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Air pollution and cardiovascular admissions association in Spain: results within the EMECAS project
  1. F Ballester1,
  2. P Rodríguez1,
  3. C Iñíguez1,
  4. M Saez2,
  5. A Daponte3,
  6. I Galán4,
  7. M Taracido5,
  8. F Arribas6,
  9. J Bellido7,
  10. F B Cirarda8,
  11. A Cañada9,
  12. J J Guillén10,
  13. F Guillén-Grima11,
  14. E López12,
  15. S Pérez-Hoyos1,
  16. A Lertxundi2,
  17. S Toro3,
  18. for the EMECAS group
  1. 1Unit of Epidemiology and Statistics, Valencian School of Health Studies (EVES), Spain
  2. 2Grup de Recerca en Estadística, Economia Aplicada i Salut (GRECS), Universitat de Girona. Spain
  3. 3Escuela Andaluza de Salud Pública, Spain
  4. 4DG Salud Pública. Comunidad de Madrid, Spain
  5. 5Universidad de Santiago. Facultad de Medicina, Spain
  6. 6Departamento de Sanidad Aragón, Spain
  7. 7Centro Salud Pública, Castelló, Spain
  8. 8Department of Health, Basque Government, Basque Country
  9. 9Dirección Regional de Salud Pública, Asturias, Spain
  10. 10Centro de Área, Cartagena, Murcia, Spain
  11. 11Universidad Pública de Navarra, Spain
  12. 12DG Salud Pública, Canarias, Spain
  1. Correspondence to:
 Dr F Ballester
 Epidemiology and Statistics Unit, Escola Valenciana d’Estudis en Salut-EVES (Valencian School of Health Studies), c/Joan de Garay 21, 46017 Valencia, Spain; ballester_fer{at}


Objective: To evaluate the short term effect of air pollution on cardiovascular admissions in 14 Spanish cities

Methods: The period under study was from 1995 to 1999. Daily emergency admissions for all cardiovascular diseases (CVD) and heart diseases (HD) were obtained from hospital records, and the corresponding daily levels of particulates, SO2, NO2, CO, and ozone were recorded. The magnitude of association was estimated using Poisson generalised additive models controlling for confounding and overdispersion. For each cause, lagged effects, up to three days, of each pollutant were examined and combined estimates were obtained. For ozone the analyses were restricted to the warm period. One and two pollutant models were performed.

Results: Associations were more consistent in lag 0 (concurrent day) and 1 (lag 0–1), except in the case of ozone where there was a more delayed relation (lag 2–3). For combined estimates an increase of 10 μg/m3 in the PM10 levels in lag 0–1 was associated with an increase of 0.9% (95% CI: 0.4 to 1.5%) in the number of hospital admissions for CVD, and 1.6% (0.8 to 2.3%) for HD. For ozone the corresponding estimates for lag 2–3 were 0.7% (0.3 to 1.0) for CVD, and 0.7% (0.1 to 1.2) for HD. An increase of 1 mg/m3 in CO levels was associated with an increase of 2.1% (0.7 to 3.5%) in CVD admissions, and 4.2% (1.3 to 7.1%) in HD admissions. SO2 and NO2 estimates were more sensitive in two pollutant models

Conclusions: A short term association between increases in daily levels of air pollutants and the number of daily admissions for cardiovascular diseases, with specificity for heart diseases, has been described in Spanish cities.

  • CVD, cardiovascular disease
  • HD, heart disease
  • O3, ozone
  • TSP, total suspended particle
  • BS, black smoke
  • CO, carbon monoxide
  • SO2, sulphur dioxide
  • NO2, nitrogen dioxide
  • air pollution
  • cardiovascular diseases
  • hospital admissions
  • multicentre study

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  • Funding: this study has received funds from the Spanish Ministry of Health (FIS 00/0010).

  • Conflicts of interest: none declared.

  • The EMECAS group consists of F Ballester, S Pérez-Hoyos, C Iñíguez, P Rodríguez, J M Tenías, F Gómez, S Medina, J L Bosch, S Peiró (Valencia); M Saez, M A Barceló, C Saurina, A Lertxundi, L Artacoz, J Sunyer, A Plasència, A Tobías (Barcelona); A Daponte, R Ocaña, S Toro, I Aguilera, J L Gurucelain, P Gutiérrez, J A Maldonado, J M Mayoral, E Caro, P López, (Granada); J M Ordóñez, E Aránguez, I Galán, A M Gandarillas, N Aragonés, M Martínez, R Fernández, P Arias, A Brezmes, F J Mantero (Madrid); K Cambra, E. Alonso, F B Cirarda, T Martínez-Rueda (Bilbao); M Taracido, A Figueiras, M R Aguiar, C Sixto, M C Sánchez (Vigo); I Aguinaga, M Y Floristan, F Guillén, M A Martínez, E Aguinaga, F J Aldaz, P Zuazo, C Moreno, A Arrazola, J J Viñes, I Serrano, M D Ugarte,A Fernández (Pamplona); J B Bellido, A Arnedo, F González, C Felis, C Herrero (Castellón); J J Guillén, L Cirera, L García, E Jiménez, M J Martínez, S Moreno, C Navarro, J Medrano, M A Martínez (Cartagena); A Cañada, C Fernández, F Fernández, J V García, I Huerta, V Rodríguez (Asturias); F Arribas, M Navarro, C Martos, M J Rabanaque, E Muniesa, J T Alcalá, J I Urraca, M Loarte (Zaragoza); E López, M D García (Canarias).

  • Preliminary results of this work have been presented at the Joint Meeting between International Epidemiological Association European Federation and the Spanish Society of Epidemiology, Toledo October 2003; at the II AIRNET Conference, Rome, November 2003; at the XVI Conference of the International Society for Environmental Epidemiology, New York August 2004; and at the V Conference of Urban Air Quality, Valencia, March 2005.

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