American Journal of Epidemiology Advance Access originally published online on June 22, 2006
American Journal of Epidemiology 2006 164(5):421-433; doi:10.1093/aje/kwj206
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Original Contribution |
A Case-Crossover Study of Fine Particulate Matter Air Pollution and Onset of Congestive Heart Failure Symptom Exacerbation Leading to Hospitalization
1 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
2 Johns Hopkins Bayview Medical Center, Baltimore, MD
3 Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
4 Department of Chemistry and Biochemistry, College of Chemical and Life Sciences, University of Maryland, College Park, MD
5 Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
Correspondence to Dr. Alison Geyh, Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6654, Baltimore, MD 21205 (e-mail: ageyh{at}jhsph.edu).
Persons with congestive heart failure may be susceptible to ambient air pollution. The authors evaluated the association between exposure to particulate matter with an aerodynamic diameter of <2.5 µm (PM2.5) and onset of symptom exacerbation leading to hospital admission in Baltimore, Maryland. They used a case-crossover design for 135 case events occurring among 125 persons with prevalent congestive heart failure who were admitted to a single hospital through the emergency department during 2002. The case period was assigned using three index times: 8-hour and 24-hour periods of symptom onset and date of hospital admission. Controlling for weather, the authors detected a modest relative increase in risk for cases defined by 8-hour symptom onset for an interquartile-range increase in PM2.5 at a 2-day lag (odds ratio = 1.09, 95% confidence interval: 0.91, 1.30). A corresponding increase in risk was not observed when admission date was used to define the case period. A series of simulations based on study data indicated that the study had adequate statistical power to detect odds ratios of 1.2 or higher. Although overall findings were not statistically significant, the identification of case events defined by an 8-hour onset period may be more relevant than either a 24-hour onset period or the admission date for estimating harmful effects of air pollutant exposure on cardiovascular health.
air pollutants; disease susceptibility; dyspnea; environmental exposure; heart failure, congestive; hospitalization
Abbreviations: BMCA, Bayview Medical Center admission date; CHF, congestive heart failure; CI, confidence interval; PM2.5, particulate matter with an aerodynamic diameter of <2.5 µm; PM10, particulate matter with an aerodynamic diameter of <10 µm; TOS, time of onset for symptom exacerbation
Editor's note: An invited commentary on this article appears on page 434.
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