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Cardiac arrhythmia emergency room visits and environmental air pollution in São Paulo, Brazil

¹ Pulmonary Division of Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
² Environmental Epidemiology Study Group, Laboratory of Experimental Air Pollution, University of São Paulo Medical School, São Paulo, Brazil
³ Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
⁴ Collective Health Postgraduation Program, Catholic University of Santos, Brazil
⁵ Environmental Pediatrics Program, University of Santo Amaro Medical School, São Paulo, Brazil

Correspondence to:
Alfésio Luís Ferreira Braga, Rua Francisco Octávio Pacca, 180, 4° Andar, Grajaú, São Paulo, CEP 04822-320, Brazil; abraga{at}unisa.br

Objectives: Air-pollution exposure has been associated with increased cardiovascular hospital admissions and mortality in time-series studies. We evaluated the relation between air pollutants and emergency room (ER) visits because of cardiac arrhythmia in a cardiology hospital.

Methods: In a time-series study, we evaluated the association between the emergency room visits as a result of cardiac arrhythmia and daily variations in SO₂, CO, NO₂, O₃ and PM₁₀, from January 1998 to August 1999. The cases of arrhythmia were modelled using generalised linear Poisson regression models, controlling for seasonality (short-term and long-term trend), and weather.

Results: Interquartile range increases in CO (1.5 ppm), NO₂ (49,5 µg/m³) and PM₁₀ (22.2 µg/m³) on the concurrent day were associated with increases of 12.3% (95% CI: 7.6% to 17.2%), 10.4% (95% CI: 5.2% to 15.9%) and 6.7% (95% CI: 1.2% to 12.4%) in arrhythmia ER visits, respectively. PM₁₀, CO and NO₂ effects were dose-dependent and gaseous pollutants had thresholds. Only CO effect resisted estimates in models with more than one pollutant.

Conclusions: Our results showed that air pollutant effects on arrhythmia are predominantly acute starting at concentrations below air quality standards, and the association with CO and NO₂ suggests a relevant role for pollution caused by cars.