Clustering of Environmental Parameters and the Risk of Acute Myocardial Infarction

Geraldine P. Y. Koo, Huili Zheng, Pin Pin Pek, Fintan Hughes, Shir Lynn Lim, Jun Wei Yeo, Marcus E. H. Ong and Andrew F. W. Ho
Additional contact information
Geraldine P. Y. Koo: Ministry of Health Holdings, Singapore 099253, Singapore
Huili Zheng: National Registry of Diseases Office, Health Promotion Board, Singapore 168937, Singapore
Pin Pin Pek: Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
Fintan Hughes: Department of Anesthesiology, Duke University Hospital, Duke University, Durham, NC 27710, USA
Shir Lynn Lim: Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore
Jun Wei Yeo: Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
Marcus E. H. Ong: Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
Andrew F. W. Ho: Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore

IJERPH, 2022, vol. 19, issue 14, 1-12

Abstract: The association between days with similar environmental parameters and cardiovascular events is unknown. We investigate the association between clusters of environmental parameters and acute myocardial infarction (AMI) risk in Singapore. Using k-means clustering and conditional Poisson models, we grouped calendar days from 2010 to 2015 based on rainfall, temperature, wind speed and the Pollutant Standards Index (PSI) and compared the incidence rate ratios (IRR) of AMI across the clusters using a time-stratified case-crossover design. Three distinct clusters were formed with Cluster 1 having high wind speed, Cluster 2 high rainfall, and Cluster 3 high temperature and PSI. Compared to Cluster 1, Cluster 3 had a higher AMI incidence with IRR 1.04 (95% confidence interval 1.01–1.07), but no significant difference was found between Cluster 1 and Cluster 2. Subgroup analyses showed that increased AMI incidence was significant only among those with age ≥65, male, non-smokers, non-ST elevation AMI (NSTEMI), history of hyperlipidemia and no history of ischemic heart disease, diabetes or hypertension. In conclusion, we found that AMI incidence, especially NSTEMI, is likely to be higher on days with high temperature and PSI. These findings have public health implications for AMI prevention and emergency health services delivery during the seasonal Southeast Asian transboundary haze.

Keywords: myocardial infarction; air pollution; haze; environmental epidemiology; clustering (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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