Ambient air quality and spatio-temporal patterns of cardiovascular emergency department visits

• Published in: International journal of health geographics Vol. 17; no. 1; pp. 18 - 16
• Main Authors: Yoo, Eun-Hye, Brown, Patrick, Eum, Youngseob
• Format: Journal Article
• Language: English
• Published: England BioMed Central 08.06.2018; BMC
• Subjects: Adolescent; Adult; Aged; Air pollution; Air Pollution - adverse effects; Air Pollution - analysis; Air quality; Ambient air quality; Bayesian analysis; Cardiovascular disease (CVD); Cardiovascular diseases; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - therapy; Child; Child, Preschool; Community multiscale air quality (CMAQ); Cross-Over Studies; Data processing; Emergency department (ED) visits; Emergency medical care; Emergency medical services; Emergency Service, Hospital - trends; Emergency services; Environmental Exposure - adverse effects; Environmental Exposure - analysis; Environmental risk; Epidemiology; Exposure; Female; Geographical variations; Geriatrics; Health risks; Heart diseases; Hierarchical Bayesian model; Humans; Infant; Infant, Newborn; Male; Mathematical models; Middle Aged; Morbidity; New York - epidemiology; Older people; Outdoor air quality; Particulate matter; Particulate Matter - adverse effects; Particulate Matter - analysis; Pollutants; Pollution; Pollution effects; Spatial Analysis; Spatial distribution; Spatial effects; Spatial heterogeneity; Statistical analysis; Statistical models; Studies; Time Factors; Utilization; Young Adult; New York; United States > US; Community multiscale air quality (CMAQ); Spatial effects; Ambient air quality; Cardiovascular disease (CVD); Emergency department (ED) visits; Hierarchical Bayesian model
• ISSN: 1476-072X; 1476-072X
• DOI: 10.1186/s12942-018-0138-8

Air pollutants have been associated with various adverse health effects, including increased rates of hospital admissions and emergency room visits. Although numerous time-series studies and case-crossover studies have estimated associations between day-to-day variation in pollutant levels and mortality/morbidity records, studies on geographic variations in emergency department use and the spatial effects in their associations with air pollution exposure are rare. We focused on the elderly who visited emergency room for cardiovascular related disease (CVD) in 2011. Using spatially and temporally resolved multi-pollutant exposures, we investigated the effect of short-term exposures to ambient air pollution on emergency department utilization. We developed two statistical models with and without spatial random effects within a hierarchical Bayesian framework to capture the spatial heterogeneity and spatial autocorrelation remaining in emergency department utilization. Although the cardiovascular effect of spatially homogeneous pollutants, such as PM2.5 and ozone, was unchanged, we found the cardiovascular effect of NO[Formula: see text] was pronounced after accounting for the spatially correlated structure in emergency department utilization. We also identified areas with high ED utilization for CVD among the elderly and assessed the uncertainty associated with risk estimates. We assessed the short-term effect of multi-pollutants on cardiovascular risk of the elderly and demonstrated the use of community multiscale air quality model-derived spatially and temporally resolved multi-pollutant exposures to an epidemiological study. Our results indicate that NO[Formula: see text] was significantly associated with the elevated ED utilization for CVD among the elderly.