (lag 0–1), delayed (lag 2–4, lag 5–7), and cumulative (lag 0–7) effects by applying station-specific confounder-adjusted Poisson regression models. We then used a novel multi-level meta-analytical method to obtain pooled risk estimates. Finally, we performed two-pollutant models to investigate interdependencies between pollutants and examined possible effect modification by age, sex, and season. ResultsUFP showed a delayed (lag 2–4) increase in respiratory hospital admissions of 0.69% [95% confidence interval (CI): −0.28%; 1.67%]. For other hospital admission endpoints, we found only suggestive results. Larger particle size fractions, such as accumulation mode particles (particles with an aerodynamic diameter of 100–800 nm), generally showed stronger effects (respiratory hospital admissions & lag 2–4: 1.55% [95% CI: 0.86%; 2.25%]). PM2.5 showed the most consistent associations for (cardio-)respiratory hospital admissions, whereas NO2 did not show any associations. Two-pollutant models showed independent effects of PM2.5 and BC. Moreover, higher risks have been observed for children. ConclusionsWe observed clear associations with PM2.5 but UFP or PNC did not show a clear association across different exposure windows and cause-specific hospital admissions. Further multi-center studies are needed using harmonized UFP measurements to draw definite conclusions on the health effects of UFP.

Low temperature, cold spells, and cardiorespiratory hospital admissions in Helsinki, Finland

There is only limited scientific evidence with varying results on the association between hospital admissions and low ambient temperatures. Furthermore, there has been no research in Northern Europe on cold-associated morbidity. Therefore, this study investigated the associations of daily wintertime temperature and cold spells with cardiorespiratory hospital admissions in the Helsinki metropolitan area, Finland. Daily number of non-elective hospital admissions for 2001–2017 was obtained from the national hospital discharge register and meteorological data from the Finnish Meteorological Institute. Quasi-Poisson regression models were fitted, controlling for potential confounders such as time trend, weekday, holidays, air pollution, barometric pressure, and influenza. The associations of cold season daily mean ambient temperature and cold spells with hospital admissions were estimated using a penalized distributed lag linear models with 21 lag days. Decreased wintertime ambient temperature was associated with an increased risk of hospitalization for myocardial infarction in the whole population (relative risk [RR] per 1 °C decrease in temperature: 1.017, 95% confidence interval [CI]: 1.002–1.032). An increased risk of hospital admission for respiratory diseases (RR: 1.012, 95% CI: 1.002, 1.022) and chronic obstructive pulmonary disease (RR: 1.031, 95% CI: 1.006, 1.056) was observed only in the ≥ 75 years age group. There was an independent effect of cold spell days only for asthma admissions (RR: 2.348, 95% CI: 1.026, 5.372) in the all-ages group. Cold temperature increases the need for acute hospital care due to myocardial infarction and respiratory causes during winter in a northern climate.

Short-Term Coarse Particulate Exposure and Daily Cardio-Respiratory Hospital Admissions in the Helsinki Capital Region

BACKGROUND AND AIM Short-term exposure to coarse inhalable particles (2.5 µg/m3>PMcoarse<10 µg/m3) has been suggested to increase the risk of respiratory disease independently of fine particles, but studies present mixed findings which are even less clear for other outcomes. This study aims to assess the relationship between short-term exposure to PMcoarse and total admissions for cardio-pulmonary diseases. METHODS We conducted a seventeen-year (01/2001-12/2017) time-series study of the daily admissions for cardio-respiratory disease in relation to the mean levels of coarse particles. We obtained air pollution data from the Helsinki Region Environmental Services Authority, meteorological data from the Finnish Meteorological Institute, and hospital exit records from the Finnish Institute for Health and Welfare. We modelled the association between particles and cardiorespiratory admissions using log-linked quasi-Poisson regression. Penalised splines were used to adjust for the time-trend and the meteorological variables. These models were also adjusted for the weekday, pollen concentration, and influenza outbreaks. Different lag structures were explored in both single-pollutant and multipollutant models. The multipollutant models were simultaneously adjusted for PM2.5, NO2, and O3. RESULTS The mean(standard deviation) concentration of PMcoarse was 6.6(5.9) (µg/m3), while the mean (standard deviation) daily numbers of cardiovascular and respiratory admissions were 25.9(7.3) and 21.3(7.4), respectively. A 10 µg/m3 increase in the same day PMcoarse was associated with a 1.7% (95% CI, 0.4%—3.1%) and a 1.9% (95% CI, 0.5%—3.4%) excess daily risk of respiratory admissions in the single-pollutant and multipollutant models, respectively; same-day excess cardiovascular admissions risks were 0.6% (95% CI, -0.5%—1.7%) and 0.3% (95% CI, -0.9%—1.4%) in similar models. CONCLUSIONS Short-term exposure to PMcoarse can increase respiratory admission risks independently of co-pollutants but has a less determinate effect on cardiovascular admissions. A guideline framework should be considered for PMcoarse. KEYWORDS Coarse Particles, Cardiovascular Admissions, Respiratory Admissions, Time-Series, Fine Particles

Acute effects of ambient non-methane hydrocarbons on cardiorespiratory hospitalizations: A multicity time-series study in Taiwan

BackgroundFew environmental epidemiological studies and no large multicity studies have evaluated the acute short-term health effects of ambient non-methane hydrocarbons (NMHC), the essential precursors of ground-level ozone and secondary organic aerosol formation. ObjectiveWe conducted this multicity time-series study in Taiwan to evaluate the association between airborne NMHC exposure and cardiorespiratory hospital admissions. MethodsWe collected the daily mean concentrations of NMHC, fine particulate matter (PM2.5), ozone (O3), weather conditions, and daily hospital admission count for cardiorespiratory diseases between 2014 and 2017 from eight major cities of Taiwan. We applied an over-dispersed generalized additive Poisson model (GAM) with adjustment for temporal trends, seasonal variations, weather conditions, and calendar effects to compute the effect estimate for each city. Then we conducted a random-effects meta-analysis to pool the eight city-specific effect estimates to obtain the overall associations of NMHC exposure on lag0 day with hospital admissions for respiratory and circulatory diseases, respectively. ResultsOn average, a 0.1-ppm increase of lag0 NMHC demonstrated an overall 0.9% (95% CI: 0.4–1.3%) and 0.8% (95% CI: 0.4–1.2%) increment of hospital admissions for respiratory and circulatory diseases, respectively. Further analyses with adjustment for PM2.5 and O3 in the multi-pollutant model or sensitivity analyses with restricting the NMHC monitoring from the general stations only confirmed the robustness of the association between ambient NMHC exposure and cardiorespiratory hospitalizations. ConclusionOur findings provide robust evidence of higher cardiorespiratory hospitalizations in association with acute exposure to ambient NMHC in eight major cities of Taiwan.

Short-Term Joint Effects of PM10, NO2 and SO2 on Cardio-Respiratory Disease Hospital Admissions in Cape Town, South Africa.

Background/Aim: In sub-Sahara Africa, few studies have investigated the short-term association between hospital admissions and ambient air pollution. Therefore, this study explored the association between multiple air pollutants and hospital admissions in Cape Town, South Africa. Methods: Generalized additive quasi-Poisson models were used within a distributed lag linear modelling framework to estimate the cumulative effects of PM10, NO2, and SO2 up to a lag of 21 days. We further conducted multi-pollutant models and stratified our analysis by age group, sex, and season. Results: The overall relative risk (95% confidence interval (CI)) for PM10, NO2, and SO2 at lag 0–1 for hospital admissions due to respiratory disease (RD) were 1.9% (0.5–3.2%), 2.3% (0.6–4%), and 1.1% (−0.2–2.4%), respectively. For cardiovascular disease (CVD), these values were 2.1% (0.6–3.5%), 1% (−0.8–2.8%), and −0.3% (−1.6–1.1%), respectively, per inter-quartile range increase of 12 µg/m3 for PM10, 7.3 µg/m3 for NO2, and 3.6 µg/m3 for SO2. The overall cumulative risks for RD per IQR increase in PM10 and NO2 for children were 2% (0.2–3.9%) and 3.1% (0.7–5.6%), respectively. Conclusion: We found robust associations of daily respiratory disease hospital admissions with daily PM10 and NO2 concentrations. Associations were strongest among children and warm season for RD.

Health impacts of wildfire-related air pollution in Brazil: a nationwide study of more than 2 million hospital admissions between 2008 and 2018

We quantified the impacts of wildfire-related PM2.5 on 2 million hospital admissions records due to cardiorespiratory diseases in Brazil between 2008 and 2018. The national analysis shows that wildfire waves are associated with an increase of 23% (95%CI: 12%–33%) in respiratory hospital admissions and an increase of 21% (95%CI: 8%–35%) in circulatory hospital admissions. In the North (where most of the Amazon region is located), we estimate an increase of 38% (95%CI: 30%–47%) in respiratory hospital admissions and 27% (95%CI: 15%–39%) in circulatory hospital admissions. Here we report epidemiological evidence that air pollution emitted by wildfires is significantly associated with a higher risk of cardiorespiratory hospital admissions.

Association between Low Ambient Temperature and Cardiorespiratory Hospital Admissions in Helsinki, Finland

BACKGROUND AND AIM: The relationship between low ambient temperature and hospital admissions is less studied than between high temperature and hospital admissions. Therefore, this study aimed to investigate the association of daily wintertime temperature with cardiorespiratory hospital admissions in the Helsinki metropolitan area, Finland. METHODS: Daily number of hospital admissions for 2001-2017 was obtained from the national hospital discharge register and weather information from the Finnish Meteorological Institute. Time-series quasi-Poisson regression models were fitted controlling for potential confounders such as time trend, weekday, holiday, air pollution, barometric pressure and an indicator for influenza count. A penalized distributed lag linear model with 21 days of lag was used to estimate the association of daily mean temperature with cause-specific cardiorespiratory hospital admissions, stratified by age-groups (All-ages, 18-64, 65-74 and ≥75), during winter months (December-March). RESULTS:The first and 99th percentiles of daily temperature were -19.6 °C and 11.5 °C respectively. Decreased ambient temperature was associated with increased risk of hospitalization for myocardial infarction in the whole population (Risk Ratio [RR] for 1°C decrease in exposure: 1.015, 95% confidence intervals [CIs]: 1.001-1.030), and in the age group 65-74 (RR: 1.035, 95% CIs: 1.003-1.069). There was also an increased risk of hospital admission for chronic obstructive pulmonary disease (RR: 1.026, 95% CIs: 1.002-1.051) and to lesser extent for respiratory diseases in general (RR: 1.006, 95% CI: 0.995-1.017) in the oldest age (≥75). CONCLUSIONS:Cold increases the need for acute hospital care due to both cardiovascular and respiratory causes during winter months. KEYWORDS: respiratory, cardiovascular, winter, hospital admissions, morbidity, weather

Short-term joint effects of multiple air pollutants on cardio-respiratory disease hospital admissions in Cape Town, 2011 – 2016

BACKGROUND AND AIM: There is limited understanding on the short-term association between hospital admissions and ambient air pollution in sub-Sahara African countries. Therefore, this study investigated the short-term association of air pollution with daily counts of hospital admissions due to respiratory and cardiovascular diseases in Cape Town, South Africa. METHODS: Generalized additive quasi-Poisson models were used within a distributed lag linear modelling framework to estimate the cumulative effects of PM10, NO2 and SO2 up to a lag of 14 days. We further conducted multi-pollutant models and stratified our analysis by age group, sex and season. RESULTS:The relative risk (95% confidence interval (CI)) for PM10, NO2 and SO2 for all ages, both sexes, and seasons, at lag 0 – 1 for hospital admissions due to respiratory disease (RD) were 3.5% (1.8 – 5.2%), 3.2% (1.0 – 5.5%), 1.8% (0 – 3.6%), respectively. In cardiovascular disease (CVD), 2.2% (0.3% - 4%), 1.8% (-0.6% - 4.3%) and -0.5% (-2.3% - 1.3%), respectively, per inter-quartile range increase of 12 ug/m3 for PM10, 7.3 ug/m3 for NO2 and 3.6 ug/m3 for SO2. In multi-pollutant models, PM10 for associations RD remained significant despite some attenuation. The overall cumulative risk per IQR increase in PM10 for females of all ages was 2.7% (-0.2% - 5.6%), 2.9% (0.1% - 5.9%) for males and 6.8% (2.6% - 11.2%) for aged ≥ 65. However, in CVD the association were not significant for all the pollutants, the overall effect estimate for all ages and sexes were 1.4% (-0.8% – 3.7%), 1.4% (-1.4% - 4.3%) and -1% (-2.9% - 1%) for PM10, NO2 and SO2 in three-pollutant models. CONCLUSIONS:We found robust associations of daily respiratory disease hospital admissions with daily PM10 concentrations. Associations were strongest during the warm season and people aged ≥ 65. KEYWORDS: cardiovascular disease, respiratory disease, multi pollutant, short-term association, DLNM, South Africa

Effect of ambient fine particulates (PM2.5) on hospital admissions for respiratory and cardiovascular diseases in Wuhan, China

BackgroundPositive associations between ambient PM2.5 and cardiorespiratory disease have been well demonstrated during the past decade. However, few studies have examined the adverse effects of PM2.5 based on an entire population of a megalopolis. In addition, most studies in China have used averaged data, which results in variations between monitoring and personal exposure values, creating an inherent and unavoidable type of measurement error.MethodsThis study was conducted in Wuhan, a megacity in central China with about 10.9 million people. Daily hospital admission records, from October 2016 to December 2018, were obtained from the Wuhan Information center of Health and Family Planning, which administrates all hospitals in Wuhan. Daily air pollution concentrations and weather variables in Wuhan during the study period were collected. We developed a land use regression model (LUR) to assess individual PM2.5 exposure. Time-stratified case-crossover design and conditional logistic regression models were adopted to estimate cardiorespiratory hospitalization risks associated with short-term exposure to PM2.5. We also conducted stratification analyses by age, sex, and season.ResultsA total of 2,806,115 hospital admissions records were collected during the study period, from which we identified 332,090 cardiovascular disease admissions and 159,365 respiratory disease admissions. Short-term exposure to PM2.5 was associated with an increased risk of a cardiorespiratory hospital admission. A 10 μg/m3 increase in PM2.5 (lag0–2 days) was associated with an increase in hospital admissions of 1.23% (95% CI 1.01–1.45%) and 1.95% (95% CI 1.63–2.27%) for cardiovascular and respiratory diseases, respectively. The elderly were at higher PM-induced risk. The associations appeared to be more evident in the cold season than in the warm season.ConclusionsThis study contributes evidence of short-term effects of PM2.5 on cardiorespiratory hospital admissions, which may be helpful for air pollution control and disease prevention in Wuhan.

Association of cardiorespiratory hospital admissions with ambient volatile organic compounds: Evidence from a time-series study in Taipei, Taiwan

As important precursors of ozone and secondary organic aerosols, the harmful impact of exposure to ambient volatile organic compounds (VOCs) is of public health interest. However, few studies have investigated the health risks of numerous individual VOC species. This study linked the daily concentrations of 54 C2–C11 VOC species monitored from the Wanhua Photochemical Assessment Monitoring Station and hospital admissions for cardiorespiratory diseases in Taipei, Taiwan, from the National Health Insurance Research Database. A standard time-series approach entailing a series of sensitivity analyses was applied to investigate the short-term health risks of exposure to VOC subgroups and species. Consistent associations of all VOC subgroups and main species with chronic obstructive pulmonary disease (COPD) hospitalizations were demonstrated. In addition, associations of the C5–C6 alkanes, C2–C3 alkenes, toluene, and xylene with asthma hospitalizations were found, as were associations of aromatic hydrocarbons with hospitalizations for heart failure. An interquartile range increase in total VOC exposure at lag0 day (102.6 parts per billion carbon) was associated with increments of 1.84% (95% confidence interval: 0.54%–3.15%), 1.65% (0.71%–2.60%), and 1.21% (0.36%–2.07%) in hospitalizations for asthma, COPD, and heart failure, respectively. The effect estimates were robust with data excluding extreme values, the second pollutant adjustment for PM2.5 and O3, and the Bonferroni correction. The associations of ambient VOC exposure with cardiorespiratory hospitalizations in Taipei serve as a reference for VOC regulations and ozone control strategies.

Association Between Particulate Matter (PM10) Exposure and Cardiorespiratory Hospital Admissions: A Time Series Analysis

Association Between Particulate Matter (PM₁₀) Exposure and Cardiorespiratory Hospital Admissions: A Time Series Analysis

Heat, Heatwaves and Cardiorespiratory Hospital Admissions in Helsinki, Finland.

Background: There is a lack of knowledge concerning the effects of ambient heat exposure on morbidity in Northern Europe. Therefore, this study aimed to evaluate the relationships of daily summertime temperature and heatwaves with cardiorespiratory hospital admissions in the Helsinki metropolitan area, Finland. Methods: Time series models adjusted for potential confounders, such as air pollution, were used to investigate the associations of daily temperature and heatwaves with cause-specific cardiorespiratory hospital admissions during summer months of 2001–2017. Daily number of hospitalizations was obtained from the national hospital discharge register and weather information from the Finnish Meteorological Institute. Results: Increased daily temperature was associated with a decreased risk of total respiratory hospital admissions and asthma. Heatwave days were associated with 20.5% (95% CI: 6.9, 35.9) increased risk of pneumonia admissions and during long or intense heatwaves also with total respiratory admissions in the oldest age group (≥75 years). There were also suggestive positive associations between heatwave days and admissions due to myocardial infarction and cerebrovascular diseases. In contrast, risk of arrhythmia admissions decreased 20.8% (95% CI: 8.0, 31.8) during heatwaves. Conclusions: Heatwaves, rather than single hot days, are a health threat affecting morbidity even in a Northern climate.

Heat, heatwaves and cardiorespiratory hospital admissions in Helsinki, Finland

Abstract Background There is a lack of knowledge concerning the effects of heat on morbidity in Northern Europe. Therefore, this study aimed to evaluate the relationships of daily summer-time temperature and heatwaves with cardiorespiratory hospital admissions in Helsinki, Finland. Methods Time-series models adjusted for potential confounders such as air pollution were used to investigate the associations of daily temperature and heatwaves with cause-specific cardiorespiratory hospital admissions, during the summer months of 2000-2017. Daily number of hospitalizations was obtained from the national hospital discharge register, weather information from the Finnish meteorological institute. Results Heatwave-days were associated with an increased risk of pneumonia (RR: 1.17, 95%CI: 1.04-1.31), any respiratory disease in some age groups, and myocardial infarction (RR: 1.54, 95% CI: 1.12-2.12) among person 65-74 years of age. In addition, high effect estimates were observed for many types of cardiorespiratory diseases in association with heatwaves in some age-groups. In contrast, risk of arrhythmia was decreased during heatwaves (RR: 0.81, 95% CI: 0.70-0.93). Conclusions We found no associations and even protective associations between daily mean temperature and cardiorespiratory hospital admissions. However, our results suggest that heatwaves are a serious health threat affecting the morbidity even in the Northern climate Key messages Heatwaves are associated with increased risk of cardio-respiratory hospital admissions. There is a need to adapt to climate change in the public health sector also in Northern Europe to protect vulnerable population groups.

Health effects of air pollution: a Southern European perspective.

ObjectiveTo summarize the main updated evidence about the health effects of air pollution, with a special focus on Southern Europe.Data sourcesLiterature was obtained through PubMed Central and the official websites of European Agencies and Scientific Societies.Study selectionRecent shreds of evidence about the health effects of air pollution coming from international reports and original research were collected and described in this review.ResultsAir pollution is an avoidable risk factor that causes a huge burden for society, in terms of death, health disorders, and huge socio-economic costs. The southern European countries face a more threatening problem because they experience the effects of both anthropogenic pollutants and natural dusts (particulate matter [PM]). The European Environment Agency reported the number of premature deaths in the 28 countries of the European Union attributable to air pollutant exposure in the year 2016: 374,000 for PM2.5, 68,000 for nitrogen dioxide, and 14,000 for ozone. In Italy, time series and analytical epidemiological studies showed increased cardio-respiratory hospital admissions and mortality, as well as increased risk of respiratory diseases in people living in urban areas.ConclusionsBased on abundant evidence, the World Health Organization, which hosts the Global Alliance against Chronic Respiratory Diseases (GARD), the scientific respiratory societies, and the patients’ associations, as well as others in the health sector, must increase their engagement in advocacy for clean air policies.

Health Impacts of Ambient Biomass Smoke in Tasmania, Australia.

The island state of Tasmania has marked seasonal variations of fine particulate matter (PM2.5) concentrations related to wood heating during winter, planned forest fires during autumn and spring, and bushfires during summer. Biomass smoke causes considerable health harms and associated costs. We estimated the historical health burden from PM2.5 attributable to wood heater smoke (WHS) and landscape fire smoke (LFS) in Tasmania between 2010 and 2019. We calculated the daily population level exposure to WHS- and LFS-related PM2.5 and estimated the number of cases and health costs due to premature mortality, cardiorespiratory hospital admissions, and asthma emergency department (ED) visits. We estimated 69 deaths, 86 hospital admissions, and 15 asthma ED visits, each year, with over 74% of impacts attributed to WHS. Average yearly costs associated with WHS were of AUD$ 293 million and AUD$ 16 million for LFS. The latter increased up to more than AUD$ 34 million during extreme bushfire seasons. This is the first study to quantify the health impacts attributable to biomass smoke for Tasmania. We estimated substantial impacts, which could be reduced through replacing heating technologies, improving fire management, and possibly implementing integrated strategies. This would most likely produce important and cost-effective health benefits.

Age-specific seasonal associations between acute exposure to PM2.5 sources and cardiorespiratory hospital admissions in California

Numerous studies have explored the relationships between short-term exposure to fine particulate matter (PM2.5) and morbidity. However, few studies have investigated which PM2.5 sources and constituents contribute to the health associations, and even fewer studies are available which explored age or seasonal effect modification for the associations between PM2.5 sources and health. We explored age-specific associations between short-term exposure to PM2.5 chemical constituents and its sources, and hospital admissions in California. We linked hospital admission data (n = 1,679,094) with PM2.5 chemical constituents and source apportionment data for eight sites in California for the period of 2002–2009. Site-specific source apportionment was conducted using Positive Matrix Factorization, and five PM2.5 sources were commonly identified in most sites (biomass burning, soil, secondary ammonium nitrate, secondary ammonium sulfate, and vehicular emissions). Age-stratified Poisson time-series regression was conducted for each site, and the health risk estimates were combined to generate overall age-specific associations with cardiovascular- and respiratory-related hospital admissions. We further conducted seasonal interaction models to assess seasonal effect modification. An interquartile range increase in PM2.5 vehicular emissions was associated with increased risk of cardiovascular-related hospital admission at lag 0 (1.32% [95% confidence interval (CI): 0.16, 2.49]) for elderly people (≥65 years old). Exposure to PM2.5 vehicular emissions increased the risk of respiratory-related hospitalizations at lag 2 (3.58% [95% CI: 0.90, 6.33]) for children (0–18 years old). Risk estimates of PM2.5 total mass, vehicular emissions, and its related constituents (e.g., iron) for respiratory admissions were higher in the warm season among children. Heterogeneous seasonal estimates were not observed for other age groups. Our results suggest that short-term exposures to several PM2.5 sources and their related constituents are more harmful than exposures to other pollutants, particularly for children in summer. Identifying toxic sources is important for developing effective interventions and protecting susceptible populations.

SOS! Summer of Smoke: An Examination of the Health Effects of a Record Wildfire Season in Canada's High-Subarctic

Background: The high-subarctic in Canada’s Northwest Territories (NWT) has warmed by 2- 2.5°C since the 1950’s. In 2014 it experienced extreme wildfires. We examined the epidemiologic health impacts of smoke, with interpretation informed by community-member interviews. Methods: Poisson regression was used to examine the relationship of 24-hour mean PM2·5 levels with 2014’s cardiorespiratory ER visits. A comparison of salbutamol dispensations, clinic visits for respiratory symptoms, cardiorespiratory ER visits and hospital admissions in 2014 with non- years (2012-2013) was also completed. Findings: Median PM2·5 peaked at 320·3 μg/m3 49 in 2014, and was five-fold higher in 2014 compared to 2012, 2013 and 2015. In 2014, a 10 μg/m3 50 increase in PM2·5 was associated with an increase in ER visits of 11% for asthma and 6% for pneumonia. Compared to 2012/13, there was a 48% increase in dispensed salbutamol; significantly more clinic visits for asthma, pneumonia and cough; double the ER visits for asthma; and 45% more ER visits for pneumonia. Interpretation: The impact of PM2·5 on respiratory health was high, possibly because prolonged smoke impacted indoor air quality or led to difficulty complying with stay inside when smoky messaging, which qualitative analysis found to be associated with isolation, decreased physical activity, disruptions to land-based activities, and Indigenous food security impacts. At-home air filtration, air shelters with recreation opportunities, attention to eco-anxiety, and go outside when not smoky messaging could improve wellness during wildfires. Funding Statement: Health Canada's Climate Change and Health Adaptation Program for First Nations and Inuit Communities. Declaration of Interests: No conflicts of interest exist. Ethics Approval Statement: This project was reviewed and approved by the Stanton Territorial and Wilfrid Laurier University Research Ethics Boards, as well as the Aurora Research Institute.

Particulate air pollution and cardiorespiratory hospital admissions in a temperate Australian city: A case-crossover analysis

Although ambient air pollution exposure has been linked with poor health in many parts of the world, no previous study has investigated the effect on morbidity in the city of Adelaide, South Australia. To explore the association between particulate matter (PM) and hospitalisations, including respiratory and cardiovascular admissions in Adelaide, South Australia. For the study period September 2001 to October 2007, daily counts of all-cause, cardiovascular and respiratory hospital admissions were collected, as well as daily air quality data including concentrations of particulates, ozone and nitrogen dioxide. Visibility codes for present weather conditions identified days when airborne dust or smoke was observed. The associations between PM and hospitalisations were estimated using time-stratified case-crossover analyses controlling for covariates including temperature, relative humidity, other pollutants, day of the week and public holidays. Mean PM(10) concentrations were higher in the warm season, whereas PM(2.5) concentrations were higher in the cool season. Hospital admissions were associated with PM(10) in the cool season and with PM(2.5) in both seasons. No significant effect of PM on all-age respiratory admissions was detected, however cardiovascular admissions were associated with both PM(2.5) and PM(10) in the cool season with the highest effects for PM(2.5) (4.48%, 95% CI: 0.74%, 8.36% increase per 10μg/m(3) increase in PM(2.5)). These findings suggest that despite the city's relatively low levels of air pollution, PM concentrations are associated with increases in morbidity in Adelaide. Further studies are needed to investigate the sources of PM which may be contributing to the higher cool season effects.

Association of size-resolved number concentrations of particulate matter with cardiovascular and respiratory hospital admissions and mortality in Prague, Czech Republic

We analyzed the association of particle number and PM2.5 concentrations with mortality and cardiorespiratory hospital admissions in Prague. Number concentrations of submicron particles in the range of 15–487 nm were measured continuously at a central site in 2006. The particle number concentrations were integrated into four groups with count median diameters of 31 (NC31), 128 (NC128), and 346 nm (NC346). The total number concentration of submicron particles 15–487 nm (NCtot) was also constructed. The studied health outcomes were the daily hospital admissions due to cardiovascular and respiratory diseases and daily cardiovascular and respiratory mortality and the total mortality. The Poisson regression was used for data analysis. The strongest association was found for the accumulation mode particles (NC346) (RR 1.164, 95% CI: 1.052–1.287 for cardiovascular and 1.334, 95% CI: 1.126–1.579 for respiratory admissions for a 7-day moving average for 1000 particles per 1 cm3 increase). Reasonable association between both the cardiovascular and respiratory admissions and NC346 was also found for lag 0, lag 1, lag 2 (not for respiratory admissions), and the 4-day moving average. For NC128 and NCtot, the association was also significant for both cardiovascular and respiratory admissions at lag 0, lag 1, and lag 2 (not for respiratory admissions) for the 4-day and 7-day moving average. The association between the PM2.5 and daily cardiovascular hospital admissions was significant at 2-day lag and for a 4-day average. Positive association with respiratory admissions was significant only for a 7-day average. No association was found between the studied air pollution variables and daily mortality.