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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2001 Jan;55(1):57–65. doi: 10.1136/jech.55.1.57

Air pollution and emergency hospital admissions for cardiovascular diseases in Valencia, Spain

F Ballester 1, J Tenias 1, S Perez-Hoyos 1
PMCID: PMC1731772  PMID: 11112952

Abstract

STUDY OBJECTIVE—To estimate the short-term association between air pollution levels and emergency hospital admissions for cardiovascular diseases in Valencia, within 1994-1996 period.
DESIGN—Daily levels of air pollution and emergency admissions for cardiovascular diseases were related to using an ecological time series design. The number of admissions was obtained from the hospital records database. Selected groups of causes were all cardiovascular diseases, heart admissions, and admissions for cerebrovascular diseases. The number of admissions for digestive diseases was used as control. Pollutants were black smoke, sulphur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and ozone (O3). Magnitude of association was estimated by Poisson autoregresive regression. Estimations were calculated according the hottest (May to October) and the coldest (November to April) periods.
SETTING—City of Valencia, Spain, about 750 000 inhabitants.
PARTICIPANTS—People being admitted to the two major hospitals in the city, with a catchment area of nearly 400 000 inhabitants.
MAIN RESULTS—For the whole period, a significant association for SO2-24 h was found so a rise in its levels of 10 µg/m3 was associated with an increment of 3% (95%CI 0.4 to 5.7%) in the expected number of cardiovascular admissions. A significant association for black smoke, SO2-24 h, SO2-1 h, and CO-1 h was found in the hottest semester. All these associations were verified with a lag of two days. The estimates of the associations for particles, SO2, and CO were affected by the inclusion of the other pollutants in their models. NO2 was independently associated with cerebrovascular admissions. There were no significant associations between air pollution and admissions for digestive diseases.
CONCLUSIONS—Current levels of air pollution and emergency cardiovascular admissions are significantly related in Valencia.


Keywords: air pollution; cardiovascular disease; hospital admissions

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Selected References

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  1. Allred E. N., Bleecker E. R., Chaitman B. R., Dahms T. E., Gottlieb S. O., Hackney J. D., Pagano M., Selvester R. H., Walden S. M., Warren J. Effects of carbon monoxide on myocardial ischemia. Environ Health Perspect. 1991 Feb;91:89–132. doi: 10.1289/ehp.919189. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Allred E. N., Bleecker E. R., Chaitman B. R., Dahms T. E., Gottlieb S. O., Hackney J. D., Pagano M., Selvester R. H., Walden S. M., Warren J. Short-term effects of carbon monoxide exposure on the exercise performance of subjects with coronary artery disease. N Engl J Med. 1989 Nov 23;321(21):1426–1432. doi: 10.1056/NEJM198911233212102. [DOI] [PubMed] [Google Scholar]
  3. Anderson H. R., Spix C., Medina S., Schouten J. P., Castellsague J., Rossi G., Zmirou D., Touloumi G., Wojtyniak B., Ponka A. Air pollution and daily admissions for chronic obstructive pulmonary disease in 6 European cities: results from the APHEA project. Eur Respir J. 1997 May;10(5):1064–1071. doi: 10.1183/09031936.97.10051064. [DOI] [PubMed] [Google Scholar]
  4. Ballester Díez F., Sáez Zafra M., Alonso Fustel M. E., Taracido Trunk M., Ordóez Iriarte J. M., Aguinaga Ontoso I., Daponte Codina A., Bellido Blasco J., Guillén Pérez J. J., Pérez Boíllos M. J. El proyecto EMECAM: Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad. Antecedentes, participantes, objetivos y métodología. Rev Esp Salud Publica. 1999 Mar-Apr;73(2):165–175. [PubMed] [Google Scholar]
  5. Ballester F., Corella D., Pérez-Hoyos S., Hervás A. Air pollution and mortality in Valencia, Spain: a study using the APHEA methodology. J Epidemiol Community Health. 1996 Oct;50(5):527–533. doi: 10.1136/jech.50.5.527. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Burnett R. T., Cakmak S., Brook J. R., Krewski D. The role of particulate size and chemistry in the association between summertime ambient air pollution and hospitalization for cardiorespiratory diseases. Environ Health Perspect. 1997 Jun;105(6):614–620. doi: 10.1289/ehp.97105614. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Burnett R. T., Dales R. E., Brook J. R., Raizenne M. E., Krewski D. Association between ambient carbon monoxide levels and hospitalizations for congestive heart failure in the elderly in 10 Canadian cities. Epidemiology. 1997 Mar;8(2):162–167. doi: 10.1097/00001648-199703000-00007. [DOI] [PubMed] [Google Scholar]
  8. Burnett R. T., Dales R., Krewski D., Vincent R., Dann T., Brook J. R. Associations between ambient particulate sulfate and admissions to Ontario hospitals for cardiac and respiratory diseases. Am J Epidemiol. 1995 Jul 1;142(1):15–22. doi: 10.1093/oxfordjournals.aje.a117540. [DOI] [PubMed] [Google Scholar]
  9. Castellsague J., Sunyer J., Sáez M., Antó J. M. Short-term association between air pollution and emergency room visits for asthma in Barcelona. Thorax. 1995 Oct;50(10):1051–1056. doi: 10.1136/thx.50.10.1051. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gordon T., Nadziejko C., Schlesinger R., Chen L. C. Pulmonary and cardiovascular effects of acute exposure to concentrated ambient particulate matter in rats. Toxicol Lett. 1998 Aug;96-97:285–288. doi: 10.1016/s0378-4274(98)00084-8. [DOI] [PubMed] [Google Scholar]
  11. Katsouyanni K. Health effects of air pollution in southern Europe: are there interacting factors? Environ Health Perspect. 1995 Mar;103 (Suppl 2):23–27. doi: 10.1289/ehp.95103s223. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Katsouyanni K., Pantazopoulou A., Touloumi G., Tselepidaki I., Moustris K., Asimakopoulos D., Poulopoulou G., Trichopoulos D. Evidence for interaction between air pollution and high temperature in the causation of excess mortality. Arch Environ Health. 1993 Jul-Aug;48(4):235–242. doi: 10.1080/00039896.1993.9940365. [DOI] [PubMed] [Google Scholar]
  13. Katsouyanni K., Schwartz J., Spix C., Touloumi G., Zmirou D., Zanobetti A., Wojtyniak B., Vonk J. M., Tobias A., Pönkä A. Short term effects of air pollution on health: a European approach using epidemiologic time series data: the APHEA protocol. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):S12–S18. doi: 10.1136/jech.50.suppl_1.s12. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Katsouyanni K., Zmirou D., Spix C., Sunyer J., Schouten J. P., Pönkä A., Anderson H. R., Le Moullec Y., Wojtyniak B., Vigotti M. A. Short-term effects of air pollution on health: a European approach using epidemiological time-series data. The APHEA project: background, objectives, design. Eur Respir J. 1995 Jun;8(6):1030–1038. [PubMed] [Google Scholar]
  15. Kelsall J. E., Samet J. M., Zeger S. L., Xu J. Air pollution and mortality in Philadelphia, 1974-1988. Am J Epidemiol. 1997 Nov 1;146(9):750–762. doi: 10.1093/oxfordjournals.aje.a009351. [DOI] [PubMed] [Google Scholar]
  16. Librero J., Ordiñana R., Peiró S. Análisis automatizado de la calidad del conjunto mínimo de datos básicos. Implicaciones para los sistemas de ajuste de riesgos. Gac Sanit. 1998 Jan-Feb;12(1):9–21. doi: 10.1016/s0213-9111(98)76438-6. [DOI] [PubMed] [Google Scholar]
  17. Michelozzi P., Forastiere F., Fusco D., Perucci C. A., Ostro B., Ancona C., Pallotti G. Air pollution and daily mortality in Rome, Italy. Occup Environ Med. 1998 Sep;55(9):605–610. doi: 10.1136/oem.55.9.605. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Morgan G., Corbett S., Wlodarczyk J. Air pollution and hospital admissions in Sydney, Australia, 1990 to 1994. Am J Public Health. 1998 Dec;88(12):1761–1766. doi: 10.2105/ajph.88.12.1761. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Morris R. D., Naumova E. N. Carbon monoxide and hospital admissions for congestive heart failure: evidence of an increased effect at low temperatures. Environ Health Perspect. 1998 Oct;106(10):649–653. doi: 10.1289/ehp.98106649. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Morris R. D., Naumova E. N., Munasinghe R. L. Ambient air pollution and hospitalization for congestive heart failure among elderly people in seven large US cities. Am J Public Health. 1995 Oct;85(10):1361–1365. doi: 10.2105/ajph.85.10.1361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Pantazopoulou A., Katsouyanni K., Kourea-Kremastinou J., Trichopoulos D. Short-term effects of air pollution on hospital emergency outpatient visits and admissions in the greater Athens, Greece area. Environ Res. 1995 Apr;69(1):31–36. doi: 10.1006/enrs.1995.1022. [DOI] [PubMed] [Google Scholar]
  22. Peters A., Döring A., Wichmann H. E., Koenig W. Increased plasma viscosity during an air pollution episode: a link to mortality? Lancet. 1997 May 31;349(9065):1582–1587. doi: 10.1016/S0140-6736(97)01211-7. [DOI] [PubMed] [Google Scholar]
  23. Poloniecki J. D., Atkinson R. W., de Leon A. P., Anderson H. R. Daily time series for cardiovascular hospital admissions and previous day's air pollution in London, UK. Occup Environ Med. 1997 Aug;54(8):535–540. doi: 10.1136/oem.54.8.535. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Pope CA3rd, Dockery D. W., Kanner R. E., Villegas G. M., Schwartz J. Oxygen saturation, pulse rate, and particulate air pollution: A daily time-series panel study. Am J Respir Crit Care Med. 1999 Feb;159(2):365–372. doi: 10.1164/ajrccm.159.2.9702103. [DOI] [PubMed] [Google Scholar]
  25. Prescott G. J., Cohen G. R., Elton R. A., Fowkes F. G., Agius R. M. Urban air pollution and cardiopulmonary ill health: a 14.5 year time series study. Occup Environ Med. 1998 Oct;55(10):697–704. doi: 10.1136/oem.55.10.697. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Pérez-Hoyos S., Sáez Zafra M., Barceló M. A., Cambra C., Figueiras Guzmán A., Ordóez J. M., Guillén Grima F., Ocaña R., Bellido J., Cirera Suárez L. Protocolo EMECAM: análisis del effecto a corto plazo de la contaminacion atmosférica sobre la mortalidad. Rev Esp Salud Publica. 1999 Mar-Apr;73(2):177–185. [PubMed] [Google Scholar]
  27. Pönkä A., Virtanen M. Low-level air pollution and hospital admissions for cardiac and cerebrovascular diseases in Helsinki. Am J Public Health. 1996 Sep;86(9):1273–1280. doi: 10.2105/ajph.86.9.1273. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Schwartz J. Air pollution and hospital admissions for cardiovascular disease in Tucson. Epidemiology. 1997 Jul;8(4):371–377. doi: 10.1097/00001648-199707000-00004. [DOI] [PubMed] [Google Scholar]
  29. Schwartz J. Air pollution and hospital admissions for heart disease in eight U.S. counties. Epidemiology. 1999 Jan;10(1):17–22. [PubMed] [Google Scholar]
  30. Schwartz J., Morris R. Air pollution and hospital admissions for cardiovascular disease in Detroit, Michigan. Am J Epidemiol. 1995 Jul 1;142(1):23–35. doi: 10.1093/oxfordjournals.aje.a117541. [DOI] [PubMed] [Google Scholar]
  31. Schwartz J., Spix C., Touloumi G., Bachárová L., Barumamdzadeh T., le Tertre A., Piekarksi T., Ponce de Leon A., Pönkä A., Rossi G. Methodological issues in studies of air pollution and daily counts of deaths or hospital admissions. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):S3–11. doi: 10.1136/jech.50.suppl_1.s3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Schwartz J. Total suspended particulate matter and daily mortality in Cincinnati, Ohio. Environ Health Perspect. 1994 Feb;102(2):186–189. doi: 10.1289/ehp.94102186. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Schwartz J. What are people dying of on high air pollution days? Environ Res. 1994 Jan;64(1):26–35. doi: 10.1006/enrs.1994.1004. [DOI] [PubMed] [Google Scholar]
  34. Stern F. B., Halperin W. E., Hornung R. W., Ringenburg V. L., McCammon C. S. Heart disease mortality among bridge and tunnel officers exposed to carbon monoxide. Am J Epidemiol. 1988 Dec;128(6):1276–1288. doi: 10.1093/oxfordjournals.aje.a115081. [DOI] [PubMed] [Google Scholar]
  35. Stieb D. M., Beveridge R. C., Rowe B. H., Walter S. D., Judek S. Assessing diagnostic classification in an emergency department: implications for daily time series studies of air pollution. Am J Epidemiol. 1998 Oct 1;148(7):666–670. doi: 10.1093/aje/148.7.666. [DOI] [PubMed] [Google Scholar]
  36. Stieb D. M., Burnett R. T., Beveridge R. C., Brook J. R. Association between ozone and asthma emergency department visits in Saint John, New Brunswick, Canada. Environ Health Perspect. 1996 Dec;104(12):1354–1360. doi: 10.1289/ehp.961041354. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Sunyer J., Castellsagué J., Sáez M., Tobias A., Antó J. M. Air pollution and mortality in Barcelona. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):s76–s80. doi: 10.1136/jech.50.suppl_1.s76. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Tenías Burillo J. M., Pérez-Hoyos S., Molina Quilis R., González-Aracil J., Ballester Díez F. Efectos a corto plazo de la contaminación atmosférica sobre la mortalidad. Resultados del proyecto EMECAM en la ciudad de Valencia, 1994-96. Rev Esp Salud Publica. 1999 Mar-Apr;73(2):267–274. [PubMed] [Google Scholar]
  39. Tenías J. M., Ballester F., Rivera M. L. Association between hospital emergency visits for asthma and air pollution in Valencia, Spain. Occup Environ Med. 1998 Aug;55(8):541–547. doi: 10.1136/oem.55.8.541. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Wichmann H. E., Mueller W., Allhoff P., Beckmann M., Bocter N., Csicsaky M. J., Jung M., Molik B., Schoeneberg G. Health effects during a smog episode in West Germany in 1985. Environ Health Perspect. 1989 Feb;79:89–99. doi: 10.1289/ehp.897989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Wong T. W., Lau T. S., Yu T. S., Neller A., Wong S. L., Tam W., Pang S. W. Air pollution and hospital admissions for respiratory and cardiovascular diseases in Hong Kong. Occup Environ Med. 1999 Oct;56(10):679–683. doi: 10.1136/oem.56.10.679. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Wordley J., Walters S., Ayres J. G. Short term variations in hospital admissions and mortality and particulate air pollution. Occup Environ Med. 1997 Feb;54(2):108–116. doi: 10.1136/oem.54.2.108. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Xu X., Gao J., Dockery D. W., Chen Y. Air pollution and daily mortality in residential areas of Beijing, China. Arch Environ Health. 1994 Jul-Aug;49(4):216–222. doi: 10.1080/00039896.1994.9937470. [DOI] [PubMed] [Google Scholar]
  44. Zmirou D., Schwartz J., Saez M., Zanobetti A., Wojtyniak B., Touloumi G., Spix C., Ponce de León A., Le Moullec Y., Bacharova L. Time-series analysis of air pollution and cause-specific mortality. Epidemiology. 1998 Sep;9(5):495–503. [PubMed] [Google Scholar]

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