title: Impact of Fine Particulate Matter (PM2.5) Exposure During Wildfires on Cardiovascular Health Outcomes.
abstract: BACKGROUND
  Epidemiological studies investigating the role of fine particulate matter (PM2.5; aerodynamic diameter <2.5 μm) in triggering acute coronary events, including out-of-hospital cardiac arrests and ischemic heart disease (IHD), during wildfires have been inconclusive.
  
  
  RESULTS
  We examined the associations of out-of-hospital cardiac arrests, IHD, acute myocardial infarction, and angina (hospital admissions and emergency department attendance) with PM2.5 concentrations during the 2006-2007 wildfires in Victoria, Australia, using a time-stratified case-crossover study design. Health data were obtained from comprehensive health-based administrative registries for the study period (December 2006 to January 2007). Modeled and validated air exposure data from wildfire smoke emissions (daily average PM2.5, temperature, relative humidity) were also estimated for this period. There were 457 out-of-hospital cardiac arrests, 2106 emergency department visits, and 3274 hospital admissions for IHD. After adjusting for temperature and relative humidity, an increase in interquartile range of 9.04 μg/m(3) in PM2.5 over 2 days moving average (lag 0-1) was associated with a 6.98% (95% CI 1.03% to 13.29%) increase in risk of out-of-hospital cardiac arrests, with strong association shown by men (9.05%,95%CI 1.63% to 17.02%) and by older adults (aged ≥65 years) (7.25%, 95% CI 0.24% to 14.75%). Increase in risk was (2.07%, 95% CI 0.09% to 4.09%) for IHD-related emergency department attendance and (1.86%, 95% CI: 0.35% to 3.4%) for IHD-related hospital admissions at lag 2 days, with strong associations shown by women (3.21%, 95% CI 0.81% to 5.67%) and by older adults (2.41%, 95% CI 0.82% to 5.67%).
  
  
  CONCLUSIONS
  PM2.5 exposure was associated with increased risk of out-of-hospital cardiac arrests and IHD during the 2006-2007 wildfires in Victoria. This evidence indicates that PM2.5 may act as a triggering factor for acute coronary events during wildfire episodes.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.H., M.A., A.D.M., M.R.S., A.M.T., M.J.A., M.D.).
authors.forename: Anjali
authors.initials: A
authors.lastname: Haikerwal
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.H., M.A., A.D.M., M.R.S., A.M.T., M.J.A., M.D.).
authors.forename: Muhammad
authors.initials: M
authors.lastname: Akram
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.H., M.A., A.D.M., M.R.S., A.M.T., M.J.A., M.D.).
authors.forename: Anthony
authors.initials: A
authors.lastname: Del Monaco
authors.affiliation: Research and Evaluation Department, Ambulance Victoria, Melbourne, Victoria, Australia (K.S.).
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.H., M.A., A.D.M., M.R.S., A.M.T., M.J.A., M.D.).
authors.forename: Malcolm R
authors.initials: MR
authors.lastname: Sim
authors.affiliation: CSIRO Oceans and Atmospheric Flagship, Aspendale, Melbourne, Victoria, Australia (M.M.).
authors.forename: Mick
authors.initials: M
authors.lastname: Meyer
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.H., M.A., A.D.M., M.R.S., A.M.T., M.J.A., M.D.).
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Tonkin
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.H., M.A., A.D.M., M.R.S., A.M.T., M.J.A., M.D.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Abramson
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.H., M.A., A.D.M., M.R.S., A.M.T., M.J.A., M.D.).
authors.forename: Martine
authors.initials: M
authors.lastname: Dennekamp
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D004636:Emergency Service, Hospital; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D005390:Fires; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000453:epidemiology; D010316:Particle Size; D010343:Patient Admission; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D012906:Smoke / Q000009:adverse effects*; D013997:Time Factors; D014739:Victoria / Q000453:epidemiology
chemical_list: D012906:Smoke
keywords: coronary disease; heart arrest; ischemic heart disease; particulate matter; wildfires