title: Air pollution and cardiovascular and respiratory emergency visits in Central Arkansas: A time-series analysis.
abstract: BACKGROUND
  Heart disease and stroke mortality and morbidity rates in Arkansas are among the highest in the U.S. While the effect of air pollution on cardiovascular health was identified in traffic-dominated metropolitan areas, there is a lack of studies for populations with variable exposure profiles, demographic and disease characteristics.
  
  
  OBJECTIVE
  Determine the short-term effects of air pollution on cardiovascular and respiratory morbidity in the stroke and heart failure belt.
  
  
  METHODS
  We investigated the associations of fine particles and ozone with respiratory and cardiovascular emergency room visits during the 2002-2012 period for adults in Central Arkansas using Poisson generalized models adjusted for temporal, seasonal and meteorological effects. We evaluated sensitivity of the associations to mutual pollutant adjustment and effect modification patterns by sex, age, race and season.
  
  
  RESULTS
  We found effects on cardiovascular and respiratory emergencies for PM2.5 (1.52% [95% (confidence interval) CI: -1.10%, 4.20%]; 1.45% [95%CI: -2.64%, 5.72%] per 10 μg/m3) and O3 (0.93% [95%CI: -0.87%, 2.76%]; 0.76 [95%CI: -1.92%, 3.52%] per 10 ppbv) during the cold period (October-March). The effects were stronger among whites, except for the respiratory effects of O3 that were higher among Blacks/African-Americans. Effect modification patterns by age and sex differed by association. Both pollutants were associated with increases in emergency room visits for hypertension, heart failure and asthma. Effects on cardiovascular and respiratory emergencies were observed during the cold period when particulate matter was dominated by secondary nitrate and wood burning.
  
  
  CONCLUSIONS
  Outdoor particulate pollution during winter had an effect on cardiovascular morbidity in central Arkansas, the region with high stroke and heart disease incidence rates.
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27, Goudi, Athens, Greece.
authors.forename: Sophia
authors.initials: S
authors.lastname: Rodopoulou
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27, Goudi, Athens, Greece.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Samoli
authors.affiliation: Department of Environmental and Occupational Health, University of Arkansas for Medical Sciences, College of Public Health, 4301 West Markham St. Little Rock, AR 72205-7199, USA.
authors.forename: Marie-Cecile G
authors.initials: MG
authors.lastname: Chalbot
authors.affiliation: Department of Environmental and Occupational Health, University of Arkansas for Medical Sciences, College of Public Health, 4301 West Markham St. Little Rock, AR 72205-7199, USA. Electronic address: igkavouras@gmail.com.
authors.forename: Ilias G
authors.initials: IG
authors.lastname: Kavouras
mesh_terms: D000328:Adult; D000368:Aged; D000393:Air Pollutants / Q000032:analysis; D000397:Air Pollution / Q000706:statistics & numerical data*; D001131:Arkansas / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012140:Respiratory Tract Diseases / Q000453:epidemiology*
chemical_list: D000393:Air Pollutants
keywords: Asthma; Biomass burning; Fine particles; Heart disease; Nitrate particles; Ozone; Stroke