Christopher P Groves1, Barbara K Butland2, Richard W Atkinson2, Anthony P Delaney3, David V Pilcher4,5. 1. Department of Intensive Care, Royal North Shore Hospital, Sydney, NSW, Australia. christopher.groves@nhs.net. 2. Population Health Research Institute, St George's, University of London, London, UK. 3. Department of Intensive Care, Royal North Shore Hospital, Sydney, NSW, Australia. 4. Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia. 5. Australia and New Zealand Intensive Care Society (ANZICS), Centre for Outcomes and Resource Evaluation (CORE), Carlton, VIC, Australia.
Abstract
PURPOSE: Short-term exposure to outdoor air pollution has been positively associated with numerous measures of acute morbidity and mortality, most consistently as excess cardiorespiratory disease associated with fine particulate matter (PM2.5), particularly in vulnerable populations. It is unknown if the critically ill, a vulnerable population with high levels of cardiorespiratory disease, is affected by air pollution. METHODS: We performed a time series analysis of emergency cardiorespiratory, stroke and sepsis intensive care (ICU) admissions for the years 2008-2016, using data from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS-APD). Case-crossover analysis was conducted to assess the relationship between air pollution and the frequency and severity of ICU admissions having adjusted for temperature, humidity, public holidays and influenza activity. RESULTS: 46,965 episodes in 87 separate ICUs were analysed. We found no statistically significant associations with admission counts. However, ICU admissions ending in death within 30 days were significantly positively associated with short-term exposure to PM2.5 [RR 1.18, 95% confidence interval (CI) 1.02-1.37, per 10 µg/m3 increase]. This association was more pronounced in those aged 65 and over (RR 1.33, 95% CI 1.11-1.58, per 10 µg/m3). CONCLUSIONS: Increased ICU mortality was associated with higher levels of PM2.5. Larger studies are required to determine if the frequency of ICU admissions is positively associated with short-term exposure to air pollution.
PURPOSE: Short-term exposure to outdoor air pollution has been positively associated with numerous measures of acute morbidity and mortality, most consistently as excess cardiorespiratory disease associated with fine particulate matter (PM2.5), particularly in vulnerable populations. It is unknown if the critically ill, a vulnerable population with high levels of cardiorespiratory disease, is affected by air pollution. METHODS: We performed a time series analysis of emergency cardiorespiratory, stroke and sepsis intensive care (ICU) admissions for the years 2008-2016, using data from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS-APD). Case-crossover analysis was conducted to assess the relationship between air pollution and the frequency and severity of ICU admissions having adjusted for temperature, humidity, public holidays and influenza activity. RESULTS: 46,965 episodes in 87 separate ICUs were analysed. We found no statistically significant associations with admission counts. However, ICU admissions ending in death within 30 days were significantly positively associated with short-term exposure to PM2.5 [RR 1.18, 95% confidence interval (CI) 1.02-1.37, per 10 µg/m3 increase]. This association was more pronounced in those aged 65 and over (RR 1.33, 95% CI 1.11-1.58, per 10 µg/m3). CONCLUSIONS: Increased ICU mortality was associated with higher levels of PM2.5. Larger studies are required to determine if the frequency of ICU admissions is positively associated with short-term exposure to air pollution.
Entities:
Keywords:
Air pollution; Critical care; Intensive care (ICU); Particulate matter (PM2.5)
Authors: Mark Ashworth; Antonis Analitis; David Whitney; Evangelia Samoli; Sofia Zafeiratou; Richard Atkinson; Konstantina Dimakopoulou; Sean Beavers; Joel Schwartz; Klea Katsouyanni Journal: Environ Health Date: 2021-05-07 Impact factor: 5.984