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International Journal of Occupational Medicine and Environmental Health


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Air Pollution and Emergency Department Visits for Ischemic Heart Disease in Montreal, Canada

Mieczysław Szyszkowicz1

Air Health Effects Research Section, Health Canada, Ottawa, Ontario, Canada1

This content is open access.

Citation Information: International Journal of Occupational Medicine and Environmental Health. Volume 20, Issue 2, Pages 167–174, ISSN (Online) 1896-494X, ISSN (Print) 1232-1087, DOI: 10.2478/v10001-007-0015-3, July 2007

Publication History

Published Online:
2007-07-17

Air Pollution and Emergency Department Visits for Ischemic Heart Disease in Montreal, Canada

Objectives: We examined the associations between emergency department (ED) visits for ischemic heart disease (IHD) and short-term elevations in ambient air pollutants (CO and NO2). Materials and Methods: A hierarchical clusters design was used to study ED visits (n = 4979) for ischemic heart disease (ICD-9: 410-414) that occurred at a Montreal hospital between 1997 and 2002. The generalized linear mixed models technique was applied to create Poisson models for the clustered counts of ED visits for IHD. The analysis was done by gender for two age categories, all patients and patients aged over 64 years. Results: The results are presented as an excess risk increase associated with the interquartile range (IQR) of daily average of the pollutant concentration. The results for NO2 (IQR = 9.5 ppb) were 5.9% (95% CI: 2.1-9.9) for all patients and 6.2% (95% CI: 1.2-11.4) for males; for patients aged over 64: 7.1% (95% CI: 2.5-11.9) for all patients, 9.1% (95% CI: 2.8-15.7) for males, and 6.5% (95% CI: 0.7-12.7) for females (for exposure lagged by 1-day). The results for CO (IQR = 0.2 ppm): 5.4% (95% CI: 2.3-8.5) for all patients, and 7.5% (95% CI: 3.6-11.6) for males. For patients aged over 64 years, 4.9% (95% CI: 1.3-8.7) for all patients, and 7.5% (95% CI: 2.6-12.6) for males. The results show the associations for the same day exposures. Conclusions: The short-term effects of nitrogen dioxide and carbon monoxide are associated significantly with daily ED visits for ischemic heart disease. For NO2 the associations are stronger for patients aged over 64 years. As indicated by our results, it is likely that vehicular traffic, a producer of NO2 and CO, contributes to an increased number of ED visits for IHD.

Keywords: Ischemic heart disease; Emergency department visit; Air pollution; Relative risk

  • Schwartz J, Morris R. Air pollution and hospital admissions for cardiovascular disease in Detroit, Michigan. Am J Epidemiol 1995;142:23-35.

  • Schwartz J. Air pollution and hospital admissions for cardiovascular disease in Tucson. Epidemiology 1997;8:371-7. [Crossref] [PubMed]

  • Schwartz J. Air pollution and hospital admissions for heart disease in eight U.S. counties. Epidemiology 1999;10:17-22. [Crossref] [PubMed]

  • Wong TW, Lau TS, Yu TS, Neller A, Wong SL, Tam W, et al. Air pollution and hospital admissions for respiratory and cardiovascular diseases in Hong Kong. Occup Environ Med 1999;56:679-83. [Crossref]

  • Atkinson RW, Bremner SA, Anderson HR, Strachan DP, Bland JM, de Leon AP. Short-term associations between emergency hospital admissions for respiratory and cardiovascular disease and outdoor air pollution in London. Arch Environ Health 1999;54:398-411. [Crossref]

  • Peters A, Perz S, Doring A, Stieber J, Koenig W, Wichmann HE. Increases in heart rate during an air pollution episode. Am J Epidemiol 1999;150:1094-8.

  • Mann JK, Tager IB, Lurmann F, Segal M, Quesenberry CP, Lugg MM, et al. Air pollution and hospital admissions for ischemic heart disease in persons with congestive heart failure or arrhythmia. Environ Health Perspect 2002;110:1247-52. [PubMed] [Crossref]

  • Allred EN, Bleecker ER, Chaitman BR, Dahms TE, Gottlieb SO, Hackney JD, et al. Acute effects of carbon monoxide exposure on individuals with coronary artery disease. Res Rep Health Effects Inst 1989;25:1-97.

  • Metzger KB, Tolbert PE, Klein M, Peel JL, Flanders WD, Todd Knox, et al. Ambient air pollution and cardiovascular emergency department visits. Epidemiology 2004;15 (1): 46-56. [Crossref] [Web of Science] [PubMed]

  • Fung KY, Luginaah I, Gorey KM, Webster G. Air pollution and daily hospital admissions for cardiovascular diseases in Windsor, Ontario. Can J Public Health Jan/Feb 2005;96:29-33.

  • Lin CA, Amador Pereira LA, de Souza Conceicao GM, Kishi HS, Milani R Jr, Ferreir Braga Al, et al. Association between air pollution and ischemic cardiovascular emergency room visits. Environ Res 2003;92(1):57-63. [Crossref]

  • Lee JT, Kim H, Cho YS, Hong YC, Ha EH, Park H. Air pollution and hospital admissions for ischemic heart diseases among individuals 64+ years of age residing in Seoul, Korea. Arch Environ Health 2003;58:617-23. [PubMed] [Crossref]

  • World Health Organization. The International Classification of Diseases, 9th Revision. Geneva: WHO; 1997.

  • Molenberghs G, Verbeke G. Models for discrete longitudinal data. New York: Springer; 1997.

  • Skrondal A, Rabe-Hesketh S. Generalized latent variable modeling: Multilevel, longitudinal and structural equation models. Boca Raton, FL: Chapman & Hall/CRC Press; 2004.

  • Rabe-Hesketh S, Skrondal A. Multilevel and longitudinal modeling using Stata. College Station, Texas: Stata Press; 2005.

  • Development Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing. Vienna, Austria: URL http://www.R-project.org

  • Szyszkowicz M. Use of generalized linear mixed models to examine the association between air pollution and health outcomes. Int J Occup Med and Environ Health 2006;19:224-7.

  • Szyszkowicz M. Air pollution and daily emergency department visits for headache in Montreal, Canada. Headache 2007 [accepted for publication]. [Web of Science]

  • Jalaludin B, Morgan G, Lincoln D, Sheppeard V, Simpson R, Corbett S. Associations between ambient air pollution and daily emergency department attendances for cardiovascular disease in the elderly (65+ years), Sydney, Australia. J Expo Sci Environ Epidemiol 2006;16:225-37. [Crossref]

  • Petra J, Koken M, Piver WT, Ye F, Elixhauser A, Lola M, et al. Temperature, air pollution, and hospitalization for cardiovascular diseases among elderly people in Denver. Environ Health Perspect 2003;111:1312-7.

  • Sunyer J, Ballester F, Le Tertre A, Atkinson R, Ayres JG, Forastiere F, et al. The association of daily sulfur dioxide air pollution levels with hospital admissions for cardiovascular diseases in Europe (The Aphea-II study). Eur Heart J 2003 24:752-60. [PubMed] [Crossref]

  • Hosseinpoor AR, Forouzanfar MH, Yunesian M, Asghari F, Naieni KH, Farhood D. Air pollution and hospitalization due to angina pectoris in Tehran, Iran: A time-series study. Environ Res 2005;99:126-31.

  • Von Klot S, Peters A, Aalto P, Bellander T, Berglind N, D'Ippoliti D, et al. Ambient air pollution is associated with increased risk of hospital cardiac readmissions of myocardial infarction survivors in five European cities. Circulation 2005;112:3073-9. [PubMed] [Crossref]

  • McCullagh P, Nelder JA. Generalized linear models. 2nd ed. London: Chapman &Hall; 1989.

  • Maclure M. The case-crossover design: A method for studying transient effects on the risk of acute events. Am J Epidemiol 1991;133:144-53.

  • SAS Institute Inc. SAS version 9.1. Cary NC: SAS Institute Inc; 2005.

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