title: A case-crossover analysis of out-of-hospital cardiac arrest and air pollution.
abstract: BACKGROUND
  Evidence of an association between the exposure to air pollution and overall cardiovascular morbidity and mortality is increasingly found in the literature. However, results from studies of the association between acute air pollution exposure and risk of out-of-hospital cardiac arrest (OHCA) are inconsistent for fine particulate matter, and, although pathophysiological evidence indicates a plausible link between OHCA and ozone, none has been reported. Approximately 300 000 persons in the United States experience an OHCA each year, of which >90% die. Understanding the association provides important information to protect public health.
  
  
  RESULTS
  The association between OHCA and air pollution concentrations hours and days before onset was assessed by using a time-stratified case-crossover design using 11 677 emergency medical service-logged OHCA events between 2004 and 2011 in Houston, Texas. Air pollution concentrations were obtained from an extensive area monitor network. An average increase of 6 µg/m(3) in fine particulate matter 2 days before onset was associated with an increased risk of OHCA (1.046; 95% confidence interval, 1.012-1.082). A 20-ppb ozone increase for the 8-hour average daily maximum was associated with an increased risk of OHCA on the day of the event (1.039; 95% confidence interval, 1.005-1.073). Each 20-ppb increase in ozone in the previous 1 to 3 hours was associated with an increased risk of OHCA (1.044; 95% confidence interval, 1.004-1.085). Relative risk estimates were higher for men, blacks, or those aged >65 years.
  
  
  CONCLUSIONS
  The findings confirm the link between OHCA and fine particulate matter and introduce evidence of a similar link with ozone.
authors: Rice University, Department of Statistics, PO Box 1892, MS 138, Houston, TX 77251-1892, USA.
authors: Katherine B
authors: KB
authors: Ensor
authors: Loren H
authors: LH
authors: Raun
authors: David
authors: D
authors: Persse
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000397:Air Pollution / Q000009:adverse effects*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology*; D010126:Ozone / Q000009:adverse effects*; D052638:Particulate Matter / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013781:Texas; D055815:Young Adult
chemical_list: D052638:Particulate Matter; D010126:Ozone