title: Air pollution and hospital admissions for ischemic heart disease in persons with congestive heart failure or arrhythmia.
abstract: We examined whether ischemic heart disease (IHD) hospital admissions were associated with air pollutants in those with and without secondary diagnoses of arrhythmia (ARR) or congestive heart failure (CHF). We assessed the occurrence of increased vulnerability among persons with these conditions to daily variations in ozone, carbon monoxide, nitrogen dioxide, or particulate matter less than or equal to 10 micro m in aerodynamic diameter (PM10). The study population consisted of members of a large health maintenance organization residing in the South Coast Air Basin of California from 1988 to 1995. After adjustment for day of week, study year, and smoothing splines for day of study, temperature, and relative humidity, CO and NO2 were both associated with admissions with the greatest effects for CO. A 1-ppm increase in 8-hr average CO was associated with a 3.60% [95% confidence interval (CI), 1.62-5.63%] increase in same-day IHD admissions in persons with a secondary diagnosis of CHF, a 2.99% (95% CI, 1.80-4.19%) increase in persons with a secondary diagnosis of ARR, and a 1.62% (95% CI, 0.65-2.59%) increase in IHD admissions in persons without either secondary diagnosis. Air pollution was most strongly associated with myocardial infarction hospital admissions. The vulnerability of the secondary CHF subgroup may be due to a greater prevalence of myocardial infarction primary diagnoses and not the modifying effect of CHF. This study suggests that people with IHD and accompanying CHF and/or ARR constitute a sensitive subgroup in relation to the effects of criteria ambient air pollutants associated with motor vehicle combustion.
authors.affiliation: Department of Epidemiology, University of California, Berkeley, 94720, USA.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Mann
authors.forename: Ira B
authors.initials: IB
authors.lastname: Tager
authors.forename: Fred
authors.initials: F
authors.lastname: Lurmann
authors.forename: Mark
authors.initials: M
authors.lastname: Segal
authors.forename: Charles P
authors.initials: CP
authors.lastname: Quesenberry
authors.forename: Marlene M
authors.initials: MM
authors.lastname: Lugg
authors.forename: Jun
authors.initials: J
authors.lastname: Shan
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Van Den Eeden
mesh_terms: D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000150:complications*; D002248:Carbon Monoxide / Q000009:adverse effects*; D016021:Epidemiologic Studies; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D009585:Nitrogen Dioxide / Q000009:adverse effects*; D010083:Oxidants, Photochemical / Q000009:adverse effects*; D010126:Ozone / Q000009:adverse effects*; D010316:Particle Size; D010343:Patient Admission / Q000706:statistics & numerical data*; D012307:Risk Factors; D001335:Vehicle Emissions / Q000009:adverse effects
chemical_list: D000393:Air Pollutants; D010083:Oxidants, Photochemical; D001335:Vehicle Emissions; D010126:Ozone; D002248:Carbon Monoxide; D009585:Nitrogen Dioxide