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Association of ozone and particulate air pollution with out-of-hospital cardiac arrest in Helsinki, Finland: Evidence for two different etiologies

Journal of Exposure Science & Environmental Epidemiology volume 23, pages 281–288 (2013)Cite this article

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Abstract

Out-of-hospital cardiac arrest (OHCA) has been previously associated with exposure to particulate air pollution. However, there is uncertainty about the agents and mechanisms that are involved. We aimed to determine the association of gases and particulates with OHCA, and differences in pollutant effects on OHCAs due to acute myocardial infarction (AMI) vs those due to other causes. Helsinki Emergency Medical Services provided data on OHCAs of cardiac origin (OHCA_Cardiac). Hospital and autopsy reports determined whether OHCAs were due to AMI (OHCA_MI) or other cardiac causes (OHCA_Other). Pollutant data was obtained from central ambient monitors. A case-crossover analysis determined odds ratios (ORs) for hourly lagged exposures (Lag 0–3) and daily lagged exposures (Lag 0d–3d), expressed per interquartile range of pollutant level. For OHCA_Cardiac, elevated ORs were found for PM2.5 (Lag 0, 1.07; 95% confidence interval (CI): 1.01–1.13) and ozone (O3) (Lag 2d, 1.18; CI: 1.03–1.35). For OHCA_MI, elevated ORs were found for PM2.5 (Lag 0, 1.14; CI: 1.03–1.27; Lag 0d, 1.17; CI: 1.03–1.33), accumulation mode particulate (Acc) (Lag 0d, 1.19; CI: 1.04–1.35), NO (Lag 0d, 1.07; CI: 1.01–1.13), and ultrafine particulate (Lag 0d, 1.27; CI: 1.05–1.54). For OHCA_Other, elevated ORs were found only for O3 (Lag 1d, 1.26; CI: 1.07–1.48; Lag 2d, 1.30; CI: 1.11–1.53). Results from two-pollutant models, with one of the pollutants either PM2.5 or O3, suggested that associations were primarily due to effects of PM2.5 and O3, rather than other pollutants. The results suggest that air pollution triggers OHCA via two distinct modes: one associated with particulates leading to AMI and one associated with O3 involving etiologies other than AMI, for example, arrhythmias or respiratory insufficiency.

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Acknowledgements

Taneli Väyrynen of the Helsinki EMS assisted in determining causes of cardiac arrest from OHCA records, and provided helpful discussions on the interpretation of these data. Air pollution data was provided by the Helsinki Metropolitan Area Council (YTV) and the University of Helsinki Department of Physics, Finland. Tarja Koskentalo provided advice on the use of YTV data. Maria Laari provided information on the procedures used to detect myocardial infarction in autopsies of cardiac arrest victims in Helsinki. Tarja Yli-Tuomi provided helpful discussions on the background of previous air pollution studies in Helsinki. Marja-Leena Hannila provided advice on statistical analysis. Bella Siangonya and Kosuke Tamura assisted with data analysis. This work was financially supported by the Laerdal Foundation for Acute Medicine, Norway. This research was initiated while Dr Rosenthal was supported by a Fulbright-Saastamoinen Foundation Grant in Environmental Health at the University of Kuopio, Finland.

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Authors and Affiliations

  1. School of Health Sciences, Purdue University, West Lafayette, Indiana, USA

    Frank S Rosenthal

  2. Helsinki Emergency Medical Services, Helsinki University Hospital, Helsinki, Finland

    Markku Kuisma & James Boyd

  3. National Institute of Health and Welfare, Kuopio, Finland

    Timo Lanki, Jaana I Halonen & Juha Pekkanen

  4. Department of Physics, University of Helsinki, Helsinki, Finland

    Tareq Hussein

  5. Department of Physics, University of Jordan, Amman, Jordan

    Tareq Hussein

  6. Finnish Institute of Occupational Health, Kuopio, Finland

    Jaana I Halonen

  7. School of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland

    Juha Pekkanen

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Correspondence to Frank S Rosenthal.

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Rosenthal, F., Kuisma, M., Lanki, T. et al. Association of ozone and particulate air pollution with out-of-hospital cardiac arrest in Helsinki, Finland: Evidence for two different etiologies. J Expo Sci Environ Epidemiol 23, 281–288 (2013). https://doi.org/10.1038/jes.2012.121

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