Short-term exposure to ambient air pollution and atrial fibrillation hospitalization: A time-series study in Yancheng, China

Yan Fang; Hongyi Cheng; Xu Li; Yifan Xu; Hang Xu; Zhichao Chen; Weixin Cai; Cong Liu; Jingyan Cao

doi:10.1016/j.ecoenv.2021.112961

Short-term exposure to ambient air pollution and atrial fibrillation hospitalization: A time-series study in Yancheng, China

Ecotoxicol Environ Saf. 2021 Nov 10:228:112961. doi: 10.1016/j.ecoenv.2021.112961. Online ahead of print.

Authors

Yan Fang¹, Hongyi Cheng², Xu Li³, Yifan Xu⁴, Hang Xu⁵, Zhichao Chen¹, Weixin Cai⁶, Cong Liu⁷, Jingyan Cao⁸

Affiliations

¹ Department of Cardiology, the Yancheng Clinical College of Xuzhou Medical University, Yancheng 224006, China; Department of Cardiology, the First People's Hospital of Yancheng, Yancheng 224006, China.
² Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
³ Department of Cardiology, the Yancheng School of Clinical Medicine of Nanjing Medical University and Yancheng Third People 's Hospital, Yancheng 224006, China.
⁴ Department of Radiology, the Fourth Affiliated Hospital of Nantong University, Yancheng 224006, China; Department of Radiology, the First People's Hospital of Yancheng, Yancheng 224006, China.
⁵ Department of Neurology, the Yancheng Clinical College of Xuzhou Medical University, Yancheng 224006, China; Department of Neurology, the First People's Hospital of Yancheng, Yancheng 224006, China.
⁶ Department of Hematology, the Yancheng Clinical College of Xuzhou Medical University, Yancheng 224006, China; Department of Hematology, the First People's Hospital of Yancheng, Yancheng 224006, China.
⁷ School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China. Electronic address: [email protected].
⁸ Department of Cardiology, the Yancheng Clinical College of Xuzhou Medical University, Yancheng 224006, China; Department of Cardiology, the First People's Hospital of Yancheng, Yancheng 224006, China. Electronic address: [email protected].

PMID: 34773847
DOI: 10.1016/j.ecoenv.2021.112961

Abstract

Atrial fibrillation (AF) is an important cardiovascular disease that causes a great burden of disease. However, there is limited evidence of a link between air pollution exposure and AF. This study aimed to explore the short-term association between air pollution and AF. We obtained daily hospitalization of AF in two major hospitals of Yancheng, China from May, 2015 to May, 2020. Generalized additive models with quasi-Poisson regression were used to assess the associations between six criteria air pollutants and AF hospitalization. We explored the lag patterns, and visualized the concentration-response relationships. The robustness of the association was tested by two-pollutant model, and we explored potential effect modification by age, sex and season. A total of 15,171 inpatients from two hospitals were collected in this study with an average daily count of eight patients. We observed consistent and significant associations between six air pollutants and AF on lag 0-4 days. A 10 ug/m³ increase in PM_2.5 was associated with 2.81% (95%CI: 1.44%, 4.20%) changes in AF, and the effect estimate was 1.67% (95%CI: 0.77%, 2.59%) for PM₁₀, 4.90% (95%CI: 1.69%, 8.22%) for NO₂, 6.81% (95%CI: 0.46%, 13.57%) for SO₂, 1.82% (95%CI: 0.60%, 3.06%) for O₃; a 0.1 mg/m³ increase in CO was associated with 2.55% (95%CI: 0.91%, 4.21%) increments in AF. Associations of PM_2.5 and PM₁₀ were robust after adjusting for SO₂, NO₂, CO, and O₃, but not vice versa. Female patients and those aged less 70 years had larger risk of AF associated with air pollution exposure. The concentration-response curves of the six pollutants were almost linear and increasing with no obvious thresholds. This time-series study in Yancheng demonstrated increased risk of AF and a delayed effect over lag 0-4 days. Our findings suggested need of prevention and protection against these environmental risk factors for AF in health departments.

Keywords: Air pollution; Atrial fibrillation; Criteria air pollutants; Time-series study.