title: Impact of meteorological parameters and air pollution on emergency department visits for cardiovascular diseases in the city of Zagreb, Croatia.
abstract: The aim of this study was to investigate whether nitrogen dioxide (NO2), ozone (O3), and certain meteorological conditions had an impact on cardiovascular disease (CVD)-related emergency department (ED) visits in the metropolitan area of Zagreb. This retrospective, ecological study included 20,228 patients with a cardiovascular disease as their primary diagnosis who were examined in the EDs of two Croatian University Hospitals, Sisters of Charity and Holy Spirit, in the study period July 2008-June 2010. The median of daily CVD-related ED visits during the study period was 28 and was the highest during winter. A significant negative correlation was found between CVD-related emergency visits and air temperature measured no more than three days prior to the visit, and the highest negative correlation coefficient was measured two days earlier (R=0.266, p≤0.001). The number of CVD-related emergency visits significantly correlated with the average NO2 concentration on the same day (R=0.191, p<0.001). The results of multiple stepwise regression analysis showed that the number of CVD-related emergency visits depended on air temperature, and NO2 and O3 concentrations. The higher the air temperatures, the lower the number of daily CVD-related emergency visits (p<0.001). An increase in NO2 concentrations (p=0.005) and a decrease in O3 concentrations of two days earlier (p=0.006) led to an increase in CVD-related ED visits. In conclusion, the decrease in O3 concentrations and the increase in NO2, even if below the legally binding thresholds, could be associated with an increase in CVD-related emergency visits and a similar effect was observed with lower temperature measured no more than three days prior to the visit.
authors.forename: Sanja
authors.initials: S
authors.lastname: Pintarić
authors.forename: Ivan
authors.initials: I
authors.lastname: Zeljković
authors.forename: Gordana
authors.initials: G
authors.lastname: Pehnec
authors.forename: Višnja
authors.initials: V
authors.lastname: Nesek
authors.forename: Mislav
authors.initials: M
authors.lastname: Vrsalović
authors.forename: Hrvoje
authors.initials: H
authors.lastname: Pintarić
mesh_terms: D000368:Aged; D000397:Air Pollution / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy*; D002947:Cities; D017523:Croatia; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008685:Meteorological Concepts; D008875:Middle Aged; D009585:Nitrogen Dioxide / Q000009:adverse effects*; D010126:Ozone / Q000009:adverse effects*; D012189:Retrospective Studies; D012621:Seasons; D013696:Temperature
chemical_list: D010126:Ozone; D009585:Nitrogen Dioxide