A Case-Crossover Study to Investigate the Effects of Atmospheric Particulate Matter Concentrations, Season, and Air Temperature on Accident and Emergency Presentations for Cardiovascular Events in Northern Italy

Paolo Contiero, Roberto Boffi, Giovanna Tagliabue, Alessandra Scaburri, Andrea Tittarelli, Martina Bertoldi, Alessandro Borgini, Immacolata Favia, Ario Alberto Ruprecht, Alfonso Maiorino, Antonio Voza, Marta Ripoll Pons, Alessandro Cau, Cinzia DeMarco, Flavio Allegri, Claudio Tresoldi and Michele Ciccarelli
Additional contact information
Paolo Contiero: Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
Roberto Boffi: Respiratory Disease Unit, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy
Giovanna Tagliabue: Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
Alessandra Scaburri: Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
Andrea Tittarelli: Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
Martina Bertoldi: Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
Alessandro Borgini: Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
Immacolata Favia: Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
Ario Alberto Ruprecht: Respiratory Disease Unit, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy
Alfonso Maiorino: Pneumology Department, Humanitas Research Hospital, 20089 Rozzano, Italy
Antonio Voza: Emergency Department, Humanitas Research Hospital, 20089 Rozzano, Italy
Marta Ripoll Pons: Emergency Department, Humanitas Research Hospital, 20089 Rozzano, Italy
Alessandro Cau: Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
Cinzia DeMarco: Biomarkers Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
Flavio Allegri: Respiratory Disease Unit, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy
Claudio Tresoldi: G. A. Maccacaro Unit of Medical Statistics, Biometry, and Epidemiology, Department of Clinical Sciences and Community Health, University of Milan, 20133 Milan, Italy
Michele Ciccarelli: Pneumology Department, Humanitas Research Hospital, 20089 Rozzano, Italy

IJERPH, 2019, vol. 16, issue 23, 1-12

Abstract: Atmospheric particulate matter (PM) has multiple adverse effects on human health, high temperatures are also associated with adverse health outcomes, and the frequency of cardiovascular events (CVEs) varies with season. We investigated a hypothesized increase in PM-related accident and emergency (A&E) presentations for CVE with high temperature, warm season, days of high influenza incidence, and in people with a cancer diagnosis, using a time-stratified case-crossover study design. Outcomes were associations of A&E presentation for CVE with atmospheric PM ≤ 10 μm (PM 10 ), season, and air temperature. PM 10 levels in the municipality of residence (exposure variable) were estimated by modeling data from local monitoring stations. Conditional logistic regression models estimated odds ratios (OR) with 95% confidence intervals (CI) for presentations in relation to supposed influencers, adjusting for confounders. Study participants were all who presented at the A&E of a large hospital near Milan, Italy, for a CVE (ICD-9: 390–459) from 1st January 2014 to 31st December 2015. There were 1349 A&E presentations for CVE in 2014–2015 and 5390 control days. Risk of A&E presentation was significantly increased on hot days with OR 1.34 (95%CI 1.05–1.71) per 10 μg/m 3 PM 10 increment (as mean PM 10 on day of presentation, and 1 and 2 days before (lags 0–2)), and (for lag 0) in autumn (OR 1.23, 95%CI 1.09–1.37) and winter (OR 1.18, 95%CI 1.01–1.38). Risks were also significantly increased when PM 10 was on lag 1, in people with a cancer diagnosis in the spring and summer months (1.88, 95%CI 1.05–3.37), and on days (lags 0–2) of high influenza incidence (OR 2.34, 95%CI 1.01–5.43). PM 10 levels exceeded the 50 μg/m 3 “safe” threshold recommended by the WHO and Italian legislation for only 3.8% of days during the warm periods of 2014–2015. Greater risk of A&E presentation for CVE in periods of high PM 10 and high temperature suggests that “safe” thresholds for PM 10 should be temperature-dependent and that the adverse effects of PM 10 will increase as temperatures increase due to climate change.

Keywords: particulate matter; atmospheric temperature; season; cardiovascular disease; climate change; accident and emergency; cancer; pollution; case-crossover study (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
References: View complete reference list from CitEc
Citations: View citations in EconPapers (3)

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