It is well known that exceeded levels of particulate matter in the air and other air pollutants harmfully affect the cardiovascular system. Empirical analyses of the effects of these factors on stroke incidence and mortality are still limited. The main objective of our analyses was to determine the association between short-term exposure to air pollutants and stroke incidence in non-industrial areas, more specifically in north-eastern Poland. To achieve this aim, we used data from the National Health Fund on patients hospitalized for stroke between 2011 and 2020 in the largest city of the region described as the Green Lungs of Poland. The pollution levels and atmospheric conditions data were obtained from the Provincial Inspectorate for Environmental Protection and the Institute of Meteorology and Water Management. Using daily data on hospitalizations, atmospheric conditions, and pollution, as well as ordered logistic regression models the hypotheses on the impact of weather and air pollution conditions on ischemic strokes were tested. The study group included 4838 patients, 45.6% of whom were male; the average patient age was approximately 74 years. The average concentrations of PM2.5 were 19.09 µg/m3, PM10 26.66 µg/m3 and CO 0.35 µg/m3. Analyses showed that an increase in PM2.5 and PM10 concentrations by 10 µg/m3 was associated with an increase in the incidence of stroke on the day of exposure (OR = 1.075, 95% CI 0.999–1.157, P = 0.053; OR = 1.056, 95% CI 1.004–1.110, P = 0.035) and the effect was even several times greater on the occurrence of a stroke event in general (PM2.5: OR = 1.120, 95% CI 1.013–1.237, P = 0.026; PM10: OR = 1.103, 95% CI 1.028–1.182, P = 0.006). Furthermore, a short-term (up to 3 days) effect of CO on stroke incidence was observed in the study area. An increase of 1 μg/m3 CO was associated with a lower incidence of stroke 2 days after the exposure (OR = 0.976, 95% CI 0.953–0.998, P = 0.037) and a higher incidence 3 days after the exposure (OR = 1.026, 95% CI 1.004–1.049, P = 0.022).
Polish smog is a specific type of air pollution present in Eastern Poland, which may cause particularly adverse cardiovascular effects. It is characterized primarily by high concentrations of particulate matter (PM) and different favorable conditions of formation. Our study aimed to assess whether PM and nitrogen dioxide (NO2) have a short-term impact on mortality due to acute coronary syndrome (ACS) and ischemic stroke (IS). The study covered the years 2016–2020, a total of 6 million person-years from five main cities in Eastern Poland. To evaluate the association between air pollution and cause-specific mortality, a case-crossover study design with conditional logistic regression was used at days with LAG from 0 to 2. We recorded 87,990 all-cause deaths, including 9688 and 3776 deaths due to ACS and IS, respectively. A 10 μg/m3 increase in air pollutants was associated with an increase in mortality due to ACS (PM2.5 OR = 1.029, 95%CI 1.011–1.047, p = 0.002; PM10 OR = 1.015, 95%CI 1–1.029, p = 0.049) on LAG 0. On LAG 1 we recorded an increase in both IS (PM2.5 OR = 1.03, 95%CI 1.001–1.058, p = 0.04) and ACS (PM2.5 OR = 1.028, 95%CI 1.01–1.047, p = 0.003; PM10 OR = 1.026, 95%CI 1.011–1.041, p = 0.001; NO2 OR = 1.036, 95%CI 1.003–1.07, p = 0.04). There was a strong association between air pollution and cause-specific mortality in women (ACS: PM2.5 OR = 1.032, 95%CI 1.006–1.058, p = 0.01; PM10 OR = 1.028, 95%CI 1.008–1.05, p = 0.01) and elderly (ACS: PM2.5 OR = 1.03, 95%CI 1.01–1.05, p = 0.003; PM10 OR = 1.027, 95% CI 1.011–1.043, p < 0.001 and IS: PM2.5 OR = 1.037, 95%CI 1.007–1.069, p = 0.01; PM10 OR = 1.025, 95%CI 1.001–1.05, p = 0.04). The negative influence of PMs was observed on mortality due to ACS and IS. NO2 was associated with only ACS-related mortality. The most vulnerable subgroups were women and the elderly.
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Science Center. Background According to WHO reports, cardiovascular diseases (CVD) are responsible for almost 18 million deaths worldwide annually. The harmful effect of air pollution on human health in highly polluted regions is well documented. However, Eastern Poland is a region with so-called "Polish smog" – air pollution causing exceptionally adverse cardiovascular effects. Purpose The aim of our study was to assess whether "Polish smog" has an impact on mortality due to CVD,. Methods All-cause deaths from 5 main cities in Eastern Poland in 2016-2020 were analyzed. Mortality data was obtained from Central Statistical Office, while air pollution concentrations (PM2.5, PM10, and NO2) were attained from Voivodeship Inspectorate for Environmental Protection. The analysis with almost 6 million person-years of follow-up with a time-stratified case-crossover design was performed. Results are reported as odds ratio (OR) and 95% Confidence Intervals (95%CI) associated with an increase of 10 μg/m3 in a daily concentration of air pollutants. The study was financed from the funds of the National Science Center granted under the contract number UMO-2021/41/B/NZ7/03716. Results We recorded 87990 all-cause deaths, including 34907, 9688, and 3776 deaths due to CVD, acute coronary syndromes (ACS), and ischemic stroke (IS) respectively. A 10 μg/m3 increase in all analyzed air pollutants was associated with an increase in mortality due to CVD on the day of exposure (PM2.5 OR 1.034, 95%CI 1.027-1.041, p<0.001; PM10 OR 1.033, 95% CI 1.027-1.039, p<0.001; NO2 OR=1.083, 95%CI 1.073-1.094, p<0.001) [Figure 1]. Moreover, a similar effect was also noted on LAG 1 and LAG 2 (LAG 1: PM2.5 OR 1.028, 95%CI 1.021-1.036, p<0.001; PM10 OR 1.025, 95% CI 1.02-1.031, p<0.001; NO2 OR=1.082, 95%CI 1.069-1.094, p<0.001 and LAG 2: PM2.5 OR 1.024, 95%CI 1.017-1.032, p<0.001; PM10 OR 1.023, 95% CI 1.017-1.029, p<0.001; NO2 OR=1.075, 95%CI 1.063-1.087, p<0.001). An increase in PM level caused increased mortality due to ACS on LAG 0 [(PM2.5 OR=1.029, 95%CI 1.011-1.047, p=0.002; PM10 OR=1.015, 95%CI 1-1.029, p=0.049)] [Figure 2]. On LAG 1 we recorded an increase in both IS- (PM2.5 OR=1.03, 95%CI 1.001-1.058, p=0.04) and ACS-related mortality (PM2.5 OR=1.028, 95%CI 1.01-1.047, p=0.003; PM10 OR=1.026, 95%CI 1.011-1.041, p=0.001; NO2 OR=1.036, 95%CI 1.003-1.07, p=0.04). These effects were the most noticeable in women (ACS: PM2.5 OR=1.032, 95%CI 1.006-1.058, p=0.01; PM10 OR=1.028, 95%CI 1.008-1.05, p=0.01) and in older adults (ACS: PM2.5 OR=1.03, 95%CI 1.01-1.05, p=0.003; PM10 OR=1.027, 95% CI 1.011-1.043, p<0.001 and IS: PM2.5 OR=1.037, 95%CI 1.007-1.069, p=0.01; PM10 OR=1.025, 95%CI 1.001-1.05, p=0.04). Conclusions "Polish smog" has a significant impact on CVD-related mortality. The negative influence of PMs was observed on mortality due to ACS and IS, whereas NO2 affected only ACS-related mortality. The most vulnerable subgroups to air pollution were women and people over 65 years old.
The EP-PARTICLES study was created to assess the impact of air pollution on the health and mortality of the population of Eastern Poland. The biggest cities of the region are Lublin, Białystok, Olsztyn, Rzeszow, and Kielce, whose inhabitants constitute less than 25% of the total population of the analyzed region. The vast majority of air pollution studies to date have been conducted in heavily polluted areas, where patients are exposed to moderate to extreme concentrations of pollutants. The composition of the pollution itself is also not without significance, as it differs significantly from the types of smog we are familiar with. The type of air pollution known as Polish smog is rich in compounds such as PM 2.5 , PM 10 , and polycyclic aromatic hydrocarbons (benzo(a)pyrene) from low emissions associated with household heating with solid fuels (coal, wood, and often also waste) and imposes detrimental effects on the health and life of the population, in particular in the context of cardiovascular effects. In this publication, we aimed to present the baseline results of the EP-PARTICLES investigators' research up to this point and propose steps aimed at changing the state of air quality and reducing existing exposure. Fields covered so far include atrial fibrillation, acute coronary syndromes, ischemic stroke, heart failure, renal function, and cardiovascular mortality.
Funding Acknowledgements Type of funding sources: None. Background Acute coronary syndromes (ACS) are the leading cause of death all over the world, in the last years chronobiology of their occurrence has been changing. Purpose The aim of this study was to assess the influence of climate change on hospital admissions due to ACS. Methods Medical records of 10,529 patients hospitalized for ACS in 2008–2017 were examined. Weather conditions data were obtained from the Institute of Meteorology. Results Among the patients, 3537 (33.6%) were hospitalized for STEMI, 3947 (37.5%) for NSTEMI, and 3045 (28.9%) for UA. The highest seasonal mean for ACS was recorded in spring (N = 2782, mean = 2.52, SD = 1.7; OR 1.07; 95% CI 1.0-1.2; P = 0.049) and it was a season with the highest temperature changes day to day (Δ temp.=11.7). On the other hand, every 10ºC change in temperature was associated with an increased admission due to ACS by 13% (RR 1.13; 95% CI 1.04-1.3; P = 0.008). Analysis of weekly changes showed that the highest frequency of ACS occurred on Thursday (N = 1703, mean = 2.7, SD = 1.9; OR 1.16; 95% CI 1.0-1.23; P = 0.004), in STEMI subgroup it was Monday (N = 592, mean = 0.9, SD = 1.6, OR 1.2; 95% CI 1.1-1.4; P = 0.002). Sunday was associated with decreased admissions due to all types of ACS (N = 1098, mean = 1.7, SD = 1.4; OR 0.69; 95% CI 0.6-0.8, P < 0.001). In the second half of the study period (2013-2018) the relative risks of hospital admissions due to ACS were 1.043 (95%CI: 1.009-1.079, P = 0.014, lag 0) and 0.957 (95%CI: 0.925-0.990, P = 0.010, lag 1) for each 10ºC decrease in temperature; 1.049 (95% CI: 1.015-1.084, P = 0.004, lag 0) and 1.045 (95%CI: 1.011-1.080, P = 0.008, lag 1) for each 10 hPa decrease in atmospheric pressure and 1.180 (95% CI: 1.078-1.324, P = 0.007, lag 0) for every 10ºC change in temperature. For the first half of the study the risk was significantly lower. Conclusion We observed a shift in the seasonal peak of ACS occurrence from winter to spring which may be related to temperature fluctuation associated with climate change in this season. The lowest frequency of ACS took place on weekends. Atmospheric changes had a much more pronounced effect on admissions due to ACS in the second half of the analyzed period, which is in line with the dynamics of global climate change.
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