J Epidemiol Community Health 2001;55:57-65 ( January )

Public health policy and practice

Air pollution and emergency hospital admissions for cardiovascular diseases in Valencia, Spain F Ballester, J M Tenías, S Pérez-Hoyos

Unit of Epidemiology and Statistics, Valencian School of Studies for Health (EVES), Conselleria de Sanitat, Generalitat Valenciana, Spain

Correspondence to: Dr Ballester, Unit of Epidemiology and Statistics, Valencian School of Studies for Health (EVES), C/Joan de Garay 21, 46017 València, Spain (ballester_fer{at}gva.es)

Accepted for publication 19 July 2000

STUDY OBJECTIVETo estimate the short-term association between air pollution levels and emergency hospital admissions for cardiovascular diseases in Valencia, within 1994-1996 period.
DESIGNDaily levels of air pollution and emergency admissions for cardiovascular diseases were related to using an ecological time series design. The number of admissions was obtained from the hospital records database. Selected groups of causes were all cardiovascular diseases, heart admissions, and admissions for cerebrovascular diseases. The number of admissions for digestive diseases was used as control. Pollutants were black smoke, sulphur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO) and ozone (O₃). Magnitude of association was estimated by Poisson autoregresive regression. Estimations were calculated according the hottest (May to October) and the coldest (November to April) periods.
SETTINGCity of Valencia, Spain, about 750 000 inhabitants.
PARTICIPANTSPeople being admitted to the two major hospitals in the city, with a catchment area of nearly 400 000 inhabitants.
MAIN RESULTSFor the whole period, a significant association for SO₂-24 h was found so a rise in its levels of 10 µg/m³ was associated with an increment of 3% (95%CI 0.4 to 5.7%) in the expected number of cardiovascular admissions. A significant association for black smoke, SO₂-24 h, SO₂-1 h, and CO-1 h was found in the hottest semester. All these associations were verified with a lag of two days. The estimates of the associations for particles, SO₂, and CO were affected by the inclusion of the other pollutants in their models. NO₂ was independently associated with cerebrovascular admissions. There were no significant associations between air pollution and admissions for digestive diseases.
CONCLUSIONSCurrent levels of air pollution and emergency cardiovascular admissions are significantly related in Valencia.


Keywords: air pollution; cardiovascular disease; hospital admissions

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© 2001 by Journal of Epidemiology and Community Health
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