Low ambient temperature and air pollution are associated with hospitalization incidence of coronary artery disease: Insights from a cross-sectional study in Northeast China

Abstract

Background: Previous studies have established a link between fluctuations in climate and increased mortality due to coronary artery disease (CAD). However, there remains a need to explore and clarify the evidence for associations between meteorological changes and hospitalization incidences related to CAD and its subtypes, especially in cold regions. This study aimed to systematically investigate the relationship between exposure to meteorological changes, air pollutants, and hospitalization for CAD in cold regions. Methods: We conducted a cross-sectional study using hospitalization records of 86,483 CAD patients between January 1, 2009, and December 31, 2019. Poisson regression analysis, based on generalized additive models, was applied to estimating the influence of hospitalization for CAD. Results: Significant associations were found between low ambient temperature [-10°C, RR = 1.65; 95% CI: (1.28-2.13)] and the incidence of hospitalization for CAD within a lag of 0-14 days. Furthermore, O3 [95.50 μg/m3, RR = 12; 95% CI: (1.03-1.21)] and NO2 [48.70 μg/m3, RR = 1.0895% CI: (1.01-1.15)] levels were identified as primary air pollutants affecting the incidence of CAD, ST-segment-elevation myocardial infarction (STEMI), and non-STEMI (NSTEMI) within the same lag period. Furthermore, O3 [95.50 μg/m3, RR = 1.12; 95% CI: (1.03-1.21)] and NO2 [48.70 μg/m3, RR = 1.0895% CI: (1.01-1.15)] levels were identified as primary air pollutants affecting the incidence of CAD, ST-segment-elevation myocardial infarction (STEMI), and non-STEMI (NSTEMI) within the same lag period. The effect curve of CAD hospitalization incidence significantly increased at lag days 2 and 4 when NO2 and O3 concentrations were higher, with a pronounced effect at 7 days, dissipating by lag 14 days. No significant associations were observed between exposure to PM, SO2, air pressure, humidity, or wind speed and hospitalization incidences due to CAD and its subtypes. Conclusion: Our findings suggest a positive correlation between short-term exposure to low ambient temperatures or air pollutants (O3 and NO2) and hospitalizations for CAD, STEMI, and NSTEMI. These results could aid the development of effective preparedness strategies for frequent extreme weather events and support clinical and public health practices aimed at reducing the disease burden associated with current and future abnormal weather events.

Keywords

meteorological changes / ambient temperature / air pollution / coronary heart disease / Poisson regression analysis

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