Fine and coarse particulate air pollution and out-of-hospital cardiac arrest onset: a nationwide case-crossover study in China

Chang Pan; Chang Xu; Jiaqi Zheng; Ruixue Song; Chuanzhu Lv; Guoqiang Zhang; Huiqiong Tan; Yu Ma; Yimin Zhu; Xiaotong Han; Chaoqian Li; Shengtao Yan; Wen Zheng; Chunyi Wang; Jianbo Zhang; Yuan Bian; Jingjing Ma; Kai Cheng; Rugang Liu; Yaping Hou; Qiran Chen; Xiangkai Zhao; Bryan McNally; Renjie Chen; Haidong Kan; Xia Meng; Yuguo Chen; Feng Xu

doi:10.1016/j.jhazmat.2023.131829

Fine and coarse particulate air pollution and out-of-hospital cardiac arrest onset: a nationwide case-crossover study in China

J Hazard Mater. 2023 Sep 5:457:131829. doi: 10.1016/j.jhazmat.2023.131829. Epub 2023 Jun 10.

Authors

Chang Pan¹, Chang Xu², Jiaqi Zheng¹, Ruixue Song¹, Chuanzhu Lv³, Guoqiang Zhang⁴, Huiqiong Tan⁵, Yu Ma⁶, Yimin Zhu⁷, Xiaotong Han⁷, Chaoqian Li⁸, Shengtao Yan⁴, Wen Zheng¹, Chunyi Wang¹, Jianbo Zhang¹, Yuan Bian¹, Jingjing Ma¹, Kai Cheng¹, Rugang Liu¹, Yaping Hou¹, Qiran Chen¹, Xiangkai Zhao¹, Bryan McNally⁹, Renjie Chen², Haidong Kan², Xia Meng¹⁰, Yuguo Chen¹¹, Feng Xu¹²

Affiliations

¹ Department of Emergency Medicine, Chest Pain Center, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China.
² School of Public Health, Fudan University, Shanghai, China.
³ Emergency Medicine Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
⁴ Department of Emergency Medicine, China-Japan Friendship Hospital, Beijing, China.
⁵ Emergency and Intensive Care Center, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁶ Department of Intensive Care Unit, Chongqing University Central Hospital, Chongqing Key Laboratory of Emergency Medicine, Chongqing Emergency Medical Center, Chongqing, China.
⁷ Department of Emergency Medicine, Hunan Provincial Institute of Emergency Medicine, Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics, Hunan Provincial People's Hospital/The First Affiliated Hospital, Hunan Normal University, Changsha, Hunan, China.
⁸ Department of Emergency, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
⁹ Emory University School of Medicine, Atlanta, GA, USA.
¹⁰ School of Public Health, Fudan University, Shanghai, China. Electronic address: mengxia@fudan.edu.cn.
¹¹ Department of Emergency Medicine, Chest Pain Center, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China. Electronic address: chen919085@sdu.edu.cn.
¹² Department of Emergency Medicine, Chest Pain Center, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China. Electronic address: xufengsdu@126.com.

PMID: 37320898
DOI: 10.1016/j.jhazmat.2023.131829

Abstract

Out-of-hospital cardiac arrest (OHCA) is a global public health concern. Nationwide studies on the effects of short-term exposure to particulate matter (PM) on OHCA risk are rare in regions with high PM levels, and evidence for coarse PM (PM_2.5-10) is limited and inconsistent. To evaluate the associations between fine PM (PM_2.5) and PM_2.5-10 and OHCA onset, a time-stratified case-crossover study was conducted on 77,261 patients with cardiac OHCA in 26 cities across China in 2020. Daily PM_2.5 and PM_2.5-10 concentrations were assessed with high-resolution and full-coverage PM estimations. Conditional logistic regression models were applied in analyses. Each interquartile range of PM increase in 3-day moving average was associated with an increased risk of cardiac OHCA onset of 2.37% (95% CI, 1.20-3.56%) for PM_2.5 and 2.12% (95% CI, 0.70-3.56%) for PM_2.5-10. Stratified analyses showed higher susceptibility in patients over 75 years for PM_2.5 exposure and with diabetes for PM_2.5-10. This first nationwide study in region with high PM levels and great PM variability found not only PM_2.5 but also PM_2.5-10 were associated with a higher risk of OHCA onset, which could add powerful epidemiological evidence to this field and provide new evidence for the formulation of air quality guidelines.

Keywords: Coarse particulate matter; Fine particulate matter; OHCA; Time-stratified case-crossover.

MeSH terms

Air Pollutants* / analysis
Air Pollution* / adverse effects
Air Pollution* / analysis
China / epidemiology
Cross-Over Studies
Dust / analysis
Environmental Exposure / analysis
Humans
Out-of-Hospital Cardiac Arrest* / chemically induced
Out-of-Hospital Cardiac Arrest* / epidemiology
Particulate Matter / analysis

Substances

Particulate Matter
Dust
Air Pollutants