Associations between air pollution and the risk of first admission and multiple readmissions for cardiovascular diseases

• Published in: Heart (British Cardiac Society) Vol. 110; no. 5; pp. 337 - 345
• Main Authors: Zhang, Shiyu, Chen, Lan, Qian, Zhengmin (Min), Li, Dan, Cai, Miao, Wang, Chongjian, Zhang, Zilong, Vaughn, Michael G., Keith, Amy E., Li, Haitao, Lin, Hualiang
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Cardiovascular Society 01.03.2024; BMJ Publishing Group LTD
• Subjects: Air Pollutants - adverse effects; Air pollution; Air Pollution - adverse effects; Cardiac arrhythmia; Cardiac risk factors and prevention; Cardiovascular disease; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - therapy; Cerebrovascular disease; Cerebrovascular Disorders - epidemiology; Cerebrovascular Disorders - therapy; Disease prevention; Education; Environmental Exposure - adverse effects; epidemiology; Ethnicity; Exercise; Female; Heart failure; Hospitals; Humans; Humidity; Ischemia; Male; Mortality; Myocardial Ischemia; Nitrogen dioxide; Older people; Outdoor air quality; Ozone; Particulate Matter - adverse effects; Patient admissions; Patient Readmission; Pollutants; United Kingdom > UK; England; Wales; epidemiology
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2023-322682

ObjectivesWe aimed to investigate the associations between air pollutants and the risk of admission and multiple readmission events for cardiovascular disease (CVD).MethodsA total of 285 009 participants free of CVD at baseline from the UK Biobank were included in this analysis. Four major cardiovascular admission events were identified during the follow-up: chronic ischaemic heart disease (CIHD), cerebrovascular disease, atrial fibrillation and heart failure. We used Prentice, Williams and Peterson-Total Time model to examine the association between ambient air pollution and first admission, as well as multiple readmissions for these CVDs.ResultsDuring a median follow-up of 12 years, 17 176 (6.03%) participants were hospitalised with CVDs, and 6203 (36.11%) patients with CVD had subsequent readmission events for CVDs. We observed significant associations between air pollution and both first admission and readmission for CVDs, with generally stronger associations on readmission for cardiovascular events. For example, the adjusted HRs for the first admission and subsequent readmission for cerebrovascular disease were 1.130 (95% CI 1.070 to 1.194) and 1.270 (95% CI 1.137 to 1.418) for each IQR increase of particulate matter with a diameter ≤2.5 µm. The corresponding HRs for CIHD were 1.060 (95% CI 1.008 to 1.114) and 1.120 (95% CI 1.070 to 1.171). Sex stratified analyses showed that the associations were generally more pronounced among females than males.ConclusionThis study provides evidence that ambient air pollutants might play an important role in both first admission and readmission for cardiovascular events. In addition, patients with pre-existing CVDs may be more vulnerable to air pollution compared with healthy population.