Ambient nitrogen dioxide is associated with emergency hospital visits for atrial fibrillation: a population-based case-crossover study in Reykjavik, Iceland
Tóm tắt
In Iceland air quality is generally good; however, previous studies indicate that there is an association between air pollution in Reykjavik and adverse health effects as measured by dispensing of medications, mortality, and increase in health care utilisation. The aim was to study the association between traffic-related ambient air pollution in the Reykjavik capital area and emergency hospital visits for heart diseases and particularly atrial fibrillation and flutter (AF). A multivariate time-stratified case-crossover design was used to study the association. Cases were those patients aged 18 years or older living in the Reykjavik capital area during the study period, 2006–2017, who made emergency visits to Landspitali University Hospital for heart diseases. In this population-based study, the primary discharge diagnoses were registered according to International Classification of Diseases, 10th edition (ICD-10). The pollutants studied were NO2, PM10, PM2.5, and SO2, with adjustment for H2S, temperature, and relative humidity. The 24-h mean of pollutants was used with lag 0 to lag 4. During the study period 9536 cases of AF were identified. The 24-h mean NO2 was 20.7 μg/m3. Each 10 μg/m3 increase in NO2 was associated with increased risk of heart diseases (ICD-10: I20-I25, I44-I50), odds ratio (OR) 1.023 (95% CI 1.012–1.034) at lag 0. Each 10 μg/m3 increase in NO2 was associated with an increased risk of AF (ICD-10: I48) on the same day, OR 1.030 (95% CI: 1.011–1.049). Females were at higher risk for AF, OR 1.051 (95% CI 1.019–1.083) at lag 0, and OR 1.050 (95% CI 1.019–1.083) at lag 1. Females aged younger than 71 years had even higher risk for AF, OR 1.077 (95% CI: 1.025–1.131) at lag 0. Significant associations were found for other pollutants and emergency hospital visits, but they were weaker and did not show a discernable pattern. Short-term increase in NO2 concentrations was associated with heart diseases, more precisely with AF. The associations were stronger among females, and among females at younger age. This is the first study in Iceland that finds an association between air pollution and cardiac arrhythmias, so the results should be interpreted with caution.
Tài liệu tham khảo
Ab Manan N, Aizuddin AN, Hod R. Effect of air pollution and hospital admission: a systematic review. Ann Glob Health. 2018;84(4):670–8.
Khan R, Konishi S, Ng CFS, Umezaki M, Kabir AF, Tasmin S, et al. Association between short-term exposure to fine particulate matter and daily emergency room visits at a cardiovascular hospital in Dhaka. Bangladesh Sci Total Environ. 2019;646:1030–6.
Liu H, Tian YH, Cao YY, Song J, Huang C, Xiang X, et al. Fine particulate air pollution and hospital admissions and readmissions for acute myocardial infarction in 26 Chinese cities. Chemosphere. 2018;192:282–8.
Wei Y, Wang Y, Di Q, Choirat C, Wang Y, Koutrakis P, et al. Short term exposure to fine particulate matter and hospital admission risks and costs in the Medicare population: time stratified, case crossover study. BMJ. 2019;367:l6258.
Milojevic A, Wilkinson P, Armstrong B, Bhaskaran K, Smeeth L, Hajat S. Short-term effects of air pollution on a range of cardiovascular events in England and Wales: case-crossover analysis of the MINAP database, hospital admissions and mortality. Heart. 2014;100(14):1093–8.
Zhao A, Chen RJ, Kuang XY, Kan HD. Ambient air pollution and daily outpatient visits for cardiac arrhythmia in Shanghai. China J Epidemiol. 2014;24(4):321–6.
Dahlquist M, Frykman V, Kemp-Gudmunsdottir K, Svennberg E, Wellenius GA, Ljungman PLS. Short-term associations between ambient air pollution and acute atrial fibrillation episodes. Environ Int. 2020;141:7.
Saifipour A, Azhari A, Pourmogpaddas A, Hosseini SM, Jafari-Koshki T, Rahimi M, et al. Association between ambient air pollution and hospitalization caused by atrial fibrillation. ARYA Atheroscler. 2019;15(3):106–12.
Solimini AG, Renzi M. Association between air pollution and emergency room visits for atrial fibrillation. Int J Environ Res Public Health. 2017;14(6):661.
Bunch TJ, Horne BD, Asirvatham SJ, Day JD, Crandall BG, Weiss JP, et al. Atrial fibrillation hospitalization is not increased with short-term elevations in exposure to fine particulate air pollution. Pacing Clin Electrophysiol. 2011;34(11):1475–9.
Cakmak S, Kauri L, Shutt R, Liu L, Green MS, Mulholland M, et al. The association between ambient air quality and cardiac rate and rhythm in ambulatory subjects. Environ Int. 2014;73:365–71.
Meng X, Liu C, Chen R, Sera F, Vicedo-Cabrera AM, Milojevic A, et al. Short term associations of ambient nitrogen dioxide with daily total, cardiovascular, and respiratory mortality: multilocation analysis in 398 cities. BMJ. 2021;372:n534.
Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114(2):119–25.
Stefansdottir H, Aspelund T, Gudnason V, Arnar DO. Trends in the incidence and prevalence of atrial fibrillation in Iceland and future projections. Europace. 2011;13(8):1110–7.
Gudmundsson G, Finnbjornsdottir R, Johannsson Þ, Rafnsson V. Air pollution in Iceland and the effects on human health. Review Laeknabladid. 2019;105(10):443–52.
The environment Agency of Iceland. Air quality in Iceland – Annual report 2018 [In Icelandic]. 2020.
Carlsen HK, Forsberg B, Meister K, Gislason T, Oudin A. Ozone is associated with cardiopulmonary and stroke emergency hospital visits in Reykjavík, Iceland 2003–2009. Environ Health. 2013;12(1):28.
Carlsen HK, Zoëga H, Valdimarsdottir U, Gislason T, Hrafnkelsson B. Hydrogen sulfide and particle matter levels associated with increased dispensing of anti-asthma drugs in Iceland's capital. Environ Res. 2012;113:33–9.
Finnbjornsdottir R, Zoega H, Olafsson O, Thorsteinsson T, Rafnsson V. Association of air pollution and use of glyceryl trinitrate against angina pectoris: a population-based case-crossover study. Environ Health. 2013;12:38.
Finnbjornsdottir RG, Carlsen HK, Thorsteinsson T, Oudin A, Lund SH, Gislason T, et al. Association between daily hydrogen sulfide exposure and incidence of emergency hospital visits: a population-based study. PLoS One. 2016;11(5):1–19.
Finnbjornsdottir RG, Oudin A, Elvarsson BT, Gislason T, Rafnsson V. Hydrogen sulfide and traffic-related air pollutants in association with increased mortality: a case-crossover study in Reykjavik, Iceland. BMJ Open. 2015;5(4):e007272.
Statistics Iceland. Population by municipality, sex, citizenship and quarters 2011–2019. (2020) https://www.hagstofa.is/talnaefni/ibuar/mannfjoldi/yfirlit/ . Accessed 06 Feb 2020.
Levy D, Lumley T, Sheppard L, Kaufman J, Checkoway H. Referent selection in case-crossover analyses of acute health effects of air pollution. Epidemiology. 2001;12(2):186–92.
Maclure M. The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol. 1991;133(2):144–53.
Monrad M, Sajadieh A, Christensen JS, Ketzel M, Raaschou-Nielsen O, Tjønneland A, et al. Long-term exposure to traffic-related air pollution and risk of incident atrial fibrillation: a cohort study. Environ Health Perspect. 2017;125(3):422–7.
Shin S, Burnett RT, Kwong JC, Hystad P, van Donkelaar A, Brook JR, et al. Ambient air pollution and the risk of atrial fibrillation and stroke: a population-based cohort study. Environ Health Perspect. 2019;127(8):15.
Xu H, Chen J, Zhao Q, Zhang Y, Wang T, Feng B, et al. Ambient air pollution is associated with cardiac repolarization abnormalities in healthy adults. Environ Res. 2019;171:239–46.
Liu X, Kong D, Liu Y, Fu J, Gao P, Chen T, et al. Effects of the short-term exposure to ambient air pollution on atrial fibrillation. Pacing Clin Electrophysiol. 2018;41(11):1441–6.
Carlsen HK, Hauksdottir A, Valdimarsdottir UA, Gíslason T, Einarsdottir G, Runolfsson H, et al. Health effects following the Eyjafjallajokull volcanic eruption: a cohort study. BMJ Open. 2012;2(6):e001851.
Carlsen HK, Ilyinskaya E. Increased respiratory morbidity associated with exposure to a mature volcanic plume from a large Icelandic fissure eruption. Nat Commun. 2021;12(1):2161.
Carlsen HK, Valdimarsdóttir U, Briem H, Dominici F, Finnbjornsdottir RG, Jóhannsson T, et al. Severe volcanic SO(2) exposure and respiratory morbidity in the Icelandic population - a register study. Environ Health. 2021;20(1):23.
Althouse AD. Adjust for multiple comparisons? It’s not that simple. Ann Thorac Surg. 2016;101(5):1644–5.
Perneger TV. What's wrong with Bonferroni adjustments. BMJ (Clinical research ed). 1998;316(7139):1236–8.
Rothman KJ. No adjustments are needed for multiple comparisons. Epidemiology. 1990;1(1):43–6.