title: Short term effects of air pollution on hospitalizations for cardiovascular diseases in eight French cities: the PSAS program.
abstract: BACKGROUND
  Short term associations between air pollution indicators and hospitalizations for cardiovascular diseases have been suggested by epidemiological and clinical studies. The present study aims at estimating the association between particles with diameter <10 microm (PM(10)), nitrogen dioxide (NO(2)) and ozone and hospitalizations for cardiovascular diseases in eight French cities during the 1998-2003 period.
  
  
  METHODS
  The daily number of hospitalizations in each city was extracted from the French hospital information system (PMSI) for cardiovascular diseases, cardiac diseases, ischemic heart diseases and stroke. Excess relative risks (ERRs) of hospitalization associated with a 10 microg/m(3) increase in pollutant levels were estimated in each city by fitting a Poisson regression model, controlling for well-known confounding factors and temporal trends. City-specific results were then combined by inverse variance weighting.
  
  
  RESULTS
  Daily number of hospitalizations for cardiovascular diseases was associated with PM(10) levels (for a 10 microg/m(3) increase, ERR=0.8%, 95% CI: [0.2, 1.5]), with NO(2) (1.1%, [0.6, 1.6]) but not with ozone (0.1% [-0.2%, 0.5%]). Associations were stronger in people aged 65 years and over, and when only hospitalizations for ischemic heart diseases were considered. No association was found between strokes and air pollution levels.
  
  
  CONCLUSIONS
  Our study suggests that the ambient levels of air pollutants currently experienced in the eight French cities, which are close to European air quality guidelines, are yet linked to a short term increase of hospitalizations for cardiovascular diseases. These results are consistent with epidemiological and toxicological data on the cardiovascular effects of air pollution.
authors.affiliation: Institute of Public Health Surveillance (InVS), Saint-Maurice, France. sophie.larrieu@sante.gouv.fr
authors.forename: Sophie
authors.initials: S
authors.lastname: Larrieu
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Jusot
authors.forename: Myriam
authors.initials: M
authors.lastname: Blanchard
authors.forename: Hélène
authors.initials: H
authors.lastname: Prouvost
authors.forename: Christophe
authors.initials: C
authors.lastname: Declercq
authors.forename: Pascal
authors.initials: P
authors.lastname: Fabre
authors.forename: Laurence
authors.initials: L
authors.lastname: Pascal
authors.forename: Alain Le
authors.initials: AL
authors.lastname: Tertre
authors.forename: Vérène
authors.initials: V
authors.lastname: Wagner
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Rivière
authors.forename: Benoît
authors.initials: B
authors.lastname: Chardon
authors.forename: David
authors.initials: D
authors.lastname: Borrelli
authors.forename: Sylvie
authors.initials: S
authors.lastname: Cassadou
authors.forename: Daniel
authors.initials: D
authors.lastname: Eilstein
authors.forename: Agnès
authors.initials: A
authors.lastname: Lefranc
mesh_terms: D000368:Aged; D000393:Air Pollutants / Q000633:toxicity; D000397:Air Pollution / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002947:Cities; D004781:Environmental Exposure / Q000009:adverse effects; D005602:France / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D009585:Nitrogen Dioxide / Q000633:toxicity; D010126:Ozone / Q000633:toxicity; D052638:Particulate Matter / Q000633:toxicity; D012306:Risk
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D010126:Ozone; D009585:Nitrogen Dioxide