Out-of-hospital cardiac arrest and airborne fine particulate matter: A case-crossover analysis of emergency medical services data in Indianapolis, Indiana

Frank S. Rosenthal, John P. Carney, Michael Olinger

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background: Previous studies have found particulate matter (PM) < 2.5 μm in aerodynamic diameter (PM2.5) associated with heart disease mortality. Although rapid effects of PM2.5 exposure on the cardiovascular system have been proposed, few studies have investigated the effect of short-term exposures on out-of-hospital cardiac arrest (OHCA). Objective: We aimed to determine whether short-term PM2.5 exposures increased the risk of OHCA and whether risk depended on subject characteristics or presenting heart rhythm. Methods: A case-crossover analysis determined hazard ratios (HRs) for OHCAs logged by emergency medical systems (EMS) versus hourly and daily PM2.5 exposures at the time of the OHCA and for daily and hourly periods before it. Results: For all OHCAs (n = 1,374), exposures on the day of the arrest or 1-3 days before arrest had no significant effect on the incidence of OHCA. For cardiac arrests witnessed by bystanders (n = 511), 10-μm/m3 risk significantly increased with PM2.5 exposure, during the hour of the arrest (HR for a 10-μm/m3 increase in PM2.5 exposure = 1.12; 95% confidence interval, 1.01-1.25). For the subsets of subjects who were white, 60-75 years of age, or presented with asystole, OHCA risk significantly increased with PM2.5 during the hour of the arrest (HRs for a 10-μm/m3 increase in PM2.5 = 1. 18, 1.25, or 1.22, respectively-, p < 0.05). HR generally decreased as the time lag between PM2.5 exposure and OHCA increased. Conclusion: The results suggest an acute effect of short-term PM2.5 exposure in precipitating OHCAs, and a need to investigate further the role of subject factors in the effects of PM on the risk of OHCA.

Original languageEnglish
Pages (from-to)631-636
Number of pages6
JournalEnvironmental Health Perspectives
Volume116
Issue number5
DOIs
StatePublished - May 2008

Fingerprint

Out-of-Hospital Cardiac Arrest
Particulate Matter
Emergency Medical Services
particulate matter
Hazards
hazard
Heart Arrest
Cardiovascular system
Cardiovascular System
exposure
hospital
services
analysis
cardiovascular system
cardiovascular disease
Heart Diseases
Aerodynamics
Emergencies
confidence interval
Confidence Intervals

Keywords

  • Air pollution
  • Cardiac arrest
  • Cardiovascular system
  • Case-crossover
  • EMS
  • Environmental health
  • Out-of-hospital
  • Particulate matter

ASJC Scopus subject areas

  • Environmental Science(all)
  • Environmental Chemistry
  • Public Health, Environmental and Occupational Health

Cite this

@article{1855539132db4560bb1467c13ea0b1f3,
title = "Out-of-hospital cardiac arrest and airborne fine particulate matter: A case-crossover analysis of emergency medical services data in Indianapolis, Indiana",
abstract = "Background: Previous studies have found particulate matter (PM) < 2.5 μm in aerodynamic diameter (PM2.5) associated with heart disease mortality. Although rapid effects of PM2.5 exposure on the cardiovascular system have been proposed, few studies have investigated the effect of short-term exposures on out-of-hospital cardiac arrest (OHCA). Objective: We aimed to determine whether short-term PM2.5 exposures increased the risk of OHCA and whether risk depended on subject characteristics or presenting heart rhythm. Methods: A case-crossover analysis determined hazard ratios (HRs) for OHCAs logged by emergency medical systems (EMS) versus hourly and daily PM2.5 exposures at the time of the OHCA and for daily and hourly periods before it. Results: For all OHCAs (n = 1,374), exposures on the day of the arrest or 1-3 days before arrest had no significant effect on the incidence of OHCA. For cardiac arrests witnessed by bystanders (n = 511), 10-μm/m3 risk significantly increased with PM2.5 exposure, during the hour of the arrest (HR for a 10-μm/m3 increase in PM2.5 exposure = 1.12; 95{\%} confidence interval, 1.01-1.25). For the subsets of subjects who were white, 60-75 years of age, or presented with asystole, OHCA risk significantly increased with PM2.5 during the hour of the arrest (HRs for a 10-μm/m3 increase in PM2.5 = 1. 18, 1.25, or 1.22, respectively-, p < 0.05). HR generally decreased as the time lag between PM2.5 exposure and OHCA increased. Conclusion: The results suggest an acute effect of short-term PM2.5 exposure in precipitating OHCAs, and a need to investigate further the role of subject factors in the effects of PM on the risk of OHCA.",
keywords = "Air pollution, Cardiac arrest, Cardiovascular system, Case-crossover, EMS, Environmental health, Out-of-hospital, Particulate matter",
author = "Rosenthal, {Frank S.} and Carney, {John P.} and Michael Olinger",
year = "2008",
month = "5",
doi = "10.1289/ehp.10757",
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volume = "116",
pages = "631--636",
journal = "Environmental Health Perspectives",
issn = "0091-6765",
publisher = "Public Health Services, US Dept of Health and Human Services",
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TY - JOUR

T1 - Out-of-hospital cardiac arrest and airborne fine particulate matter

T2 - A case-crossover analysis of emergency medical services data in Indianapolis, Indiana

AU - Rosenthal, Frank S.

AU - Carney, John P.

AU - Olinger, Michael

PY - 2008/5

Y1 - 2008/5

N2 - Background: Previous studies have found particulate matter (PM) < 2.5 μm in aerodynamic diameter (PM2.5) associated with heart disease mortality. Although rapid effects of PM2.5 exposure on the cardiovascular system have been proposed, few studies have investigated the effect of short-term exposures on out-of-hospital cardiac arrest (OHCA). Objective: We aimed to determine whether short-term PM2.5 exposures increased the risk of OHCA and whether risk depended on subject characteristics or presenting heart rhythm. Methods: A case-crossover analysis determined hazard ratios (HRs) for OHCAs logged by emergency medical systems (EMS) versus hourly and daily PM2.5 exposures at the time of the OHCA and for daily and hourly periods before it. Results: For all OHCAs (n = 1,374), exposures on the day of the arrest or 1-3 days before arrest had no significant effect on the incidence of OHCA. For cardiac arrests witnessed by bystanders (n = 511), 10-μm/m3 risk significantly increased with PM2.5 exposure, during the hour of the arrest (HR for a 10-μm/m3 increase in PM2.5 exposure = 1.12; 95% confidence interval, 1.01-1.25). For the subsets of subjects who were white, 60-75 years of age, or presented with asystole, OHCA risk significantly increased with PM2.5 during the hour of the arrest (HRs for a 10-μm/m3 increase in PM2.5 = 1. 18, 1.25, or 1.22, respectively-, p < 0.05). HR generally decreased as the time lag between PM2.5 exposure and OHCA increased. Conclusion: The results suggest an acute effect of short-term PM2.5 exposure in precipitating OHCAs, and a need to investigate further the role of subject factors in the effects of PM on the risk of OHCA.

AB - Background: Previous studies have found particulate matter (PM) < 2.5 μm in aerodynamic diameter (PM2.5) associated with heart disease mortality. Although rapid effects of PM2.5 exposure on the cardiovascular system have been proposed, few studies have investigated the effect of short-term exposures on out-of-hospital cardiac arrest (OHCA). Objective: We aimed to determine whether short-term PM2.5 exposures increased the risk of OHCA and whether risk depended on subject characteristics or presenting heart rhythm. Methods: A case-crossover analysis determined hazard ratios (HRs) for OHCAs logged by emergency medical systems (EMS) versus hourly and daily PM2.5 exposures at the time of the OHCA and for daily and hourly periods before it. Results: For all OHCAs (n = 1,374), exposures on the day of the arrest or 1-3 days before arrest had no significant effect on the incidence of OHCA. For cardiac arrests witnessed by bystanders (n = 511), 10-μm/m3 risk significantly increased with PM2.5 exposure, during the hour of the arrest (HR for a 10-μm/m3 increase in PM2.5 exposure = 1.12; 95% confidence interval, 1.01-1.25). For the subsets of subjects who were white, 60-75 years of age, or presented with asystole, OHCA risk significantly increased with PM2.5 during the hour of the arrest (HRs for a 10-μm/m3 increase in PM2.5 = 1. 18, 1.25, or 1.22, respectively-, p < 0.05). HR generally decreased as the time lag between PM2.5 exposure and OHCA increased. Conclusion: The results suggest an acute effect of short-term PM2.5 exposure in precipitating OHCAs, and a need to investigate further the role of subject factors in the effects of PM on the risk of OHCA.

KW - Air pollution

KW - Cardiac arrest

KW - Cardiovascular system

KW - Case-crossover

KW - EMS

KW - Environmental health

KW - Out-of-hospital

KW - Particulate matter

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