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Forastiere, F., Stafoggia, M., Picciotto, S., Bellander, T., D'Ippoliti, D., Lanki, T., von Klot, S., Nyberg, F., Paatero, P., Peters, A., Pekkanen, J., Sunyer, J., Perucci, C. A

A Case-crossover Analysis of Out-of-Hospital Coronary Deaths and Air pollution in Rome, Italy

Am.J.Respir.Crit Care Med., 2005, 172, 12, 1549, 55, IF: 8.689, PMID: 15994461

Rationale. Out-of-hospital coronary heart disease death is a major public health problem but the association with air pollution is not well understood. Objectives. We evaluated the association between daily ambient air pollution levels (Particle Number Concentration (PNC), a proxy for ultrafine particles (diameter <0.1 microm), mass of particles <10 microm (PM10), CO, NO2, and O3) and the occurrence of fatal non-hospitalized coronary events. Methods. Subjects were 5,144 out-of-hospital fatalities (410-414, ICD-9) (years 1998-2000) among Rome residents. Hospitalizations during the three years before death were considered to identify comorbidities (e.g. diabetes, hypertension, heart failure, dysrhythmia, chronic obstructive pulmonary disease). Statistical analyses were performed using a case-crossover design. Measurements and Main Results. The association with out-of-hospital coronary deaths was statistically significant for PNC, PM10 and CO. Air pollution on the day of death had strongest effect, e.g. 7.6 % increase (95% CI 2.0 - 13.6%) for an interquartile range of PNC (27,790 particles/cm(3)). The age groups 65-74 and 75+ years were at higher risk than the 35-64 age group, and there was a suggestion of effect modification for people with hypertension and COPD. Conclusions. Air pollutants originating from combustion processes, including ultrafine particles, are related to fatal non-hospitalized coronary events. The effect is stronger among people above 65 years of age but is not limited to a group with a specific comorbidity


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