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. 2025 Jun 19.
doi: 10.1007/s11739-025-04013-2. Online ahead of print.

Particulate matter concentration is associated with increased utilization of the emergency department: a single-centre time-series analysis

Alessio Gnerucci #  1 , Andrea Rossetto #  2 , Paola Faraoni  3 , Francesco Ranaldi  3 , Gabriele Cavallaro  4 , Barbara Tonietti  5 , Ugo Santosuosso  6 , Lorella Bonaccorsi  6 , Peiman Nazerian  4 ; SIMEU Study Group
Collaborators, Affiliations

Particulate matter concentration is associated with increased utilization of the emergency department: a single-centre time-series analysis

Alessio Gnerucci et al. Intern Emerg Med. .

Abstract

Fluctuations in emergency department (ED) utilization may be related to pollutant concentration variations that can heighten acute pathologies, exacerbate chronic conditions or indicate increased human activity. This study investigates the association between particulate matter (PM2.5-PM10) concentrations in patients' residential areas and ED visits. Retrospective, single-centre, time-series cohort study on a 100km2 urban area around a level 1 hospital in Florence, Italy, with 307,279 ED visits of patients of age > 14 years between 01/01/2019 and 31/12/2022. PM2.5 and PM10 daily concentrations, recorded by 14 air-quality stations, were interpolated at patients' residences, in a 250m2 grid, with inverse distance weighting and averaged on various time windows (lag) up to 30 days before ED visit. The association between ED visits and pollutant concentrations as percent excess of incidence rate (%Er) with 95% confidence intervals were investigated with generalized additive models. Significant association was found with short-term PM2.5 and PM10 fluctuations (PM2.5Lag1: 1.24%Er, 0.59-1.99 95%CI; PM10Lag2: 1.79%Er, 1.08-2.72). Such association was stronger for the subgroups of deceased patients (PM2.5Lag1 5.71%Er, 1.44-8.99; PM10Lag2 6.38%Er, 2.02-10.83), elderly patients presenting with dyspnoea (PM2.5Lag1 4.18%Er, 2.36-6.33; PM10Lag2 4.99%Er, 2.77-7.32) and younger patients suffering traumatic events (PM2.5Lag1 1.29%Er, 0.32-2.51; PM10Lag2 2.14%Er, 0.88-3.50). Exposure-response curves showed that particulate matter is associated with ED visits even at concentrations below the WHO guard levels. A short-term rise in PM2.5 and PM10, even below guard levels, was associated with increased ED utilization, particularly related to elderly patients with dyspnoea and the concomitant lurking occurrence of vehicle accidents in the younger population. Trial registration: NCT06491290; 09/07/2024; retrospectively registered.

Keywords: Air pollution; Emergency department; Particulate matter; Services utilization.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflict of interest. Ethical standards: This study was approved by the local Ethics Committee (24192_oss, 14/11/2023). Human and animal rights: All procedures involving human subjects were performed in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethics. Informed consent: Not applicable. Consent for publication: This manuscript has not been published elsewhere and that it has not been submitted simultaneously for publication elsewhere.

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