Effects of Ambient Air Pollution on Daily Mortality in a Cohort of Patients with Congestive Heart Failure

Abstract

This study was planned to test the hypothesis that patients with congestive heart failure are more susceptible to the harmful effects of ambient air pollution than the general population. We used both general additive Poisson regression and the case-crossover approach to test the hypothesis. The effect of air pollution on daily mortality of patients with congestive heart failure among residents of Seoul, South Korea, during the period 1994--1998 was compared with that of the general population in the same area and the same period. The odds ratios and 95% confidence intervals (95% CIs) estimated from general additive models in the general population for an interquartile range increase of particulate matter less than 10 microm in diameter (42.1 microg/m(3)), carbon monoxide (0.59 ppm), nitrogen dioxide (14.6 ppb), sulfur dioxide (9.9 ppb), and ozone (20.5 ppb) were 1.014 (95% CI = 1.006- 1.022), 1.022 (95% CI = 1.017- 1.029), 1.021 (95% CI = 1.014- 1.029), 1.020 (95% CI = 1.012--1.028), and 1.010 (95% CI = 1.002--1.017), respectively. The estimated effects appeared larger among the congestive heart failure patients than among the general population (2.5 approximately 4.1 times higher depending on the pollutants). The results from the case-crossover analysis were similar. The finding of a stronger association in the patients with congestive heart failure reinforces the evidence that a harmful effect of air pollution is mediated by cardiovascular mechanisms.

Associations between ambient air pollution and daily emergency department attendances for cardiovascular disease in the elderly (65+ years), Sydney, Australia

“…Our findings are corroborated by studies that have investigated effects on other CVD outcomes, for example, hospital admissions and mortality. Internationally, ambient air pollutants have been associated with both hospital admissions for CVD (Ponka and Virtanen, 1996;Schwartz, 1999;Pope, 2000;Morris, 2001;Koken et al, 2003;Tsai et al, 2003) and mortality from CVD (Zmirou et al, 1998;Pope, 2000;Kwon et al, 2001;Hong et al, 2002).…”

Design and Feasibility Assessment of a Retrospective Epidemiological Study of Coal-Fired Power Plant Emissions in the Pittsburgh Pennsylvania Region

“…The application of casecrossover analysis of daily mortality and particulate matter was first carried out by Neas et al (1999) in Philadelphia, Pennsylvania. Subsequently, the case-crossover design has been widely applied to assess the association between air pollution and adverse health effects, including mortality and cardiopulmonary hospitalizations (D'Ippoliti et al, 2003;Kwon et al, 2001;Sunyer et al, 2000;Tsai et al, 2006;Zanobetti 4.7 Case-Crossover Analysis and Schwartz, 2005). …”

A new approach for combining information available from multiple particulate air pollution monitors

“…Numerous time-series studies have investigated the association between an adverse health outcome and some measure of daily ambient particulate matter (PM) air pollution (Ito et al, 1995;Styer et al, 1995;Kelsall et al, 1997;Ostro et al, 1999;Chock et al, 2000;Cifuentes et al, 2000;Klemm et al, 2000;Moolgavkar, 2000;Smith et al, 2000a, b;Kwon et al, 2001;Roemer and van Wijnen, 2001;Stieb et al, 2002;Goldberg et al, 2003). These studies typically fit a Poisson log-linear model to concurrent time series of daily mortality, PM, and meteorological covariates.…”