title: The association of daily sulfur dioxide air pollution levels with hospital admissions for cardiovascular diseases in Europe (The Aphea-II study).
abstract: The objective of this study is to assess the short-term effect of sulfur dioxide (SO(2)) air pollution levels on hospital admissions for cardiovascular diseases. Daily mean hospital admissions for cardiovascular diseases, ischemic heart diseases (IHDs), and stroke in seven European areas (the cities of Birmingham, London, Milan, Paris, Rome, and Stockholm, and in The Netherlands) participating in the multicenter European study of air pollution (Aphea-II), were measured. Time series analysis of daily hospital admission counts was performed using poison autoregressive models. A summary regression coefficient for all cities was provided. Daily numbers of all cardiovascular admissions except stroke, and particularly IHDs, rose significantly with an increase of daily SO(2)levels of the same day and day before. After adjusting for PM(10)(i.e. particles with size <10 microm), the association of SO(2)with IHD admissions remained significant (i.e. an increase of 0.7%; 95% confidence interval=0.1-1.3, per each 10 microg/m(3)increase of SO(2)) among subjects younger than 65 years, but not among subjects older than 65. In the older group the increase was only significant for particles (1.3%; CI 0.7-1.8, per each increase in 10 microg/m(3)of PM(10)). This study provides new evidence for the effects of urban air pollution on cardiac diseases in Europe, and suggests that SO(2)pollution may play an independent role in triggering ischemic cardiac events. From a Public Health perspective these results suggest that reduction in SO(2)levels in European cities could imply a reduction of admissions for IHDs.
authors.affiliation: Unitat de Recerca Respiratoria i Ambiental, Institut Municipal Investigació Médica (IMIM), c./Dr Aiguader 80, Barcelona 08003, Spain. jsunyer@imim.es
authors.forename: Jordi
authors.initials: J
authors.lastname: Sunyer
authors.forename: Ferran
authors.initials: F
authors.lastname: Ballester
authors.forename: Alain Le
authors.initials: AL
authors.lastname: Tertre
authors.forename: Richard
authors.initials: R
authors.lastname: Atkinson
authors.forename: Jon G
authors.initials: JG
authors.lastname: Ayres
authors.forename: Francesco
authors.initials: F
authors.lastname: Forastiere
authors.forename: Bertil
authors.initials: B
authors.lastname: Forsberg
authors.forename: Judith M
authors.initials: JM
authors.lastname: Vonk
authors.forename: Luigi
authors.initials: L
authors.lastname: Bisanti
authors.forename: José M
authors.initials: JM
authors.lastname: Tenías
authors.forename: Sylvia
authors.initials: S
authors.lastname: Medina
authors.forename: Joel
authors.initials: J
authors.lastname: Schwartz
authors.forename: Klea
authors.initials: K
authors.lastname: Katsouyanni
mesh_terms: D000328:Adult; D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects*; D000397:Air Pollution / Q000009:adverse effects*; D016009:Chi-Square Distribution; D005060:Europe / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology*; D013458:Sulfur Dioxide / Q000009:adverse effects*
chemical_list: D000393:Air Pollutants; D013458:Sulfur Dioxide