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Observational Study
. 2021 Aug 25;16(8):e0256526.
doi: 10.1371/journal.pone.0256526. eCollection 2021.

Out-of-hospital cardiac arrest and ambient air pollution: A dose-effect relationship and an association with OHCA incidence

Francesca Romana Gentile  1   2 , Roberto Primi  1 , Enrico Baldi  2   3 , Sara Compagnoni  1   2 , Claudio Mare  4 , Enrico Contri  5 , Francesca Reali  6 , Daniele Bussi  7 , Fabio Facchin  8 , Alessia Currao  1 , Sara Bendotti  1 , Simone Savastano  1 ; Lombardia CARe researchers
Affiliations
Observational Study

Out-of-hospital cardiac arrest and ambient air pollution: A dose-effect relationship and an association with OHCA incidence

Francesca Romana Gentile et al. PLoS One. .

Abstract

Background: Pollution has been suggested as a precipitating factor for cardiovascular diseases. However, data about the link between air pollution and the risk of out-of-hospital cardiac arrest (OHCA) are limited and controversial.

Methods: By collecting data both in the OHCA registry and in the database of the regional agency for environmental protection (ARPA) of the Lombardy region, all medical OHCAs and the mean daily concentration of pollutants including fine particulate matter (PM10, PM2.5), benzene (C6H6), carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2), and ozone (O3) were considered from January 1st to December 31st, 2019 in the southern part of the Lombardy region (provinces of Pavia, Lodi, Cremona and Mantua; 7863 km2; about 1550000 inhabitants). Days were divided into high or low incidence of OHCA according to the median value. A Probit dose-response analysis and both uni- and multivariable logistic regression models were provided for each pollutant.

Results: The concentrations of all the pollutants were significantly higher in days with high incidence of OHCA except for O3, which showed a significant countertrend. After correcting for temperature, a significant dose-response relationship was demonstrated for all the pollutants examined. All the pollutants were also strongly associated with high incidence of OHCA in multivariable analysis with correction for temperature, humidity, and day-to-day concentration changes.

Conclusions: Our results clarify the link between pollutants and the acute risk of cardiac arrest suggesting the need of both improving the air quality and integrating pollution data in future models for the organization of emergency medical services.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Map of the Lombardy region.
The study territory in which OHCA are displayed as light-blue dots and monitoring stations as red dots. Created by Tableau Public software (Version 2020.3, LLC, Salesforce Company).
Fig 2
Fig 2. Panels and trends.
The left panels depict the daily trend combined with the seven-days mean trend of each pollutant for every province. In the right panels the daily trend combined with the seven-days mean of all the study territory are displayed. The R value is the multiple correlation coefficient, resulting from the multiple regression analysis and referred to the correlation between the different provinces. R value is provided for every pollutant.
Fig 3
Fig 3. Forest-plot.
Odds ratio resulting from multivariable logistic regression model for the probability of having a higher incidence of OHCA (>0.3 cases/100.000) after correction for temperature, day-to-day concentration change and humidity.
Fig 4
Fig 4. Dose-response curves.
Probit analysis for every pollutant before (left panels) and after (right panels) correction for temperature.
See this image and copyright information in PMC

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