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European Heart Journal Advance Access published online on September 15, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi457
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received March 8, 2005
Revised July 18, 2005
Accepted July 22, 2005

Clinical research

Outdoor air pollution, mortality, and hospital admissions from coronary heart disease in Sheffield, UK: a small-area level ecological study

Ravi Maheswaran 1*, Robert P. Haining 2, Paul Brindley 3, Jane Law 2, Tim Pearson 1, Peter R. Fryers 1, Stephen Wise 3, and Michael J. Campbell 4

1 Public Health GIS Unit, School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
2 Department of Geography, The University of Cambridge, UK
3 Sheffield Centre for Geographic Information and Spatial Analysis, The University of Sheffield, UK
4 Institute of Primary Care, School of Health and Related Research, The University of Sheffield, UK

* To whom correspondence should be addressed.
Ravi Maheswaran, E-mail: r.maheswaran{at}sheffield.ac.uk


  Abstract

Aims To examine the hypothesis that coronary heart disease mortality and emergency hospital admission rates are higher in areas with higher outdoor air pollution levels.

Methods and results Modelled nitrogen oxides (NOx), particulate matter (PM10), and carbon monoxide (CO) levels were interpolated to 1030 census enumeration districts using an ecological study design. Results, based on 6857 deaths and 11 407 admissions from 1994-98 and a population of 199 682 aged ≥ 45 years, were adjusted for age, sex, deprivation, and smoking prevalence. Mortality rate ratios were 1.17 (95% CI 1.06-1.29), 1.08 (95% CI 0.96-1.20), and 1.05 (95% CI 0.95-1.16) in the highest relative to the lowest NOx, PM10, and CO quintile categories, respectively. Corresponding admission rate ratios were 1.00 (95% CI 0.90-1.10), 1.01 (95% CI 0.90-1.14), and 0.88 (95% CI 0.79-0.98).

Conclusion The results are consistent with an excess risk of coronary heart disease mortality in areas with high outdoor NOx, a proxy for traffic-related pollution, but residual confounding cannot be ruled out. If causality were assumed, 6% of coronary heart disease deaths would have been attributable to outdoor NOx, and targeting pollution reduction measures at high pollution areas would be an option for coronary mortality prevention.

Keywords: Air pollution; Coronary disease; Hospitalization; Mortality.
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