Short term effects of air pollution on hospitalizations for cardiovascular diseases in eight French cities:: The PSAS program

Introduction: Short term associations between air pollution indicators and hospitalizations for cardiovascular diseases have been suggested by epidemiological and clinical studies. The present study aims at estimating the association between particles with diameter < 10 gm (PM 10), nitrogen dioxide (NO2) and ozone and hospitalizations for cardiovascular diseases in eight French cities during the 1998-2003 period. Methods: The daily number of hospitalizations in each city was extracted from the French hospital information system (PMSI) for cardiovascular diseases, cardiac diseases, ischemic heart diseases and stroke. Excess relative risks (ERRs) of hospitalization associated with a 10 [mu g/m(3) increase in pollutant levels were estimated in each city by fitting a Poisson regression model, controlling for well-known confounding factors and temporal trends. City-specific results were then combined by inverse variance weighting. Results: Daily number of hospitalizations for cardiovascular diseases was associated with PM10 levels (for a 10 mu g/m(3) increase, ERR=0.8%, 95% Cl: [0.2, 1.5]), with NO2 (1-1%, [0.6, 1.6]) but not with ozone (0.1% [-0.2%, 0.5%1). Associations were stronger in people aged 65 years and over, and when only hospitalizations for ischemic heart diseases were considered. No association was found between strokes and air pollution levels. Discussion: Our study suggests that the ambient levels of air pollutants currently experienced in the eight French cities, which are close to European air quality guidelines, are yet linked to a short term increase of hospitalizations for cardiovascular diseases. These results are consistent with epidemiological and toxicological data on the cardiovascular effects of air pollution. (C) 2007 Elsevier B.V. All rights reserved.