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Air Pollution and Acute Myocardial Infarction Hospital Admission in Alberta, Canada: A Three-Step Procedure Case-Crossover Study

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  • Xiaoming Wang
  • Warren Kindzierski
  • Padma Kaul

Abstract

Adverse associations between air pollution and myocardial infarction (MI) are widely reported in medical literature. However, inconsistency and sensitivity of the findings are still big concerns. An exploratory investigation was undertaken to examine associations between air pollutants and risk of acute MI (AMI) hospitalization in Alberta, Canada. A time stratified case-crossover design was used to assess the transient effect of five air pollutants (carbon monoxide (CO), nitrogen dioxide (NO2), nitric oxide (NO), ozone (O3) and particulate matter with an aerodynamic diameter ≤2.5 (PM2.5)) on the risk of AMI hospitalization over the period 1999–2009. Subgroups were predefined to see if any susceptible group of individuals existed. A three-step procedure, including univariate analysis, multivariate analysis, and bootstrap model averaging, was used. The multivariate analysis was used in an effort to address adjustment uncertainty; whereas the bootstrap technique was used as a way to account for regression model uncertainty. There were 25,894 AMI hospital admissions during the 11-year period. Estimating health effects that are properly adjusted for all possible confounding factors and accounting for model uncertainty are important for making interpretations of air pollution–health effect associations. The most robust findings included: (1) only 1-day lag NO2 concentrations (6-, 12- or 24-hour average), but not those of CO, NO, O3 or PM2.5, were associated with an elevated risk of AMI hospitalization; (2) evidence was suggested for an effect of elevated risk of hospitalization for NSTEMI (Non-ST Segment Elevation Myocardial Infarction), but not for STEMI (ST segment elevation myocardial infarction); and (3) susceptible subgroups included elders (age ≥65) and elders with hypertension. As this was only an exploratory study there is a need to replicate these findings with other methodologies and datasets.

Suggested Citation

  • Xiaoming Wang & Warren Kindzierski & Padma Kaul, 2015. "Air Pollution and Acute Myocardial Infarction Hospital Admission in Alberta, Canada: A Three-Step Procedure Case-Crossover Study," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-15, July.
    • Handle: RePEc:plo:pone00:0132769
    DOI: 10.1371/journal.pone.0132769
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    References listed on IDEAS

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    1. Francesca Dominici & Aidan M.C. Dermott & Trevor J. Hastie, 2004. "Improved Semiparametric Time Series Models of Air Pollution and Mortality," Journal of the American Statistical Association, American Statistical Association, vol. 99, pages 938-948, December.
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    1. Xiaoming Wang & Sukun Wang & Warren Kindzierski, 2021. "Control of Weekly Time Trend in Time-Stratified Case-Crossover Design," International Journal of Statistics and Probability, Canadian Center of Science and Education, vol. 10(5), pages 1-85, September.
    2. Xiaoxiao Liu & Stefania Bertazzon, 2017. "Exploratory Temporal and Spatial Analysis of Myocardial Infarction Hospitalizations in Calgary, Canada," IJERPH, MDPI, vol. 14(12), pages 1-20, December.
    3. Xu Meng & Ying Zhang & Kun-Qi Yang & Yan-Kun Yang & Xian-Liang Zhou, 2016. "Potential Harmful Effects of PM 2.5 on Occurrence and Progression of Acute Coronary Syndrome: Epidemiology, Mechanisms, and Prevention Measures," IJERPH, MDPI, vol. 13(8), pages 1-16, July.
    4. McKenzie H. Tilstra & Ishwar Tiwari & Leigh Niwa & Sandra Campbell & Charlene C. Nielsen & C. Allyson Jones & Alvaro Osornio Vargas & Okan Bulut & Bernadette Quemerais & Jordana Salma & Kyle Whitfield, 2021. "Risk and Resilience: How Is the Health of Older Adults and Immigrant People Living in Canada Impacted by Climate- and Air Pollution-Related Exposures?," IJERPH, MDPI, vol. 18(20), pages 1-22, October.

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