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European Heart Journal 2003 24(8):752-760; doi:10.1016/S0195-668X(02)00808-4
Copyright © 2003 by the European Society of Cardiology.
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The association of daily sulfur dioxide air pollution levels with hospital admissions for cardiovascular diseases in Europe (The Aphea-II study)

Jordi Sunyera,*, Ferran Ballesterb, Alain Le Tertrec, Richard Atkinsond, Jon G Ayrese, Francesco Forastieref, Bertil Forsbergg, Judith M Vonkh, Luigi Bisantii, José M Teníasb, Sylvia Medinac, Joel Schwartzj and Klea Katsouyannik

a Unitat de Recerca Respiratoria i Ambiental, Institut Municipal Investigació Médica (IMIM), c./Dr Aiguader 80, Barcelona 08003, Spain
b Escola Valenciana d'Estudis per a la Salut (EVES), Valencia 46017, Spain
c Environmental health unit, National Institute of Public Health Surveillance, France
d Department of Public Health Sciences, St. George's Hospital Medical School, London SW17 0RE, UK
e Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK
f Department of Epidemiology, Health Authority, Rome, Italy
g Department of Public Health and Clinical Medicine, Umea University, S-901 87, Umea, Sweden
h Department of Epidemiology and Statistics, Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
i Department of Epidemiology; Local Health Authority, Milan, Italy
j Environmental Epidemiology Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
k Department Hygiene-Epidemiolgy, 75 Mikras Asias strasse, 115 27 Athens, Greece

* Corresponding author. Fax: +34-93-2216448
E-mail address: jsunyer{at}imim.es

Received 21 October 2002; accepted 23 October 2002

The objective of this study is to assess the short-term effect of sulfur dioxide (SO2) air pollution levels on hospital admissions for cardiovascular diseases. Daily mean hospital admissions for cardiovascular diseases, ischemic heart diseases (IHDs), and stroke in seven European areas (the cities of Birmingham, London, Milan, Paris, Rome, and Stockholm, and in The Netherlands) participating in the multicenter European study of air pollution (Aphea-II), were measured. Time series analysis of daily hospital admission counts was performed using poison autoregressive models. A summary regression coefficient for all cities was provided. Daily numbers of all cardiovascular admissions except stroke, and particularly IHDs, rose significantly with an increase of daily SO2levels of the same day and day before. After adjusting for PM10(i.e. particles with size <10µm), the association of SO2with IHD admissions remained significant (i.e. an increase of 0.7%; 95% confidence interval=0.1–1.3, per each 10µg/m3increase of SO2) among subjects younger than 65 years, but not among subjects older than 65. In the older group the increase was only significant for particles (1.3%; CI 0.7–1.8, per each increase in 10µg/m3of PM10). This study provides new evidence for the effects of urban air pollution on cardiac diseases in Europe, and suggests that SO2pollution may play an independent role in triggering ischemic cardiac events. From a Public Health perspective these results suggest that reduction in SO2levels in European cities could imply a reduction of admissions for IHDs.

Key Words: Sulfur dioxide • Air pollution • Cardiovascular diseases


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