Exposure to ambient air pollution and the incidence of congestive heart failure and acute myocardial infarction: A population-based study of 5.1 million Canadian adults living in Ontario

Li Bai; Saeha Shin; Richard T Burnett; Jeffrey C Kwong; Perry Hystad; Aaron van Donkelaar; Mark S Goldberg; Eric Lavigne; Ray Copes; Randall V Martin; Alexander Kopp; Hong Chen

doi:10.1016/j.envint.2019.105004

Exposure to ambient air pollution and the incidence of congestive heart failure and acute myocardial infarction: A population-based study of 5.1 million Canadian adults living in Ontario

Environ Int. 2019 Nov:132:105004. doi: 10.1016/j.envint.2019.105004. Epub 2019 Aug 3.

Authors

Li Bai¹, Saeha Shin², Richard T Burnett³, Jeffrey C Kwong⁴, Perry Hystad⁵, Aaron van Donkelaar⁶, Mark S Goldberg⁷, Eric Lavigne⁸, Ray Copes⁹, Randall V Martin¹⁰, Alexander Kopp¹¹, Hong Chen¹²

Affiliations

¹ ICES, Toronto, ON, Canada. Electronic address: li.bai@ices.on.ca.
² Public Health Ontario, Toronto, ON, Canada.
³ Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada.
⁴ ICES, Toronto, ON, Canada; Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, ON, Canada.
⁵ College of Public Health and Human Studies, Oregon State University, Oregon, USA.
⁶ Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada.
⁷ Department of Medicine, McGill University, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
⁸ Air Health Effects Division, Health Canada, Ottawa, ON, Canada; School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada.
⁹ Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹⁰ Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada; Smithsonian Astrophysical Observatory, Harvard-Smithsonian Center for Astrophysics, Cambridge, MA, USA.
¹¹ ICES, Toronto, ON, Canada.
¹² ICES, Toronto, ON, Canada; Public Health Ontario, Toronto, ON, Canada; Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

PMID: 31387019
DOI: 10.1016/j.envint.2019.105004

Abstract

Long-term exposure to ambient air pollution has been linked to cardiovascular mortality, but the associations with incidence of major cardiovascular diseases are not fully understood, especially at low concentrations. We aimed to investigate the associations between exposure to fine particulate matter (PM_2.5), nitrogen dioxide (NO₂), ozone (O₃), redox-weighted average of NO₂ and O₃ (O_x) and incidence of congestive heart failure (CHF) and acute myocardial infarction (AMI). Our study population included all long-term residents aged 35-85 years who lived in Ontario, Canada, from 2001 to 2015 (~5.1 million). Incidence of CHF and AMI were ascertained from validated registries. We assigned estimates of annual concentrations of pollutants to the residential postal codes of subjects for each year during follow-up. We estimated hazard ratios (HRs) and 95% CIs for each pollutant separately using Cox proportional hazards models. We examined the shape of concentration-response associations using shape-constrained health impact functions. From 2001 to 2015, there were 422,625 and 197,628 incident cases of CHF and AMI, respectively. In the fully adjusted analyses, the HRs of CHF corresponding to each interquartile range increase in exposure were 1.05 (95% CI: 1.04-1.05) for PM_2.5, 1.02 (95% CI: 1.01-1.04) for NO₂, 1.03 (95% CI: 1.02-1.03) for O₃, and 1.02 (95% CI: 1.02-1.03) for O_x, respectively. Similarly, exposure to PM_2.5, O₃, and O_x were positively associated with AMI. The concentration-response relationships were different for individual pollutant and outcome combinations (e.g., for PM_2.5 the relationship was supralinear with CHF, and linear with AMI).

Keywords: Acute myocardial infarction; Ambient air pollution; Cardiovascular events; Concentration-response curves; Congestive heart failure; Incidence.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Air Pollution / adverse effects*
Air Pollution / analysis
Cohort Studies
Environmental Exposure / analysis
Female
Heart Failure / epidemiology
Heart Failure / etiology*
Humans
Incidence
Male
Middle Aged
Myocardial Infarction / epidemiology
Myocardial Infarction / etiology*
Nitrogen Dioxide / adverse effects
Nitrogen Dioxide / analysis
Ontario / epidemiology
Ozone / adverse effects
Ozone / analysis
Particulate Matter / adverse effects
Particulate Matter / analysis
Proportional Hazards Models

Substances

Particulate Matter
Ozone
Nitrogen Dioxide