Number Of Emergency Hospital Admissions Research Articles

Promoting eCo-responsibility, eCo-literacy, and eCo-centricity in emergency triAge Regarding climate changE consequences (I-CARE THE 3 Cs): study protocol

Background: Climate change, ambient air pollution, and non-optimal temperatures are recognized as a global health emergency. Many studies have highlighted increases in the number of emergency hospital admissions and hospitalizations for respiratory and cardiovascular diseases associated with non-optimal temperatures, unconventional gas reserves, particulate matter, grounded level O3, sulphur dioxide, or nitrogen dioxide exposure. Problem statement: According to the Swiss Health Observatory, 14% of the Swiss population used a hospital emergency department (ED) at least once in 2016, representing 1,7 million admissions or 4,718 admissions per day. In the face of evolving climate-associated reasons for presenting at the ED, the scales used for emergency triage are now proving insufficient for their task. It is becoming critical to introduce and implement more appropriate ED triage tools that incorporate risk factors such as ambient temperature and air pollution. It will also require raising nurses’ eco-literacy, eco-responsibility, and eco-centricity, which are currently rated as moderate to low, to ensure adaptation and/or mitigation in the face of this global threat. Future directions and perspectives for the nursing discipline: The nursing discipline must develop its eco-literacy, eco-responsibility, and eco-centricity to take social and professional responsibility for addressing the health-related impacts of climate change. To do so, the research project’s overall aim, which will be achieved in five stages, is to develop, pilot-test, and evaluate the feasibility of a complex nursing intervention named “Education Intervention promoting eCo-literacy, eCo-responsibility, and eCo-centricity in emergency triAge Regarding climate changE consequences (I-CARE the 3 Cs). The I-CARE the 3 Cs intervention aims to provide an adequate, effective, efficient, fair, safe, and patient-centered response to patients’ and nurses’ needs and to develop guidelines for dealing with the health consequences of climate change.

Short-term effects of tropospheric ozone and other environmental factors on emergency admissions due to pregnancy complications: A time-series analysis in the Madrid Region

Air pollution has been linked to adverse neonatal outcomes, mainly in the case of prolonged exposures. This study focuses on the short-term effects on maternal health.We conducted a retrospective ecological time-series study in the Madrid Region covering the period 2013–2018. The independent variables were mean daily concentrations of tropospheric ozone (O3), particulate matter (PM10/PM2.5) and nitrogen dioxide (NO2), as well as noise levels. The dependent variables were daily emergency hospital admissions due to complications in pregnancy, childbirth and the puerperium. Poisson generalised linear regression models were fitted to quantify the relative and attributable risks, controlling for trend, seasonality, the autoregressive nature of the series, and a number of meteorological factors.There were 318 069 emergency hospital admissions due to obstetric complications across the 2191 days of study. Of this total: 13 164 (95%CI: 9930–16 398) admissions were attributable to exposure to O3, the only pollutant to show a statistically significant (p < 0.05) association with admissions due to hypertensive disorders; and 10 575 (95%CI: 3573–17 566) admissions were attributable to daytime noise levels, while admissions due to hyperemesis gravidarum and vomiting were related to exposure to night noise. Other pollutants which also displayed statistically significant associations were: NO2 concentrations, with admissions due to vomiting and preterm labour; PM10 concentrations, with premature rupture of membranes: and PM2.5 concentrations, with total complications.Exposure to a range of air pollutants, and ozone in particular, is associated with a higher number of emergency hospital admissions due to gestational complications. Hence, surveillance of environmental effects on maternal health should be intensified, and plans and strategies to minimise these should be drawn up.

The potential benefits to cardiovascular health from reduction of air pollution. Krakow example

BACKGROUND AND AIM: Based on Global Burden of Diseases estimates, in 2019 the air pollution accounted for nearly 6.75 million deaths and 213 million years of healthy life lost. Numerous studies indicate that ambient particulate matter (PM) is strongly associated with increased cardiovascular disease incidence and mortality. The aim of this study was to assess the potential benefits from reduction of PM2.5 and PM10 to the mortality and hospital admissions due to cardiovascular events in Krakow, one of the most polluted cities in Europe. METHODS: The Environmental Benefits Mapping and Analysis Program was used to estimate changes in cardiovascular health due to changes in the ambient concentration of particulate matter (both PM2.5 and PM10) in Krakow, based on data for 2016. The baseline level of pollutants was based on data from air pollution monitoring system operated by Provincial Environmental Protection Inspectorate. The demographic structure as well as the number of deaths were gathered from Statistics Poland, and number of emergency hospital admissions due to cardiovascular causes (ICD-10 codes: I00–I99) was obtained from National Health Found. RESULTS:Average daily air pollution levels in Krakow ranged from 2 to 235 μg/m³ for PM2.5 and from 8 to 299 μg/m³ for PM10, and it exceeded the daily limit values recommended by European Union Air Quality Directive on about 30% of days for PM2.5 and 20% for PM10. The reduction of PM2.5 to the limit value results decrease of more than 3% in cardiovascular hospitalizations and 5% in cardiovascular mortality. The reduction of PM10 level to 40 μg/m³ is associated with over 4% and more than 7% decrease in cardiovascular hospitalizations and mortality, respectively. CONCLUSIONS:Decrease of ambient particulate matter to the limit recommended by Air Quality Directive can provide considerable reduction of cardiovascular events that were attributable to air pollution. KEYWORDS: Air pollution, particulate matter, cardiovascular disease

89 Geographical Variation of Emergency Hospital Admissions for Ambulatory Care Sensitive Conditions in Older Adults in the Republic of Ireland

Abstract Background Hospitalisation for specific conditions considered to be `ambulatory-care sensitive' (ACS) could signify problems with primary or outpatient care access. The aims of this study are to quantify and explore potential causes for geographical variation across emergency hospital admissions for relevant ACS conditions in older adults in Ireland. Methods The number of emergency hospital admissions among adults aged 65+ with a diagnosis of an ACS condition between 2012-2016 were extracted from Ireland’s Hospital Inpatient Enquiry system according to condition, sex, age-group, residence area and year. Conditions included chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), diabetes complications, angina (excluding therapeutic procedures), pyelonephritis and urinary tract infections (UTI), dehydration and pneumonia. Age-sex standardised discharge rates (SDRs) were calculated for 21 areas. Systematic components of variance (SCV) quantified variation. Regression analyses were conducted between SDRs and year, unemployment rate, % urban population, General Practitioner (GP) supply, and % short emergency hospital stays. Results In total, 147,722 emergency hospital admissions (50 per 1,000 eligible population; 49% male) were included. COPD was the most common condition (31%), followed by pneumonia (22%), pyelonephritis/UTI (21%) and CHF (16%). CHF showed low geographic variation (SCV=2-3). COPD, diabetes, pyelonephritis/UTI and pneumonia showed high variation (SCV=4-12). Angina and dehydration showed very high variation (SCV=12-50). In multivariable analysis, higher unemployment was associated with higher SDRs for COPD. Lower GP supply was associated with higher SDRs for CHF, diabetes and pneumonia. Rurality was associated with SDRs for angina. Conclusion The rate of emergency admissions for ACS conditions studied is in line with research in the United States, although COPD and angina account for a higher proportion of admissions in our study. There is significant geographical variation in ACS admission rates among older adults in Ireland. Further research should explore local factors influencing emergency admission, particularly in socio-economically disadvantaged areas and those with lower GP supply.

The impact of a named GP scheme on continuity of care and emergency hospital admission: a cohort study among older patients in England, 2012–2016

ObjectiveTo investigate whether the introduction of a named general practitioner (GP, family physician) improved patients’ healthcare for patients aged 75 and over in England.SettingRandom sample of 27 500 patients aged...

The association of hospital emergency admissions due to respiratory-cardiovascular diseases and acute myocardial infarction with air pollution in Tehran during 2005-2014.

Background: Air pollution is one of the main reasons for disease and emergency hospitalizations. Therefore, air pollution control and hospital preparedness are of paramount importance. This study was conducted to determine the association of air pollutant levels with the rate of hospital emergency admissions due to respiratory and cardiovascular diseases and acute myocardial infarction in Tehran during the last decade. Methods: This was a cross sectional study. At first, information on hourly concentration of air pollutants was gathered from Tehran Environmental Protection Agency and Air Quality Control Company. Raw data and meteorological parameters were used in Excel format to prepare an input file. The number of emergency hospital admissions due to pollutant exposure was assessed using the AirQ2.2.3 model. Results: Results of this study revealed that there were 54 352 cases of emergency hospitalizations due to respiratory diseases in a relative risk of 1.0048 [1.0008-1.0112] and 20 990 cases of emergency hospitalizations due to cardiovascular diseases in a relative risk of 1.009[1.006-1.013] during 2005-2014. In addition, 3478 patients were admitted to the emergency department because of acute myocardial infarction with RR of 1.0026 [1.0026-1.0101]. Conclusion: This study demonstrated that a high percentage of hospital emergency admissions was because of respiratory and cardiovascular diseases. Moreover, it was found that acute myocardial infarction could be due to the high level of air pollution and could increase admissions to the emergency department. Therefore, appropriate measures are needed to reduce air pollution and increase hospital preparedness.

Study protocol for investigating the impact of community home modification services on hospital utilisation for fall injuries: a controlled longitudinal study using data linkage

IntroductionThis study will evaluate the effectiveness of home adaptations, both in preventing hospital admissions due to falls for older people, and improving timely discharge. Results will provide evidence for services...

Effects on Public Health of Heat Waves to Improve the Urban Quality of Life

Life satisfaction has been widely used in recent studies to evaluate the effect of environmental factors on individuals’ well-being. In the last few years, many studies have shown that the potential impact of climate change on cities depends on a variety of social, economic, and environmental determinants. In particular, extreme events, such as flood and heat waves, may cause more severe impacts and induce a relatively higher level of vulnerability in populations that live in urban areas. Therefore, the impact of climate change and related extreme events certainly influences the economy and quality of life in affected cities. Heat wave frequency, intensity, and duration are increasing in global and local climate change scenarios. The association between high temperatures and morbidity is well-documented, but few studies have examined the role of meteo-climatic variables on hospital admissions. This study investigates the effects of temperature, relative humidity, and barometric pressure on health by linking daily access to a Matera (Italy) hospital with meteorological conditions in summer 2012. Extreme heat wave episodes that affected most of the city from 1 June to 31 August 2012 (among the selected years 2003, 2012, and 2017) were analyzed. Results were compared with heat waves from other years included in the base period (1971–2000) and the number of emergency hospital admissions on each day was considered. The meteorological data used in this study were collected from two weather stations in Matera. In order to detect correlations between the daily emergency admissions and the extreme health events, a combined methodology based on a heat wave identification technique, multivariate analysis (PCA), and regression analysis was applied. The results highlight that the role of relative humidity decreases as the severity level of heat waves increases. Moreover, the combination of temperatures and daily barometric pressure range (DPR) has been identified as a precursor for a surveillance system of risk factors in hospital admissions.

Association between emergency admission for peptic ulcer bleeding and air pollution: a case-crossover analysis in Hong Kong's elderly population

Air pollution increases intestinal permeability, alters the gut microbiome, and promotes inflammation, which might contribute towards gastrointestinal bleeding. In the present study, we aim to examine whether short-term elevations in air pollution are associated with increased numbers of emergency hospital admissions for peptic ulcer bleeding in Hong Kong. Daily air pollution (particulate matter with aerodynamic diameter less than 2·5 μm [PM2·5], nitric oxide [NO2], sulpher dioxide [SO2], and ozone [O3]) data during 2005-10 were collected from the Environmental Protection Department and emergency admission data for peptic ulcer bleeding in elderly people (aged 65 years or older) from the Hospital Authority of Hong Kong. A time stratified case-crossover analysis with conditional logistic regression was used to estimate the excess risk of peptic ulcer bleeding associated with each air pollutant, in single-pollutant and multi-pollutant models. Cardiorespiratory diseases were used as positive controls. 8566 emergency admissions for peptic ulcer bleeding were recorded among Hong Kong's elderly population during 2005-10; the daily number of admissions ranged from 0 to 13. An IQR increment of 5-day moving average (lag04) of NO2 concentration (25·8 μg/m3) was associated with a 7·6% (95% CI 2·2-13·2) increase in emergency admissions for peptic ulcer bleeding. Multi-pollutant models confirmed the robustness of the risk estimates for NO2. Other pollutants (PM2·5, SO2, and O3) were not associated with peptic ulcer bleeding admissions. Short-term elevation in ambient NO2 might trigger peptic ulcer bleeding events and increase the risk of emergency admissions for peptic ulcer bleeding in Hong Kong's elderly population. These findings strengthen the hypothesis that air pollution affects not just cardiopulmonary diseases, but also certain diseases of the digestive system. None.

The Housing Regeneration and Health Study

ABSTRACT&#x0D; ObjectivesA social housing regeneration programme, delivered by one Welsh local authority, has invested £204M (US$308M) to upgrade its housing stock in order to meet a national housing quality standard; the Welsh Housing Quality Standard (WHQS). Homes may receive new bathrooms, kitchens, heating, windows and doors, and insulation. Our objective is to evaluate the effect of implementing the concentrated WHQS investment policy on the physical and mental health of the residents compared to the standard ‘business as usual’ policy of housing stock maintenance.&#x0D; ApproachUsing housing and regeneration data from the Local Authority and an anonymised databank (Secure Anonymised Information Linkage, SAIL) we have established a residence-based cohort. The primary outcome is a relative change in emergency hospital admissions (injuries, cardiovascular and respiratory conditions) following housing improvements; secondary outcomes include health care utilisation costs, primary care mental health conditions and deaths. Different comparator groups will be used to adjust for trends over time.&#x0D; ResultsWe have linked housing data to individuals and their health data using a novel data linkage system. There are about 32 000 residents in the intervention group, 49 000 in a social housing comparator group; and 231 000 in a large general comparator group. Residents who migrate within the social housing cohort are retained using data linkage methods. Records relating to respiratory and cardiovascular conditions as well as falls and burns were obtained retrospectively for each individual, from 2005 to 2015, with measurements captured in 123 monthly time intervals. We are using a three-level negative binomial model, in which time is nested within individuals within properties, to examine the effects of the housing improvements on the mean number of emergency hospital admissions, whilst adjusting for individual-level explanatory variables such as gender, age and comorbidities.&#x0D; Conclusion We discuss the challenges and benefits of linking routine housing and health data to evaluate a natural experiment. We have identified differences between residents in the study area and the comparator groups to evaluate the health benefits of a targeted housing improvement program to implement the WHQS.&#x0D; The evaluation was funded by the National Institute for Health Research, Public Health Research Programme, United Kingdom. (http://www.nets.nihr.ac.uk/projects/phr/09300602).

First steps in demonstrating an impact on health service use of the Welsh Government Supporting People homelessness prevention programme using linked administrative data

ABSTRACT&#x0D; ObjectivesTo assess the feasibility of using linked administrative data to deliver a quantitative component to the evaluation of the national homelessness prevention programme in Wales, Supporting People. Specifically, to establish whether any impact of Supporting People on the use of health services could be demonstrated. Approach: Data on the Supporting People programme was acquired from two pathfinder Local Authorities in Wales and anonymously linked to the routine health records held in the SAIL Databank at Swansea University. Any bias in linking rates was examined and health events analysed for the period 12 months before and 12 months after the point when homelessness prevention support began (the ‘crisis point’). The study evaluated a range of possible control groups that could be created using administrative data and undertook some preliminary comparative analysis. ResultsThe results of the study are due to be published on 10th March 2016 so detailed results will be available for August. We will briefly explore the unique contribution of data linking to researching the hard-to-reach and/or vulnerable groups supported by the intervention (e.g. people with substance misuse problems, women experiencing domestic violence and people with a criminal offending history) and the challenges of delivering a quantitative evaluation using linked administrative data. Findings will be reported on linking rates including any potential areas where particular service groups were relatively less well represented. Patterns of the following health events will be reported around the ‘crisis point’: i) number of days when GP events occurred; ii) number of A&amp;E visits and iii) number of emergency hospital admissions. Interpretations are made of consistent patterns of health events across different service user subgroups. The GP diagnosis codes, GP prescribing codes, reasons for visiting A&amp;E and reasons for emergency hospital admissions that showed the greatest decrease after the intervention will be reported. A brief discussion will be presented of the suitability of different control groups and the findings of the preliminary comparative analysis. ConclusionsUsing primary research methods, demonstrating the impact of a homelessness prevention programme on outcomes like health service use represents an insuperable challenge. The use of data linking data delivers a challenging but potentially robust method to demonstrate impact and the feasibility study was able to take the first steps towards demonstrating improved health outcomes for individuals.

Predicting surface temperature variation in urban settings using real-time weather forecasts

Densely populated cities experience adverse effects of Urban Heat Island (UHI) including higher numbers of emergency hospital admissions and heat related illnesses. Studying UHI effects and temperature variations has become even more important as global temperatures continue to rise. To better understand UHIs within New York City, an exploratory study was done using a field campaign to measure high resolution spatial and temporal temperature variations within Manhattan's urban setting. These time correlated temperature measurements along with weather model data of temperature and relative humidity were used to predict temperature variability using weather forecasts. The amplitude of spatial variations was most dependent on temperature (r=0.400) and low level lapse rate (r=−0.258) while temporal variations were most dependent on temperature (r=0.398), low level lapse rates (r=−0.361), and mid-level lapse rate (r=−0.320). Regression of weather variables can be used to predict the amplitude of spatial and temporal variation in temperature within a city for each day. This study directs attention towards high resolution near-surface air temperature analysis and offers a new look at surface thermal properties. The application of the resulting data and modeling is most suitable for forecasting microscale variability in urban settings.

Trends in emergency hospital admissions in England due to adverse drug reactions: 2008-2015

Objectives To determine the scale of adverse drug reaction (ADR)-related emergency hospital admissions in England from 2008 to 2015 using the Hospital Episode Statistics (HES) database. Methods Part of the HES database contains information about all hospital admissions in England. Annual data are published online and are publically available. These hospital admission data were analysed to determine how many emergency admissions were due to ADRs. International classification of diseases, 10th edition (ICD-10) codes that indicated a drug was the primary cause of the admission were included in the study. Key findings The total number of emergency hospital admissions increased by 12.1%, from 5 010 670 in 2008/2009 to 5 615 707 in 2014/2015. Over the same period, emergency admissions due to ADRs increased by 53.4%, from 60 055 in 2008/2009 to 92 114 in 2014/2015. These figures indicate an increase in the proportion of emergency hospital admissions due to ADRs over the period of study, from 1.2% in 2008/2009 to 1.6% in 2014/2015. The total number of bed days utilised decreased by 7.1%, from 51 841 443 in 2008/2009 to 48 183 084 in 2014/2015. Despite this overall decrease, the number of bed days that were used due to ADRs increased by 51.5% from 625 011 (1.2% of all bed days) in 2008/2009 to 947 016 (2.0% of all bed days) in 2014/2015. The most common ADRs were mental and behavioural disorders due to drugs and the drugs most commonly implicated in ADRs were systemic agents such as anticancer drugs and immunosuppressants. Conclusions This study demonstrates that emergency hospital admissions due to ADRs are an increasing problem for the National Health Service (NHS) in England and further research is needed to discover which interventions are most likely to reduce them.

Target to reduce emergency hospital admissions by 3.5%.

THIS MONTH, England's health and wellbeing boards, which are made up of councils and health services, must set annual targets for reducing the numbers of emergency hospital admissions in their regions.

Effect of telephone health coaching (Birmingham OwnHealth) on hospital use and associated costs: cohort study with matched controls

Objectives To test the effect of a telephone health coaching service (Birmingham OwnHealth) on hospital use and associated costs. Design Analysis of person level administrative data. Difference-in-difference analysis was done...

From tobacco control research to policy: the example of smoke-free legislation in England

BackgroundTobacco control policies, such as legislation to make all enclosed public places and workplaces smoke free, are often highly contested. Despite growing evidence that smoke-free laws are effective in reducing secondhand smoke exposure and provide early health benefits, efforts to contest evidence for secondhand smoke and the effects of legislation are widespread. The Tobacco Control Research Group at Bath, UK, has produced a wide range of work assessing various effects of smoke-free legislation introduced on July 1, 2007, in England. We use our assessment of whether the legislation reduced hospital admissions for heart attacks as an example of our research. When this assessment was published in the British Medical Journal in 2010, several studies showing a decrease in admissions for heart attack after the introduction of smoke-free laws in other countries had already been published. In view of efforts to contest these findings by pro-tobacco bloggers, media articles questioning the credibility of tobacco control research, and spurious coverage of our work in national newspapers before it was published, we had two aims: to build on existing research by taking into account long-term trends; and to ensure the findings, when published, were accurately reported in the media and to policy makers. MethodsWe investigated the short-term effect of the English smoke-free legislation with numbers of emergency hospital admissions per week coded with a primary diagnosis of a myocardial infarction from July 1, 2002, to Sept 30, 2008, in all patients aged 18 years and older. The analysis was done with a segmented Poisson regression analysis that adjusted for long-term trends and other potential confounders. Cost savings to the NHS were calculated in collaboration with the London Health Observatory. For the media strategy, we prepared simple but accurate media briefings, which we disseminated to ten key parties that were likely to be contacted by the media. We held a press briefing at the Science Media Centre (London), and worked closely with them, Bath University press office, and the British Medical Journal. FindingsSmoke-free legislation was association with a 2·4% (95% CI −4·06 to −0·66) reduction in the number of emergency admissions for myocardial infarction. This reduction equates to 1200 fewer emergency admissions for myocardial infarction in the first year after legislation. The London Health Observatory estimated that £8·4 million has been saved in emergency hospital care for heart attacks in the first year since smoke-free legislation was introduced. The research received wide reaching, positive coverage in both print and broadcast media, featuring on the BBC, BBC Radio 4's Today programme, BBC Radio 5 Live, and local BBC radio stations. National newspapers that featured the story included The Times, Financial Times, Independent, and Daily Mail. Internationally, the research was reported by media in several countries, including the USA, Canada, and New Zealand. Our efforts to ensure that coverage was accurate were successful, despite later efforts by pro-tobacco bloggers to undermine it. InterpretationThis study adds to the growing evidence that smoke-free legislation leads to reductions in myocardial infarctions and builds on previous work by showing that such decreases are noted even when underlying reductions in admissions and other potential confounders are controlled for. With careful planning and communication, public health research in a contested field can be effectively and accurately disseminated. The research has subsequently contributed to the present government's tobacco control strategy. FundingDepartment of Health's Policy Research Programme.

The cost of emergency hospital admissions for falls on snow and ice in England during winter 2009/10: a cross sectional analysis

BackgroundIn the UK, the 2009/10 winter was characterised by sustained low temperatures; grit stocks became depleted and surfaces left untreated. We describe the relationship between temperature and emergency hospital admissions for falls on snow and ice in England, identify the age and gender of those most likely to be admitted, and estimate the inpatient costs of these admissions during the 2009/10 winter.MethodsHospital Episode Statistics were used to identify episodes of emergency admissions for falls on snow and ice during winters 2005/06 to 2009/10; these were plotted against mean winter temperature. By region, the logs of the rates of weekly emergency admissions for falls on snow and ice were plotted against the mean weekly temperature for winters 2005/06 to 2009/10 and a linear regression analysis undertaken. For the 2009/10 winter the number of emergency hospital admissions for falls on snow and ice were plotted by age and gender. The inpatient costs of admissions in the 2009/10 winter for falls on snow and ice were calculated using Healthcare Resource Group costs and Admitted Patient Care 2009/10 National Tariff Information.ResultsThe number of emergency hospital admissions due to falls on snow and ice varied considerably across years; the number was 18 times greater in 2009/10 (N = 16,064) than in 2007/08 (N = 890). There is an exponential increase [Ln(rate of admissions) = 0.456 - 0.463*(mean weekly temperature)] in the rate of emergency hospital admissions for falls on snow and ice as temperature falls. The rate of admissions in 2009/10 was highest among the elderly and particularly men aged 80 and over. The total inpatient cost of falls on snow and ice in the 2009/10 winter was 42 million GBP.ConclusionsEmergency hospital admissions for falls on snow and ice vary greatly across winters, and according to temperature, age and gender. The cost of these admissions in England in 2009/10 was considerable. With responsibility for health improvement moving to local councils, they will have to balance the cost of public health measures like gritting with the healthcare costs associated with falls. The economic burden of falls on snow and ice is substantial; keeping surfaces clear of snow and ice is a public health priority.

Fife Cares

‘Fife Cares’ is an integral part of Fife Community Safety Partnerships work to improve the safety of vulnerable residents and deliver the community safety outcome Fewer injuries and losses of...

Short-term effect of PM2.5 on daily hospital admissions in Madrid (2003–2005)

The aim of this paper was to analyse the effect of particulate matter PM2.5, a recent air quality guideline value for the protection of health, on hospital admissions in Madrid, Spain. This dependent variable was used as a measure against the daily number of emergency hospital admissions from 2003–2005. The causes analysed were: all causes, respiratory and circulatory. The independent variables were daily records of PM2.5, PM10, NO2, NOx, SO2 and O3. Seasonalities, trend, flu epidemics, noise and pollen were used as control variables. Poisson Regression Models were performed to calculate the Relative Risk (RR) and the Attributable Risk (AR). The function relationship with hospital admissions was linear and without threshold. The RR for an increase of 25 μg/m3 in PM2.5 concentrations was 1.07 IC 95% (1.05 1.09) for all causes; for circulatory was 1.08 IC 95%: (1.03 1.13) and for respiratory was 1.07 IC 95% (1.02 1.11). PM2.5 concentrations were the only primary pollutant that showed a statistical association with hospital admissions in Madrid.

Short-term effect of concentrations of fine particulate matter on hospital admissions due to cardiovascular and respiratory causes among the over-75 age group in Madrid, Spain

This study sought to analyse the effect of daily mean concentrations of fine particulate matter (diameter <2.5 microm; PM(2.5)) on hospital admissions due to circulatory and respiratory causes among an elderly population (>75 years) in Madrid between 2003 and 2005. Ecological longitudinal time-series study. The dependent variable used was the daily number of emergency hospital admissions registered at the Gregorio Marañón University Teaching Hospital. The following causes were analysed: all causes [International Classification of Diseases 9th Version (ICD-9:1-799)], respiratory causes (ICD-9: 460-519) and circulatory causes (ICD-9: 390-459). Analysis focused on subjects over 75 years of age. Daily records of mean concentrations of PM(2.5), PM(10), NO(2), NO(x), SO(2) and O(3) in Madrid were used as independent variables. The control variables were seasonalities, trend, influenza epidemics, noise and pollen concentrations. Poisson regression models were constructed to calculate the relative risk (RR) and attributable risk (AR). Analyses were performed for the entire year and for the winter and summer. PM(2.5) was the single primary pollutant that proved statistically significant in all models. The functional relationship with hospital admissions was linear and had no threshold. Taking the year as a whole, the RRs among people over 75 years of age for an increase of 10 microg/m(3) in PM(2.5) concentrations were: 1.038 [95% confidence interval (CI) 1.022-1.053] for all causes at lag 0; 1.062 (95% CI 1.036-1.089) for circulatory causes at lag 0; and 1.049 (95% CI 1.019-1.078) for respiratory causes at lag 3. The ARs were 3.6%, 5.9% and 4.6%, respectively. These risks increased in winter and no statistically significant associations were observed in summer. PM(2.5) was the only primary pollutant that showed a statistically significant association with hospital admissions among people over 75 years of age in Madrid across the study period. Measures should be implemented to reduce PM(2.5) concentrations in Madrid.