Out-of-hospital cardiac arrests in a large metropolitan area: synergistic effect of exposure to air particulates and high temperature

Eleonora Tobaldini, Simona Iodice, Rodolfo Bonora, Matteo Bonzini, Annamaria Brambilla, Giovanni Sesana, Valentina Bollati, Nicola Montano

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1 Citation (Scopus)

Abstract

Aims: Air pollution and climate change are intrinsically linked to emerging hazards for global health. High air particulate matter (PM) levels may trigger out-of-hospital cardiac arrest (OHCA). High temperature could act synergistically with PM in determining OHCA. The aim of the present study was to investigate the effect of PM exposure alone, and in combination with temperature, on the risk of OHCA, in a large European metropolitan area with population >4 million. Methods: We evaluated the association between short-term PM exposure, temperature, and the risk of OHCA over a two-year study period, allowing us to investigate 5761 events using a time-stratified case-crossover design combined with a distributed lag non-linear model. Results: Higher risk of OHCA was associated with short-term exposure to PM10. The strongest association was experienced three days before the cardiac event where the estimated change in risk was 1.70% (0.48–2.93%) per 10 µg/m3 of PM. The cumulative exposure risk over the lags 0–6 was 8.5% (0.0–17.9%). We observed a joint effect of PM and temperature in triggering cardiac arrests, with a maximum effect of 14.9% (10.0–20.0%) increase, for high levels of PM before the cardiac event, in the presence of high temperature. Conclusion: The present study helps to clarify the controversial role of PM as OHCA determinant. It also highlights the role of increased temperature as a key factor in triggering cardiac events. This evidence suggests that tackling both air pollution and climate change might have a relevant impact in terms of public health.

Original languageEnglish
JournalEuropean Journal of Preventive Cardiology
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Out-of-Hospital Cardiac Arrest
Particulate Matter
Air
Temperature
Climate Change
Air Pollution
Nonlinear Dynamics
Heart Arrest
Cross-Over Studies
Public Health

Keywords

  • air pollution
  • climate change
  • Out-of-hospital cardiac arrests
  • particulate matter
  • public health
  • temperature

ASJC Scopus subject areas

  • Epidemiology
  • Cardiology and Cardiovascular Medicine

Cite this

@article{2a9c2800e3c94a4596c1636906be94ff,
title = "Out-of-hospital cardiac arrests in a large metropolitan area: synergistic effect of exposure to air particulates and high temperature",
abstract = "Aims: Air pollution and climate change are intrinsically linked to emerging hazards for global health. High air particulate matter (PM) levels may trigger out-of-hospital cardiac arrest (OHCA). High temperature could act synergistically with PM in determining OHCA. The aim of the present study was to investigate the effect of PM exposure alone, and in combination with temperature, on the risk of OHCA, in a large European metropolitan area with population >4 million. Methods: We evaluated the association between short-term PM exposure, temperature, and the risk of OHCA over a two-year study period, allowing us to investigate 5761 events using a time-stratified case-crossover design combined with a distributed lag non-linear model. Results: Higher risk of OHCA was associated with short-term exposure to PM10. The strongest association was experienced three days before the cardiac event where the estimated change in risk was 1.70{\%} (0.48–2.93{\%}) per 10 µg/m3 of PM. The cumulative exposure risk over the lags 0–6 was 8.5{\%} (0.0–17.9{\%}). We observed a joint effect of PM and temperature in triggering cardiac arrests, with a maximum effect of 14.9{\%} (10.0–20.0{\%}) increase, for high levels of PM before the cardiac event, in the presence of high temperature. Conclusion: The present study helps to clarify the controversial role of PM as OHCA determinant. It also highlights the role of increased temperature as a key factor in triggering cardiac events. This evidence suggests that tackling both air pollution and climate change might have a relevant impact in terms of public health.",
keywords = "air pollution, climate change, Out-of-hospital cardiac arrests, particulate matter, public health, temperature",
author = "Eleonora Tobaldini and Simona Iodice and Rodolfo Bonora and Matteo Bonzini and Annamaria Brambilla and Giovanni Sesana and Valentina Bollati and Nicola Montano",
year = "2019",
month = "1",
day = "1",
doi = "10.1177/2047487319862063",
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T1 - Out-of-hospital cardiac arrests in a large metropolitan area

T2 - synergistic effect of exposure to air particulates and high temperature

AU - Tobaldini, Eleonora

AU - Iodice, Simona

AU - Bonora, Rodolfo

AU - Bonzini, Matteo

AU - Brambilla, Annamaria

AU - Sesana, Giovanni

AU - Bollati, Valentina

AU - Montano, Nicola

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aims: Air pollution and climate change are intrinsically linked to emerging hazards for global health. High air particulate matter (PM) levels may trigger out-of-hospital cardiac arrest (OHCA). High temperature could act synergistically with PM in determining OHCA. The aim of the present study was to investigate the effect of PM exposure alone, and in combination with temperature, on the risk of OHCA, in a large European metropolitan area with population >4 million. Methods: We evaluated the association between short-term PM exposure, temperature, and the risk of OHCA over a two-year study period, allowing us to investigate 5761 events using a time-stratified case-crossover design combined with a distributed lag non-linear model. Results: Higher risk of OHCA was associated with short-term exposure to PM10. The strongest association was experienced three days before the cardiac event where the estimated change in risk was 1.70% (0.48–2.93%) per 10 µg/m3 of PM. The cumulative exposure risk over the lags 0–6 was 8.5% (0.0–17.9%). We observed a joint effect of PM and temperature in triggering cardiac arrests, with a maximum effect of 14.9% (10.0–20.0%) increase, for high levels of PM before the cardiac event, in the presence of high temperature. Conclusion: The present study helps to clarify the controversial role of PM as OHCA determinant. It also highlights the role of increased temperature as a key factor in triggering cardiac events. This evidence suggests that tackling both air pollution and climate change might have a relevant impact in terms of public health.

AB - Aims: Air pollution and climate change are intrinsically linked to emerging hazards for global health. High air particulate matter (PM) levels may trigger out-of-hospital cardiac arrest (OHCA). High temperature could act synergistically with PM in determining OHCA. The aim of the present study was to investigate the effect of PM exposure alone, and in combination with temperature, on the risk of OHCA, in a large European metropolitan area with population >4 million. Methods: We evaluated the association between short-term PM exposure, temperature, and the risk of OHCA over a two-year study period, allowing us to investigate 5761 events using a time-stratified case-crossover design combined with a distributed lag non-linear model. Results: Higher risk of OHCA was associated with short-term exposure to PM10. The strongest association was experienced three days before the cardiac event where the estimated change in risk was 1.70% (0.48–2.93%) per 10 µg/m3 of PM. The cumulative exposure risk over the lags 0–6 was 8.5% (0.0–17.9%). We observed a joint effect of PM and temperature in triggering cardiac arrests, with a maximum effect of 14.9% (10.0–20.0%) increase, for high levels of PM before the cardiac event, in the presence of high temperature. Conclusion: The present study helps to clarify the controversial role of PM as OHCA determinant. It also highlights the role of increased temperature as a key factor in triggering cardiac events. This evidence suggests that tackling both air pollution and climate change might have a relevant impact in terms of public health.

KW - air pollution

KW - climate change

KW - Out-of-hospital cardiac arrests

KW - particulate matter

KW - public health

KW - temperature

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