Hospital Admissions For Heart Disease Research Articles

The Missing Health Link: How a transition to electrified vehicles may benefit more than just the environment

Worldwide, more than 1 billion vehicles are used regularly, with the majority being gasoline powered. These transport methods are known emitters of carbon dioxide, particulate matter (PM), and other pollutants (i.e., nitric oxides). Such compounds pose a great environmental risk, but recent research has also suggested health consequences. PM, a microscopic carcinogenic substance, affects many biological systems and has been associated with medical concerns in clinical and laboratory settings. In clinical settings, research on the effects of PM of 25 pm or lower in diameter (PM25) have focused on interactions with the cardiovascular, respiratory, and nervous systems. Vulnerable populations (i.e., the elderly and hospitalized patients) disproportionately experience an increase in cardiovascular and respiratory deaths along with hospital admissions for heart disease and asthma. Also, studies have found an increase in tumorigenesis.

Interactive effect between temperature and fine particulate matter on chronic disease hospital admissions in the urban area of Tianjin, China

ABSTRACT This study focuses on effects of fine particulate matter (PM2.5) on chronic disease under different levels of temperature. We obtained type 2 diabetes, cerebral stroke and coronary heart disease hospital admissions (HAs) from five hospitals in urban Tianjin as well as the concentrations of PM2.5, nitrogen dioxide (NO2) and sulphur dioxide (SO2). We used distributed lag nonlinear models to explore nonlinear and lag effects of PM2.5. In single-pollutant models, PM2.5 was positively associated with type 2 diabetes, cerebral stroke and coronary heart disease HAs, with strongest effects at lag1, lag0 and lag06, respectively. The corresponding relative risk rates (RR%) were 1.836%, 2.083% and 6.428%. In co-pollutant models, the correlation between PM2.5 and HAs on high-temperature days was generally stronger than that on low-temperature days. This study indicated that PM2.5 can increase HA rates for these chronic diseases, and effects of PM2.5 on high-temperature days were stronger than that on low-temperature days.

Effectiveness of residential wood-burning regulation on decreasing particulate matter levels and hospitalizations in the San Joaquin Valley Air Basin.

We examined the impact of Rule 4901, aimed at reducing residential wood burning, on particulate matter levels and hospitalizations in the San Joaquin Valley Air Basin (SJVAB). Using general linear mixed models and generalized estimating equation models, we compared levels of particulate matter and of hospital admissions (age groups = 45-64 and ≥ 65 years) in the SJVAB for cardiovascular disease (CVD), ischemic heart disease (IHD), and chronic obstructive pulmonary disease during the burn seasons before (2000-2003) and after (2003-2006) implementation. After implementation, we observed reductions of 12%, 11%, and 15% in particulate matter 2.5 micrometers in diameter or smaller (PM2.5), and 8%, 7%, and 11% in coarse particles, in the entire SJVAB and in rural and urban regions of the air basin, respectively. Among those aged 65 years and older, Rule 4901 was estimated to prevent 7%, 8%, and 5% of CVD cases, and 16%, 17%, and 13% of IHD cases, in the entire SJVAB and in rural and urban regions, respectively. The study suggests that Rule 4901 is effective at reducing wintertime ambient PM2.5 levels and decreasing hospital admissions for heart disease among people aged 65 years and older.

Spatio-temporal Analysis of the Impact of Socioeconomic Status on Admissions for Acute Myocardial Infarction and Related Procedures, in New South Wales, Australia

P-385 Introduction: Our objective was to use spatio-temporal models to examine the relationship between socio-economic status and hospital admissions for heart disease and related procedures. We also quantified the effect of including other variables such as remoteness, Sydney postal areas and Indigenous status. Methods: The main source of outcome data was the New South Wales (NSW) Inpatient Statistics Collection, which is a census of all hospital admissions. Estimated population size from the Australian Bureau of Statistics (ABS) 2001 census, was used to calculate indirect sex and age standardised counts of the outcomes at the postal-area level for the period 1996–2002. Data on Index of Relative Social Disadvantage (IRSD), Accessibility and Remoteness Index for Australia (ARIA-plus), and proportion of Aboriginal & Torres Strait Islander (ATSI) data was also obtained from the ABS. We applied the Bernardinelli spatio-temporal model in our analysis, where both the area-specific intercepts and temporal trends were modelled as random effects. Results: We found an exposure-response relationship between IRSD and acute myocardial infarction (AMI) admissions. i.e. those living in socio-economically disadvantaged postal areas were more likely to be admitted for AMI. We also found that including ARIAP-plus to IRSD actually resulted in a lower percentage of spatial correlation (from 85% to 78%), indicating that accessibility and remoteness does seem to explain away some of the spatial variation in the admissions data, after adjusting for socio-economic status. There was no overall linear temporal increase in relative risks from 1996 to 2002, but we did find a small and significant interaction random effect, indicating that there could be some regions showing a temporal trend over time. We also examined the spatio-temporal distribution of related procedures such cardiac catheterisations, Coronary Artery Bypass Grafts and stents. These demonstrated an inverse relationship with disadvantage and, in some regions, this disparity appeared to worsen rather than improve over the study period. Discussion: We found strong spatially correlated effects in the risk estimates of heart disease and related procedures hospital admissions in NSW, Australia from 1996 to 2002. While low socio-economic status was associated with higher rates of admissions for AMI, it was also associated with low intervention rates. This disparity appears to be increasing in some regions.

Hospital admissions for heart disease: the effects of temperature and humidity.

We estimated the effects of temperature and humidity on hospital admissions for heart disease (International Classification of Diseases, 9th revision [ICD-9] codes 390-429) and myocardial infarction (ICD-9 code 410) of persons age 65 and older in 12 U.S. cities with a wide range of climates. To account for possible delayed effects and harvesting, we examined the impact of weather up to 20 days before each admission. Poisson regression models were fitted in each city, with regression splines used to control for season and barometric pressure. We also controlled day of the week. We estimated the effect and the lag structure of both temperature and humidity based on a distributed lag model. For cities in both hot and cold climates, we found that hospital admissions for all heart disease increased monotonically with average temperature on the same day as and the day before admission. The effect of very high temperatures had a temporal pattern consistent with harvesting: several days after an episode of high temperature, there were fewer admissions. In contrast, a protective effect of cold temperature persisted without rebound. The effects of either hot or cold temperature disappeared within 10 days of exposure. There was no evidence for a humidity effect. Similar but smaller effects of temperature were seen for admissions for myocardial infarction specifically. The effects of temperature on hospital admissions predominantly occur within a few days after exposure, and much of the effect of hot temperatures is short-term displacement of events.

Is there harvesting in the association of airborne particles with daily deaths and hospital admissions?

Although many studies have shown that airborne particles are associated with increased daily death and hospitalization rates, some have questioned whether these events are occurring in persons who would die or enter the hospital within a few days in any case. This hypothesis is usually called the harvesting effect. Harvesting is postulated to occur because the size of the pool of susceptibles decreases as a result of air pollution. I have developed a framework for examining this hypothesis. I used a smoothing technique that allowed me to examine the association between daily deaths and daily hospital admissions net of any such rebound that occurred within a fixed time scale. By varying that time scale I could look at effects net of rebounds on successively larger time scales, ranging from 15 to 60 days. I examined daily deaths and hospital admissions in Chicago for the years 1988-1993. In baseline analyses, particulate matter less than 10 microm in aerodynamic diameter (PM10) was associated with increased daily deaths and hospital admissions for heart disease, pneumonia, and chronic obstructive pulmonary disease. A 10 microg/m3 increase in PM10 was associated with a 0.89% increase in daily deaths (95% confidence interval = 0.61-1.16%), for example. Using smoothing to look at effects net of short-term rebounds, the effect-size estimates for daily deaths and for chronic obstructive pulmonary disease admissions more than doubled. They did not change for pneumonia and heart disease admissions. The increased effect size for daily deaths occurred only for deaths outside of the hospital. These results are consistent with air pollution increasing the size of the risk pool and for most of the deaths being advanced by months to years.

Are there sensitive subgroups for the effects of airborne particles?

Recent studies have shown that particulate air pollution is a risk factor for hospitalization for heart and lung disease; however, little is known about what subpopulations are most sensitive to this pollutant. We analyzed Medicare hospital admissions for heart disease, chronic obstructive pulmonary disorders (COPD) and pneumonia in Chicago, Cook County, Illinois, between 1985 and 1994. We examined whether previous admissions or secondary diagnoses for selected conditions predisposed persons to having a greater risk from air pollution. We also considered effect modification by age, sex, and race. We found that the air-pollution-associated increase in hospital admissions for cardiovascular diseases was almost doubled in subjects with concurrent respiratory infections. The risk was also increased by a previous admission for conduction disorders. For COPD and pneumonia admissions, diagnosis of conduction disorders or dysrhythmias increased the risk of particulate matter < 10 microm in aerodynamic diameter (PM(10))-associated admissions. Persons with asthma had twice the risk of a PM(10)-associated pneumonia admission and persons with heart failure had twice the risk of PM(10)-induced COPD admissions. The PM(10) effect did not vary by sex, age, and race. These results suggest that patients with acute respiratory infections or defects in the electrical control of the heart are a risk group for particulate matter effects.

Air Pollution and Hospital Admissions for Heart Disease in Eight U.S. Counties

Causal diagrams have a long history of informal use and, more recently, have undergone formal development for applications in expert systems and robotics. We provide an introduction to these developments and their use in epidemiologic research. Causal diagrams can provide a starting point for identifying variables that must be measured and controlled to obtain unconfounded effect estimates. They also provide a method for critical evaluation of traditional epidemiologic criteria for confounding. In particular, they reveal certain heretofore unnoticed shortcomings of those criteria when used in considering multiple potential confounders. We show how to modify the traditional criteria to correct those shortcomings.

Air Pollution and Hospital Admissions for Heart Disease in Eight US Counties

This study examines the consistency of the association between particulate matter less than 10 microm in aerodynamic diameter (PM10), carbon monoxide (CO), and hospital admissions for cardiovascular disease across eight urban counties with different levels of correlation between pollutants and between the pollutants and weather. I fit Poisson regression models controlling for day-of-week effects and using nonparametric smoothing to control for season and weather. Daily variation in PM10 was associated with hospital admissions for heart disease in the elderly (2.48% increase, for an interquartile range increase in exposure; 95% confidence limits = 1.82%, 3.15%). Daily variation in CO was also associated with admissions (2.79% increase, for an interquartile range (1.75 parts per million) increase in exposure; 95% confidence limits = 1.89%, 3.68%). These associations held in both humid and dry locations and were independent of the correlation between the pollutants and weather or other pollutants. The effect size estimates for PM10 and CO likewise showed no association with their correlation in each location, as one would expect if one pollutant were merely a proxy for the other. The PM10 effects are consistent with recent animal data showing cardiovascular effects and with preliminary human data showing effects on heart rate variability and plasma viscosity. The CO results are consistent with literature on angina exacerbations.