Triggering of cardiovascular hospital admissions by fine particle concentrations in New York state: Before, during, and after implementation of multiple environmental policies and a recession

• Published in: Environmental pollution (1987) 2018-11, Vol.242 (Pt B), p.1404-1416
• Main Authors: Zhang, Wangjian, Lin, Shao, Hopke, Philip K., Thurston, Sally W., van Wijngaarden, Edwin, Croft, Daniel, Squizzato, Stefania, Masiol, Mauro, Rich, David Q.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Air Pollutants - adverse effects; Air Pollutants - analysis; Air Pollution - analysis; Cardiovascular Diseases - epidemiology; Cardiovascular events; Cities - epidemiology; Cross-Over Studies; Economic Recession; Environmental Policy; Excess rate; Female; Hospitalization - statistics & numerical data; Humans; Increases; Logistic Models; Male; Middle Aged; New York - epidemiology; Particulate Matter - adverse effects; Particulate Matter - analysis; PM2.5; Policy; Young Adult
• ISSN: 0269-7491; 1873-6424
• DOI: 10.1016/j.envpol.2018.08.030

Previous studies reported triggering of acute cardiovascular events by short-term increasedPM2.5 concentrations. From 2007 to 2013, national and New York state air quality policies and economic influences resulted in reduced concentrations of PM2.5 and other pollutants across the state. We estimated the rate of cardiovascular hospital admissions associated with increased PM2.5 concentrations in the previous 1–7 days, and evaluated whether they differed before (2005–2007), during (2008–2013), and after these concentration changes (2014–2016). Using the Statewide Planning and Research Cooperative System (SPARCS) database, we retained all hospital admissions with a primary diagnosis of nine cardiovascular disease (CVD) subtypes, for residents living within 15 miles of PM2.5 monitoring sites in Buffalo, Rochester, Albany, Queens, Bronx, and Manhattan from 2005 to 2016 (N = 1,922,918). We used a case-crossover design and conditional logistic regression to estimate the admission rate for total CVD, and nine specific subtypes, associated with increased PM2.5 concentrations. Interquartile range (IQR) increases in PM2.5 on the same and previous 6 days were associated with 0.6%–1.2% increases in CVD admission rate (2005–2016). There were similar patterns for cardiac arrhythmia, ischemic stroke, congestive heart failure, ischemic heart disease (IHD), and myocardial infarction (MI). Ambient PM2.5 concentrations and annual total CVD admission rates decreased across the period. However, the excess rate of IHD admissions associated with each IQR increase in PM2.5 in previous 2 days was larger in the after period (2.8%; 95%CI = 1.5%–4.0%) than in the during (0.6%; 95%CI = 0.0%–1.2%) or before periods (0.8%; 95%CI = 0.2%–1.3%), with similar patterns for total CVD and MI, but not other subtypes. While pollutant concentrations and CVD admission rates decreased after emission changes, the same PM2.5 mass was associated with a higher rate of ischemic heart disease events. Future work should confirm these findings in another population, and investigate whether specific PM components and/or sources trigger IHD events. [Display omitted] •Rate of cardiovascular (CVD) admissions was associated with increased PM2.5•Both pollutant levels and CVD admission rates decreased after emissions changes.•Rate of ischemic heart disease related to PM2.5 increased after policies/recession.•Similar patterns were observed for total CVD and myocardial infarction.•PM2.5 composition changes may expla