Hospital Admissions For Cardiovascular Diseases Research Articles

Cause-Specific Hospital Admissions on Hot Days in Sydney, Australia

Background While morbidity outcomes for major disease categories during extreme heat have received increasing research attention, there has been very limited investigation at the level of specific disease subcategories.Methodology/Principal FindingsWe analyzed daily hospital admissions for cardiovascular (CVD), respiratory (RD), genitourinary (GU) and mental diseases (MD), diabetes (DIA), dehydration (DEH) and ‘the effects of heat and light’ (HEAT) in Sydney between 1991 and 2009. We further investigated the sensitivity to heat of subcategories within the major disease groups. We defined hot days as those with temperatures in the 95th and 99th percentiles within the study period. We applied time-stratified case-crossover analysis to compare the hospital admissions on hot days with those on non-hot days matched by day of the week. We calculated the odds ratios (OR) of admissions between the two types of days, accounting for other environmental variables (relative humidity, ozone and particulate matter) and non-environmental trends (public and school holidays). On hot days, hospital admissions increased for all major categories except GU. This increase was not shared homogeneously across all diseases within a major category: within RD, only ‘other diseases of the respiratory system’ (includes pleurisy or empyema) increased significantly, while admissions for asthma decreased. Within MD, hospital admissions increased only for psychoses. Admissions due to some major categories increased one to three days after a hot day (e.g., DIA, RD and CVD) and on two and three consecutive days (e.g., HEAT and RD).Conclusions/SignificanceHigh ambient temperatures were associated with increased hospital admissions for several disease categories, with some within-category variation. Future analyses should focus on subgroups within broad disease categories to pinpoint medical conditions most affected by ambient heat.

Acute effects of urban and industrial pollution in a government-designated “Environmental risk area”: the case of Brindisi, Italy

Exposure to air pollutants has been associated with increased hospital admissions (HAs) for respiratory and cardiovascular diseases. This work describes a short-term epidemiological study in Brindisi, a highly industrialized town in Southern Italy. The effects of daily exposure to PM10 and NO2 on daily HAs for cardiac, respiratory, and cerebrovascular diseases were investigated by means of a case-crossover design in the period 2001–2007. Results showed positive associations between PM10 and HAs for cardiac and respiratory diseases and between NO2 and HAs for all the categories of diseases considered, particularly among females. Although not statistically significant, increased risk was observed for wind blowing from the port and the industrial area. Findings confirm the health risks associated with ambient air pollution exposure, even though NO2 and PM10 concentrations were below the legal limits. This may be due to the complex scenario of emissions in the area, which should be better investigated.

Air pollution in pristina, influence on cardiovascular hospital morbidity.

ABSTRACTIntroduction:Numerous studies observed health effects of particulate air pollution. Ambient air quality is particularly bad in Pristina. The principal sources of contaminants are sulfur dioxide (SO2), nitrogen oxides NO and NO2 (NOx), ozone (O3), lead (Pb), carbon dioxide (CO2), particulate matter (PM or dust).Objective:to investigate effects of concentrations of pollutants in ambient air on hospital admissions for cardiovascular disease in UCCK- Pristina.Methods:Retrospective ecological study. During the three year analytical research predict the potential benefit of decreasing for concentration of PM 2.5, PM 10 were measured in two station in Pristina. The study population consisted of all hospitalization patient in intern clinic for 2010,2011 and 2012 year. Air pollution measurements will be used by KHMI data for the year of 2010, 2011 and 2012 for the municipality ofPristina in the measurements point in:KHMI-MESP which is equipped with automatic analyzer- Air Compact Monitoring System (Version 2.2) recordum MESSTECHNIK GmbH. Statistical data processing will be done with SPSS 17.0 statistical package.Results:Based on the results obtained during the study period concentrated PM are higher level than standards value. The results showed that the number of hospital admissions for cardiovascular disease are positively correlated with concentration pollutants. Results show clear seasonal variation in the effects of PM on hospital admissions in Kosovo. The study period was short but the mean daily admissions for cardiovascular illnesses were quite large.Conclusion:The main source for air pollution was coal-burned power plant and traffic (old vehicles) in Kosovo.

Effect of air pollution on daily morbidity in Karachi, Pakistan

Levels of daily particulates (PM2.5) were monitored at two sites in Karachi, Pakistan. One site (Korangi) is an industrial and residential neighborhood, while the other (Tibet Center) is a commercial and residential area near a major highway. Monitoring was done daily for a period of six weeks during spring, summer, fall and winter. Particulate levels were extraordinarily high, with the great majority of days falling into the “unhealthy for sensitive groups” or “very unhealthy” categories. The mean PM2.5 levels in Karachi exceeded the WHO's 24 h air quality guideline almost every day and often by a factor of greater than 5-fold. Daily emergency room (ER) visits and hospital admissions for cardiovascular diseases were obtained by review of medical records at three major tertiary and specialized hospitals. ER and hospitalizations were reported relative to days in which the concentration of PM2.5 was less than 50 μg/m3, and by 50 μg/m3 increments up to 300 μg/m3. There were statistically significant elevations in rates of hospital admissions at each of the PM2.5 categories at the Korangi site, and at concentrations >150 μg/m3 at the Tibet Center site. ER visits were significantly elevated only at PM2.5 concentrations of between 151 and 200 μg/m3 at both sites. These results show that the extremely elevated concentrations of PM2.5 in Karachi, Pakistan are, as expected, associated with significantly elevated rates of hospital admission, and to a lesser extent, ER visits for cardiovascular disease.

Desigualdades na mortalidade por doenças cardiovasculares em pequenos municípios

The scope of this ecological study was to identify mortality from cardiovascular disease in the municipalities of the 16th Health Region of Rio Grande do Sul between 2003 and 2007. It looked at differences among them, sex and age distribution and related the mean coefficient of mortality during the period to socioeconomic variables of investment, healthcare coverage and access, seeking to identify a few factors that might be significant to explain these differences. Correlation and multiple regression were analyzed. The results indicated that in counties with up to 5000 inhabitants the Family Health Strategy coverage may be a better protective factor than in larger municipalities, and per capita income has less influence on mortality. A direct relationship was found between hospital admissions for cardiovascular disease and mortality, especially in the larger municipalities. Multiple regression showed health costs per inhabitant/year as the factor most closely related to increased mortality. It was concluded that the variables selected explain partially the differences in mortality caused by cardiovascular disease in a similar group of municipalities of a regional health area in southern Brazil.

Differential effects of fine and coarse particles on daily emergency cardiovascular hospitalizations in Hong Kong

Few studies have investigated the relationship of hospital admissions for cardiovascular diseases with fine (PM2.5: particles with an aerodynamic diameter less than 2.5 μm) and coarse particles (PMc: particles with an aerodynamic diameter between 2.5 and 10 μm) simultaneously. We aimed to estimate the differential effects of PM2.5 and PMc on emergency hospital admissions for cardiovascular diseases, after controlling for the gaseous pollutants. We conducted a time series analysis in Hong Kong using daily emergency hospital admissions for cardiovascular diseases, PM2.5 and PMc concentrations from January 2000 to December 2005. PMc concentrations were estimated by subtracting PM2.5 from PM10 measurements. Generalized additive Poisson models allowing overdispersion and autocorrelation were used to examine the effects of PM2.5 and PMc simultaneously, adjusting for time trends, weather conditions, influenza outbreaks, and gaseous pollutants. In two-pollutant model, an interquartile range (IQR) increase in the 2-day moving average (lag01) concentration of PM2.5 and PMc corresponded to 1.86% (95% CI: 0.85%, 2.88%) and −0.16% (95% CI: −1.07%, 0.76%) change of emergency hospital admissions for total circulatory diseases respectively. Results were sensitive to further inclusion of nitrogen dioxide but not of ozone and sulfur dioxide. We did not find any effects of PMc on circulatory hospitalizations independent of PM2.5. In conclusion, we confirmed the stronger and significant adverse effects of PM2.5, but no independent effect of PMc on emergency cardiovascular hospitalizations. The biological mechanisms underlying the differential effects of PM2.5 and PMc on cardiovascular diseases were discussed.

Effects of meteorological parameters on hospital admission for respiratory and cardiovascular diseases

Aim Meteorological factors play a role in respiratory and cardiovascular diseases. However, previous studies demonstrated inconsistent results regarding their associations. This paper aims to evaluate their relationships to facilitate anticipatory care for patients with respiratory and cardiovascular diseases.

Developing a risk-based air quality health index

We developed a risk-based, multi-pollutant air quality health index (AQHI) reporting system in Hong Kong, based on the Canadian approach. We performed time series studies to obtain the relative risks of hospital admissions for respiratory and cardiovascular diseases associated with four air pollutants: sulphur dioxide, nitrogen dioxide, ozone, and particulate matter with an aerodynamic diameter less than 10 μm (PM10). We then calculated the sum of excess risks of the hospital admissions associated with these air pollutants. The cut-off points of the summed excess risk, for the issuance of different health warnings, were based on the concentrations of these pollutants recommended as short-term Air Quality Guidelines by the World Health Organization. The excess risks were adjusted downwards for young children and the elderly. Health risk was grouped into five categories and sub-divided into eleven bands, with equal increments in excess risk from band 1 up to band 10 (the 11th band is ‘band 10+’). We developed health warning messages for the general public, including at-risk groups: young children, the elderly, and people with pre-existing cardiac or respiratory diseases. The new system addressed two major shortcomings of the current standard-based system; namely, the time lag between a sudden rise in air pollutant concentrations and the issue of a health warning, and the reliance on one dominant pollutant to calculate the index. Hence, the AQHI represents an improvement over Hong Kong's existing air pollution index.

Long term outcomes in men screened for abdominal aortic aneurysm: prospective cohort study

Objective To determine whether there is a relation between aortic diameter and morbidity and mortality in men screened for abdominal aortic aneurysm.Design Prospective cohort study.Setting Highland and Western Isles (a...

Association between ambient ozone and health outcomes in Prague

Though numerous studies investigating ambient ozone (O(3)) effects on human health were published, such a study for Central Europe is still lacking. We have investigated the association between ozone (O(3)) levels and hospital admissions and mortality due to cardiovascular and respiratory diseases for Prague inhabitants for summer months (April-September) over the 5-year period 2002-2006. Our hypothesis was that ambient O(3) levels in Prague resulted in adverse health outcomes and were associated with increased mortality and hospital admissions. The effect of O(3) on mortality and hospital admissions was investigated using the negative binomial regression after controlling for the influence of meteorological factors (air temperature and relative humidity) and calendar effects (seasonal patterns, long-term trends and day of week). We found a statistically significant association between O(3) levels and daily mortality from respiratory diseases. Relative risk of 1.080 (95% CI: 1.031-1.132) was observed for mortality from respiratory diseases per 10 μg m(-3) increase in 1-day lagged daily mean O(3) concentration. No statistically significant association was detected between O(3) concentrations and daily mortality from all causes, daily mortality from cardiovascular diseases and hospital admissions for respiratory and cardiovascular diseases. The O(3) effects differed in men and women, nevertheless, the results were ambiguous with respect to used lag and O(3) metrics. No significant confounding effects of PM(10) on the investigated association were observed. O(3) exposure in Prague, though lower as compared to many other cities in Europe, is high enough to cause adverse health effects.

Hospital admissions for acute myocardial infarction before and after implementation of a comprehensive smoke-free policy in Uruguay

BackgroundStimulated by the WHO Framework Convention on Tobacco Control, many countries in Latin America adopted comprehensive smoke-free policies. In March 2006, Uruguay became the first Latin American country to adopt...

Health effects for the population living near a cement plant: An epidemiological assessment

Epidemiological studies have shown the association between the exposure to air pollution and several adverse health effects. To evaluate the possible acute health effects of air pollution due to the emissions of a cement plant in two small municipalities in Italy (Mazzano and Rezzato), a case–control study design was used. The risks of hospital admission for cardiovascular or respiratory diseases for increasing levels of exposure to cement plant emissions were estimated, separately for adults (age>34years) and children (0–14years). Odds ratios (OR) were estimated using unconditional regression models. Attributable risks were also calculated.Statistically significant risks were found mainly for respiratory diseases among children: OR 1.67 (95% CI 1.08–2.58) for the moderately exposed category (E1), OR 1.88 (95% CI 1.19–2.97) for the highly exposed category (E2), with an attributable risk of 38% of hospital admissions due to the exposure to cement plant exhausts. Adults had a weaker risk: OR 1.38 (95% CI 1.18–1.61) for group E1, OR 1.31 (95% CI 1.10–1.56) for group E2; the attributable risk was 23%. Risks were higher for females and for the age group 35–64. These results showed an association between the exposure to plant emissions and the risk of hospital admission for cardiovascular or respiratory causes; this association was particularly strong for children.

Effect of Dust Storm Events on Daily Emergency Admissions for Cardiovascular Diseases

Dust storm is a meteorological phenomenon and dust particles have been suspected as harmful to heart and lungs. The aim of this study was to investigate the association between coarse particles and emergency hospital admissions for cardiovascular diseases (CVD) in Hong Kong. Data on mean daily emergency admissions for CVD to major hospitals in Hong Kong, concentrations of air pollutants and meteorological variables from January 1998 to December 2002 were obtained from several government departments. We identified 5 dust storm days during the study period. Independent t-tests were used to compare the mean daily number of admissions on dust storm and non-dust storm days. Case-crossover analysis, using the Poisson regression, was used to examine the effects of coarse particles' concentration on emergency hospital admissions for CVD. A marginally significant increase in emergency hospital admissions for ischemic heart disease (IHD) was found with RR=1.04 (95% confidence interval: 1.00, 1.08) per 10 µg/m(3) increase in the concentration of coarse particles. This study demonstrated a marginally significant increase in emergency hospital admissions for IHD on the day of dust storm events in Hong Kong, when the levels of coarse particles were very high. Further studies are required to assess the role of coarse particles on cardiac health.

AMBIENT AIR POLLUTION AND CARDIOVASCULAR MORBIDITY AMONG POTENTIALLY SUSCEPTIBLE GROUPS

Background and Aims: Evidence suggests that risks associated with exposure to ambient air pollutants are not uniform across individuals; however, there is considerable uncertainty in estimates for susceptible populations. Methods: We conducted a five-year study (2003-07) examining the association of fine particulate matter (PM2.5) and gases with cardiovascular hospital admissions in Denver, Colorado. We investigated the relationships between daily counts of cardiovascular disease admissions and same-day concentrations of ambient air pollutants (PM2.5 mass, elemental carbon [EC], organic carbon [OC], sulfate, nitrate, source-apportioned PM, gases) among potentially susceptible subgroups defined by comorbid illness (using secondary diagnoses, e.g. hypertension, diabetes), age, race, sex, and payment type. Results: The mean daily concentration of PM2.5 mass was 8.0•g/m3(standard deviation 5.1•g/m3). We observed increases in cardiovascular disease hospital admissions, particularly for ischemic heart disease, in relation to increases in PM2.5 mass, EC, and OC concentrations as well as several of the PM source factors. For the PM species, the associations were strongest for EC (relative risk [RR per interquartile range] = 1.019; 95% confidence interval [CI] 1.010-1.028 per 0.33•g/m3 increase) and OC (RR=1.017; 95%CI 1.006-1.028 per 1.7•g/m3 increase). We did not observe consistent evidence of heterogeneity of these associations by subgroups. Some indication of stronger effects among patients with comorbid ischemic heart disease (IHD), including coronary atherosclerosis, compared to patients without comorbid IHD and among non-white patients compared to white patients was observed, although confidence intervals were wide and overlapping. Conclusions: Although associations were detected among the total population at relatively low PM mass and component concentrations, we did not observe strong evidence of effect modification by potentially susceptible subgroups. The use of secondary diagnoses may have limited our ability to detect comorbid illness. The views expressed are those of the authors and do not necessarily reflect the views or policies of the U.S.EPA.

Association between coarse particles air pollution and hospital admissions for respiratory and cardiovascular diseases in Busan, Korea

Background and Aims: Research on the health effects of coarse particles, greater than 2.5 μm and 10 μm or less in diameter (PM10-2.5) is limited and findings have been mixed. The chemical compositi...

RISK ASSESSMENT OF EXPOSURE BY PM 2,5 FROM THE BIOMASS BURNING IN CHILDREN OF BRAZILIAN AMAZON: ESTIMATIVE OF POTENTIAL DOSE AND RISK TOXICOLOGY

Background and Aims: Exposure to fine fractions of particulate matter (PM2,5) was associated with increased hospital admissions for respiratory disease and cardiovascular disease in children and elderly (Pope III and Dockery 2006; Gouveia et al 2006). This study aims to estimate the toxicological risk of PM2,5 from the burning biomass in children between 6 to 14 years of age in Tangará da Serra, a municipality of Subequatorial Brazilian Amazon. Methods: Study of Risk Assessment of PM2.5 by estimated the potential dose and risk quotient in two scenarios of exposure according to local seasonality. The exposure scenarios were defined using the average of concentrations PM2,5 during the dry and rainy season. The potential dose of PM2,5 was estimated using Monte Carlo simulation, according age, gender, asthma and Body Mass Index (BMI). Results: The children incorporated a potential average dose of PM2.5 of 2.05 μg/kg.dia (CI 95%: 1.91-2.18) in dry season and 0.32 μg/kg.dia (CI 95%: 0.31-0.34) in the rain scenario. During dry season, children and adolescents showed toxicological risk to PM2.5 of 2.41 (CI 95%: 2.25-2.57). In the rain scenario, the exposure to PM2.5 not configured toxicological risk (RQ=0.54; CI 95%: 0.52-0.56). Conclusions: Children and adolescents living in the Subequatorial Brazilian Amazon region were exposed to higher potential average doses of PM2.5, resulting in toxicological risk for this pollutant.

General mortality and emergency hospital admissions for respiratory and cardiovascular diseases during A/H1N1v pandemic influenza in Parma

General mortality and emergency hospital admissions for respiratory and cardiovascular diseases during A/H1N1v pandemic influenza in Parma

Air pollution and cardiovascular hospital admissions in a medium-sized city in São Paulo State, Brazil

The objective of the present study was to estimate the contribution of environmental pollutants to hospital admissions for cardiovascular disease. A time series ecological study was conducted on subjects aged over 60 years and living in São José dos Campos, Brazil, with a population near 700,000 inhabitants. Hospital admission data of public health patients (SUS) were obtained from DATASUS for the period between January 1, 2004 and December 31, 2006, according to the ICD-10 diagnoses I20 to I22 and I24. Particulate matter with less than 10 µm in aerodynamic diameter, sulfur dioxide and ozone were the pollutants examined, and the control variables were mean temperature and relative humidity. Data on pollutants were obtained from the São Paulo State Sanitary Agency. The generalized linear model Poisson regression with lags of up to 5 days was used. There were 1303 hospital admissions during the period. Exposure to particulate matter was significantly associated with hospitalization for cardiovascular disease 3 days after exposure (RR = 1.006; 95%CI = 1.000 to 1.010) and an increase of 16 µg/m³ was associated with a 10% increase in risk of hospitalization; other pollutants were not associated with hospitalization. Thus, it was possible to identify the role of exposure to particulate matter as an environmental pollutant in hospitalization for cardiovascular disease in a medium-sized city inSoutheastern Brazil.

Journal Digest

Journal Digest

Chemical Properties of Air Pollutants and Cause-Specific Hospital Admissions among the Elderly in Atlanta, Georgia

Background: Health risks differ by fine particle (aerodynamic diameter ≤ 2.5 μm) component, although with substantial variability. Traditional methods to assess component-specific risks are limited, suggesting the need for alternative methods.Objectives: We examined whether the odds of daily hospital admissions differ by pollutant chemical properties.Methods: We categorized pollutants by chemical properties and examined their impacts on the odds of daily hospital admissions among Medicare recipients > 64 years of age in counties in Atlanta, Georgia, for 1998–2006. We analyzed data in two stages. In the first stage we applied a case-crossover analysis to simultaneously estimate effects of 65 pollutants measured in the Aerosol Research and Inhalation Epidemiology Study on cause-specific hospital admissions, controlling for temperature and ozone. In the second stage, we regressed pollutant-specific slopes from the first stage on pollutant properties. We calculated uncertainty estimates using a bootstrap procedure. We repeated the two-stage analyses using coefficients from first-stage models that included single pollutants plus ozone and meteorological variables only. We based our primary analyses on exposures on day of admission.Results: We found that 24-hr transition metals and alkanes were associated with increased odds [0.26%; 95% confidence interval (CI), 0.02–0.48; and 0.37%; 95% CI, 0.04–0.72, respectively] of hospital admissions for cardiovascular disease (CVD). Transition metals were significantly associated with increased hospital admissions for ischemic heart disease, congestive heart failure, and atrial fibrillation. Increased respiratory-related hospital admissions were significantly associated with alkanes. Aromatics and microcrystalline oxides were significantly associated with decreased CVD- and respiratory-related hospital admissions.Conclusions: The two-stage approach showed transition metals to be consistently associated with increased odds of CVD-related hospital admissions.