title: Air pollution and emergency department visits for cardiac and respiratory conditions: a multi-city time-series analysis.
abstract: BACKGROUND
  Relatively few studies have been conducted of the association between air pollution and emergency department (ED) visits, and most of these have been based on a small number of visits, for a limited number of health conditions and pollutants, and only daily measures of exposure and response.
  
  
  METHODS
  A time-series analysis was conducted on nearly 400,000 ED visits to 14 hospitals in seven Canadian cities during the 1990 s and early 2000s. Associations were examined between carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), sulfur dioxide (SO2), and particulate matter (PM 10 and PM2.5), and visits for angina/myocardial infarction, heart failure, dysrhythmia/conduction disturbance, asthma, chronic obstructive pulmonary disease (COPD), and respiratory infections. Daily and 3-hourly visit counts were modeled as quasi-Poisson and analyses controlled for effects of temporal cycles, weather, day of week and holidays.
  
  
  RESULTS
  24-hour average concentrations of CO and NO2 lag 0 days exhibited the most consistent associations with cardiac conditions (2.1% (95% CI, 0.0-4.2%) and 2.6% (95% CI, 0.2-5.0%) increase in visits for myocardial infarction/angina per 0.7 ppm CO and 18.4 ppb NO2 respectively; 3.8% (95% CI, 0.7-6.9%) and 4.7% (95% CI, 1.2-8.4%) increase in visits for heart failure). Ozone (lag 2 days) was most consistently associated with respiratory visits (3.2% (95% CI, 0.3-6.2%), and 3.7% (95% CI, -0.5-7.9%) increases in asthma and COPD visits respectively per 18.4 ppb). Associations tended to be of greater magnitude during the warm season (April - September). In particular, the associations of PM 10 and PM2.5 with asthma visits were respectively nearly three- and over fourfold larger vs. all year analyses (14.4% increase in visits, 95% CI, 0.2-30.7, per 20.6 microg/m3 PM 10 and 7.6% increase in visits, 95% CI, 5.1-10.1, per 8.2 microg/m3 PM2.5). No consistent associations were observed between three hour average pollutant concentrations and same-day three hour averages of ED visits.
  
  
  CONCLUSIONS
  In this large multicenter analysis, daily average concentrations of CO and NO2 exhibited the most consistent associations with ED visits for cardiac conditions, while ozone exhibited the most consistent associations with visits for respiratory conditions. PM 10 and PM2.5 were strongly associated with asthma visits during the warm season.
authors.affiliation: Population Studies Division, Healthy Environments and Consumer Safety Branch, Health Canada, Postal locator 4903C, 269 Laurier Ave West Ottawa, Ontario, K1A 0K9, Canada. dave_stieb@hc-sc.gc.ca
authors.forename: David M
authors.initials: DM
authors.lastname: Stieb
authors.forename: Mieczyslaw
authors.initials: M
authors.lastname: Szyszkowicz
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.forename: Judith A
authors.initials: JA
authors.lastname: Leech
mesh_terms: D000393:Air Pollutants / Q000032:analysis; D000397:Air Pollution / Q000032:analysis / Q000706:statistics & numerical data*; D002248:Carbon Monoxide / Q000032:analysis; D002947:Cities; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D005843:Geography; D006331:Heart Diseases / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D019570:Inhalation Exposure / Q000032:analysis; D009585:Nitrogen Dioxide / Q000032:analysis; D010126:Ozone / Q000032:analysis; D052638:Particulate Matter / Q000032:analysis; D012120:Respiration Disorders / Q000453:epidemiology*; D012621:Seasons; D013458:Sulfur Dioxide / Q000032:analysis
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D013458:Sulfur Dioxide; D010126:Ozone; D002248:Carbon Monoxide; D009585:Nitrogen Dioxide