title: Acute exposure to fine particulate matter and cardiovascular hospital emergency room visits in Beijing, China.
abstract: Fine particulate matter (PM2.5) air pollution outbreaks have recently occurred frequently in China. However, evidence of the associations between short-term exposure to PM2.5and cardiovascular morbidity is still limited in China. This study aimed to evaluate the associations between PM2.5and hospital emergency room visits (ERVs) for cardiovascular diseases in urban areas in Beijing. Daily counts of cardiovascular ERVs were collected from ten large general hospitals from Jan 1 to Dec 31, 2013. Air pollution data were obtained from the Beijing Environmental Protection Bureau including 17 monitoring stations. A generalized additive Poisson model was used to examine the associations between PM2.5and cardiovascular ERVs after controlling for seasonality, day of the week, public holidays, influenza outbreaks, and weather conditions. In total, there were 56,221 cardiovascular ERVs during the study period. The daily mean PM2.5concentration was 102.1 μg/m3, ranging from 6.7 μg/m3to 508.5 μg/m3. Per 10 μg/m3increase in PM2.5was associated with a 0.14% (95% confidence interval [CI]: 0.01%-0.27%) increase in cardiovascular ERVs at lag3. Cumulative delayed estimates were greatest at lag0-5(0.30%, 95% CI: 0.09%-0.52%). The estimates of percentage change in daily ERVs per 10 μg/m3increase in PM2.5were 0.56% (95%CI: 0.16%-0.95%) for ischemic heart disease (IHD) at lag0-1, 0.81% (95%CI: 0.05%-1.57%) for heart rhythm disturbances (HRD) at lag0-1and 1.21% (95%CI: 0.27%-2.15%) for heart failure (HF) at lag0, respectively. The effects of PM2.5on IHD ERVs during high temperature days (>11.01 °C) were significantly higher than that on low temperature days (≤11.01 °C) at lag0, lag0-1, lag0-3and lag0-5(P < 0.05). The study suggests that PM2.5has acute impacts on cardiovascular ERVs in Beijing, especially on IHD, HRD and HF. The effects of PM2.5on IHD ERVs vary by temperature.
authors.affiliation: School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Xu
authors.affiliation: Beijing Chao-yang Hospital, Capital Medical University, Beijing, China.
authors.forename: Shuo
authors.initials: S
authors.lastname: Wang
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, University of Queensland, Brisbane, Australia.
authors.forename: Yuming
authors.initials: Y
authors.lastname: Guo
authors.affiliation: School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Wang
authors.affiliation: School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
authors.forename: Fangfang
authors.initials: F
authors.lastname: Huang
authors.affiliation: School of Public Health, Capital Medical University, Beijing, China; Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: Xia
authors.initials: X
authors.lastname: Li
authors.affiliation: School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Gao
authors.affiliation: School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
authors.forename: Lijuan
authors.initials: L
authors.lastname: Wu
authors.affiliation: School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
authors.forename: Lixin
authors.initials: L
authors.lastname: Tao
authors.affiliation: School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Guo
authors.affiliation: School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China; School of Medical Sciences, Edith Cowan University, Perth, Australia.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China. Electronic address: statguo@ccmu.edu.cn.
authors.forename: Xiuhua
authors.initials: X
authors.lastname: Guo
mesh_terms: D000328:Adult; D000368:Aged; D000393:Air Pollutants / Q000032:analysis*; D000397:Air Pollution / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D004636:Emergency Service, Hospital; D004784:Environmental Monitoring; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D052638:Particulate Matter / Q000032:analysis*; D013696:Temperature; D014887:Weather
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter
keywords: Beijing, China; Cardiovascular diseases; Fine particulate matter air pollution; Hospital emergency room visits