Association between air temperature, air pollution and hospital admissions for pulmonary embolism and venous thrombosis in Italy

• Published in: European journal of internal medicine 2022-02, Vol.96, p.74-80
• Main Authors: Di Blasi, Chiara, Renzi, Matteo, Michelozzi, Paola, de’ Donato, Francesca, Scortichini, Matteo, Davoli, Marina, Forastiere, Francesco, Mannucci, Pier Mannuccio, Stafoggia, Massimo
• Format: Article
• Language: English
• Subjects: Air Pollutants - adverse effects; Air Pollutants - analysis; Air Pollution - adverse effects; Air Pollution - analysis; Air temperature; Epidemiology; Hospitalization; Hospitals; Humans; Italy - epidemiology; Particulate matter; Particulate Matter - adverse effects; Particulate Matter - analysis; Pulmonary embolism; Pulmonary Embolism - epidemiology; Pulmonary Embolism - etiology; Temperature; Venous thromboembolism; Venous thrombosis; Venous Thrombosis - epidemiology
• ISSN: 0953-6205; 1879-0828
• DOI: 10.1016/j.ejim.2021.09.019

•An association between environmental stressors and venous thromboembolism is not firmly established.•We analyzed hospital discharge data for the entire Italy during 2006–2015.•An adverse effect of low temperatures in winter/autumn on pulmonary embolism was found.•There was also a negative impact of high temperatures in summer on pulmonary embolism.•No short-term effect of air pollution on these outcomes was observed. Previous studies reported a link between short-term exposure to environmental stressors (air pollution and air temperature) and atherothrombotic cardiovascular diseases. However, only few of them reported consistent associations with venous thromboembolism (VTE). Our aim was to estimate the association between daily air temperature and particulate matter (PM) air pollution with hospital admissions for pulmonary embolism (PE) and venous thrombosis (VT) at national level in Italy. We collected daily hospital PE and VT admissions from the Italian Ministry of Health during 2006–2015 in all the 8,084 municipalities of Italy, and we merged them with air temperature and daily PM10 concentrations estimated by satellite-based spatiotemporal models. First, we applied multivariate Poisson regression models at province level. Then, we obtained national overall effects by random-effects meta-analysis. This analysis was conducted on 219,952 PE and 275,506 VT hospitalizations. Meta-analytical results showed weak associations between the two exposures and the study outcomes in the full year analysis. During autumn and winter, PE hospital admissions increased by 1.07% (95% confidence intervals [CI]: 0.21%; 1.92%) and 0.96% (95% CI: 0.07%; 1.83%) respectively, per 1 °C decrement of air temperature in the previous 10 days (lag 0–10). In summer we observed adverse effects at high temperatures, with a 1% (95% CI: 0.10%; 1.91%) increasing risk per 1 °C increment. We found no association between VT and cold temperatures. Results show a significant effect of air temperature on PE hospitalizations in the cold seasons and summer. No effect of particulate matter was detected.