A case-crossover study to investigate the effects of atmospheric particulate matter concentrations, season, and air temperature on accident and emergency presentations for cardiovascular events in Northern Italy

Paolo Contiero, Roberto Boffi, Giovanna Tagliabue, Alessandra Scaburri, Andrea Tittarelli, Martina Bertoldi, Alessandro Borgini, Immacolata Favia, Ario Alberto Ruprecht, Alfonso Maiorino, Antonio Voza, Marta Ripoll Pons, Alessandro Cau, Cinzia Demarco, Flavio Allegri, Claudio Tresoldi, Michele Ciccarelli

Research output: Contribution to journalArticle

Abstract

Atmospheric particulate matter (PM) has multiple adverse effects on human health, high temperatures are also associated with adverse health outcomes, and the frequency of cardiovascular events (CVEs) varies with season. We investigated a hypothesized increase in PM-related accident and emergency (A&E) presentations for CVE with high temperature, warm season, days of high influenza incidence, and in people with a cancer diagnosis, using a time-stratified case-crossover study design. Outcomes were associations of A&E presentation for CVE with atmospheric PM ≤ 10 µm (PM10), season, and air temperature. PM10 levels in the municipality of residence (exposure variable) were estimated by modeling data from local monitoring stations. Conditional logistic regression models estimated odds ratios (OR) with 95% confidence intervals (CI) for presentations in relation to supposed influencers, adjusting for confounders. Study participants were all who presented at the A&E of a large hospital near Milan, Italy, for a CVE (ICD-9: 390–459) from 1st January 2014 to 31st December 2015. There were 1349 A&E presentations for CVE in 2014–2015 and 5390 control days. Risk of A&E presentation was significantly increased on hot days with OR 1.34 (95%CI 1.05–1.71) per 10 µg/m3 PM10 increment (as mean PM10 on day of presentation, and 1 and 2 days before (lags 0–2)), and (for lag 0) in autumn (OR 1.23, 95%CI 1.09–1.37) and winter (OR 1.18, 95%CI 1.01–1.38). Risks were also significantly increased when PM10 was on lag 1, in people with a cancer diagnosis in the spring and summer months (1.88, 95%CI 1.05–3.37), and on days (lags 0–2) of high influenza incidence (OR 2.34, 95%CI 1.01–5.43). PM10 levels exceeded the 50 µg/m3 “safe” threshold recommended by the WHO and Italian legislation for only 3.8% of days during the warm periods of 2014–2015. Greater risk of A&E presentation for CVE in periods of high PM10 and high temperature suggests that “safe” thresholds for PM10 should be temperature-dependent and that the adverse effects of PM10 will increase as temperatures increase due to climate change.

Original languageEnglish
Article number4627
JournalInternational Journal of Environmental Research and Public Health
Volume16
Issue number23
DOIs
Publication statusPublished - Dec 1 2019

Fingerprint

Particulate Matter
Cross-Over Studies
Italy
Accidents
Emergencies
Air
Confidence Intervals
Odds Ratio
Temperature
Human Influenza
Logistic Models
Climate Change
Incidence
Health
International Classification of Diseases
Legislation
Neoplasms

Keywords

  • Accident and emergency
  • Atmospheric temperature
  • Cancer
  • Cardiovascular disease
  • Case-crossover study
  • Climate change
  • Particulate matter
  • Pollution
  • Season

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis

Cite this

@article{41a14a8854364b4fad911097177516d8,
title = "A case-crossover study to investigate the effects of atmospheric particulate matter concentrations, season, and air temperature on accident and emergency presentations for cardiovascular events in Northern Italy",
abstract = "Atmospheric particulate matter (PM) has multiple adverse effects on human health, high temperatures are also associated with adverse health outcomes, and the frequency of cardiovascular events (CVEs) varies with season. We investigated a hypothesized increase in PM-related accident and emergency (A&E) presentations for CVE with high temperature, warm season, days of high influenza incidence, and in people with a cancer diagnosis, using a time-stratified case-crossover study design. Outcomes were associations of A&E presentation for CVE with atmospheric PM ≤ 10 µm (PM10), season, and air temperature. PM10 levels in the municipality of residence (exposure variable) were estimated by modeling data from local monitoring stations. Conditional logistic regression models estimated odds ratios (OR) with 95{\%} confidence intervals (CI) for presentations in relation to supposed influencers, adjusting for confounders. Study participants were all who presented at the A&E of a large hospital near Milan, Italy, for a CVE (ICD-9: 390–459) from 1st January 2014 to 31st December 2015. There were 1349 A&E presentations for CVE in 2014–2015 and 5390 control days. Risk of A&E presentation was significantly increased on hot days with OR 1.34 (95{\%}CI 1.05–1.71) per 10 µg/m3 PM10 increment (as mean PM10 on day of presentation, and 1 and 2 days before (lags 0–2)), and (for lag 0) in autumn (OR 1.23, 95{\%}CI 1.09–1.37) and winter (OR 1.18, 95{\%}CI 1.01–1.38). Risks were also significantly increased when PM10 was on lag 1, in people with a cancer diagnosis in the spring and summer months (1.88, 95{\%}CI 1.05–3.37), and on days (lags 0–2) of high influenza incidence (OR 2.34, 95{\%}CI 1.01–5.43). PM10 levels exceeded the 50 µg/m3 “safe” threshold recommended by the WHO and Italian legislation for only 3.8{\%} of days during the warm periods of 2014–2015. Greater risk of A&E presentation for CVE in periods of high PM10 and high temperature suggests that “safe” thresholds for PM10 should be temperature-dependent and that the adverse effects of PM10 will increase as temperatures increase due to climate change.",
keywords = "Accident and emergency, Atmospheric temperature, Cancer, Cardiovascular disease, Case-crossover study, Climate change, Particulate matter, Pollution, Season",
author = "Paolo Contiero and Roberto Boffi and Giovanna Tagliabue and Alessandra Scaburri and Andrea Tittarelli and Martina Bertoldi and Alessandro Borgini and Immacolata Favia and Ruprecht, {Ario Alberto} and Alfonso Maiorino and Antonio Voza and Pons, {Marta Ripoll} and Alessandro Cau and Cinzia Demarco and Flavio Allegri and Claudio Tresoldi and Michele Ciccarelli",
year = "2019",
month = "12",
day = "1",
doi = "10.3390/ijerph16234627",
language = "English",
volume = "16",
journal = "International Journal of Environmental Research and Public Health",
issn = "1661-7827",
publisher = "MDPI AG",
number = "23",

}

TY - JOUR

T1 - A case-crossover study to investigate the effects of atmospheric particulate matter concentrations, season, and air temperature on accident and emergency presentations for cardiovascular events in Northern Italy

AU - Contiero, Paolo

AU - Boffi, Roberto

AU - Tagliabue, Giovanna

AU - Scaburri, Alessandra

AU - Tittarelli, Andrea

AU - Bertoldi, Martina

AU - Borgini, Alessandro

AU - Favia, Immacolata

AU - Ruprecht, Ario Alberto

AU - Maiorino, Alfonso

AU - Voza, Antonio

AU - Pons, Marta Ripoll

AU - Cau, Alessandro

AU - Demarco, Cinzia

AU - Allegri, Flavio

AU - Tresoldi, Claudio

AU - Ciccarelli, Michele

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Atmospheric particulate matter (PM) has multiple adverse effects on human health, high temperatures are also associated with adverse health outcomes, and the frequency of cardiovascular events (CVEs) varies with season. We investigated a hypothesized increase in PM-related accident and emergency (A&E) presentations for CVE with high temperature, warm season, days of high influenza incidence, and in people with a cancer diagnosis, using a time-stratified case-crossover study design. Outcomes were associations of A&E presentation for CVE with atmospheric PM ≤ 10 µm (PM10), season, and air temperature. PM10 levels in the municipality of residence (exposure variable) were estimated by modeling data from local monitoring stations. Conditional logistic regression models estimated odds ratios (OR) with 95% confidence intervals (CI) for presentations in relation to supposed influencers, adjusting for confounders. Study participants were all who presented at the A&E of a large hospital near Milan, Italy, for a CVE (ICD-9: 390–459) from 1st January 2014 to 31st December 2015. There were 1349 A&E presentations for CVE in 2014–2015 and 5390 control days. Risk of A&E presentation was significantly increased on hot days with OR 1.34 (95%CI 1.05–1.71) per 10 µg/m3 PM10 increment (as mean PM10 on day of presentation, and 1 and 2 days before (lags 0–2)), and (for lag 0) in autumn (OR 1.23, 95%CI 1.09–1.37) and winter (OR 1.18, 95%CI 1.01–1.38). Risks were also significantly increased when PM10 was on lag 1, in people with a cancer diagnosis in the spring and summer months (1.88, 95%CI 1.05–3.37), and on days (lags 0–2) of high influenza incidence (OR 2.34, 95%CI 1.01–5.43). PM10 levels exceeded the 50 µg/m3 “safe” threshold recommended by the WHO and Italian legislation for only 3.8% of days during the warm periods of 2014–2015. Greater risk of A&E presentation for CVE in periods of high PM10 and high temperature suggests that “safe” thresholds for PM10 should be temperature-dependent and that the adverse effects of PM10 will increase as temperatures increase due to climate change.

AB - Atmospheric particulate matter (PM) has multiple adverse effects on human health, high temperatures are also associated with adverse health outcomes, and the frequency of cardiovascular events (CVEs) varies with season. We investigated a hypothesized increase in PM-related accident and emergency (A&E) presentations for CVE with high temperature, warm season, days of high influenza incidence, and in people with a cancer diagnosis, using a time-stratified case-crossover study design. Outcomes were associations of A&E presentation for CVE with atmospheric PM ≤ 10 µm (PM10), season, and air temperature. PM10 levels in the municipality of residence (exposure variable) were estimated by modeling data from local monitoring stations. Conditional logistic regression models estimated odds ratios (OR) with 95% confidence intervals (CI) for presentations in relation to supposed influencers, adjusting for confounders. Study participants were all who presented at the A&E of a large hospital near Milan, Italy, for a CVE (ICD-9: 390–459) from 1st January 2014 to 31st December 2015. There were 1349 A&E presentations for CVE in 2014–2015 and 5390 control days. Risk of A&E presentation was significantly increased on hot days with OR 1.34 (95%CI 1.05–1.71) per 10 µg/m3 PM10 increment (as mean PM10 on day of presentation, and 1 and 2 days before (lags 0–2)), and (for lag 0) in autumn (OR 1.23, 95%CI 1.09–1.37) and winter (OR 1.18, 95%CI 1.01–1.38). Risks were also significantly increased when PM10 was on lag 1, in people with a cancer diagnosis in the spring and summer months (1.88, 95%CI 1.05–3.37), and on days (lags 0–2) of high influenza incidence (OR 2.34, 95%CI 1.01–5.43). PM10 levels exceeded the 50 µg/m3 “safe” threshold recommended by the WHO and Italian legislation for only 3.8% of days during the warm periods of 2014–2015. Greater risk of A&E presentation for CVE in periods of high PM10 and high temperature suggests that “safe” thresholds for PM10 should be temperature-dependent and that the adverse effects of PM10 will increase as temperatures increase due to climate change.

KW - Accident and emergency

KW - Atmospheric temperature

KW - Cancer

KW - Cardiovascular disease

KW - Case-crossover study

KW - Climate change

KW - Particulate matter

KW - Pollution

KW - Season

UR - http://www.scopus.com/inward/record.url?scp=85075321231&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85075321231&partnerID=8YFLogxK

U2 - 10.3390/ijerph16234627

DO - 10.3390/ijerph16234627

M3 - Article

C2 - 31766396

AN - SCOPUS:85075321231

VL - 16

JO - International Journal of Environmental Research and Public Health

JF - International Journal of Environmental Research and Public Health

SN - 1661-7827

IS - 23

M1 - 4627

ER -