Associations between ambient air pollution and daily mortality among elderly persons in Montreal, Quebec,☆☆

https://doi.org/10.1016/j.scitotenv.2013.06.095Get rights and content

Highlights

  • We studied daily mortality and air pollution in persons 65 years of age and older.

  • Health conditions 1 year before death were identified using Medicare data.

  • We found positive associations for heart failure, atrial fibrillation, diabetes.

  • Associations in the warm season for coronary artery disease, hypertension, cancer

  • No associations were found for stroke, acute and chronic respiratory disease.

Abstract

Background

Persons with underlying health conditions may be at higher risk for the short-term effects of air pollution. We have extended our original mortality time series study in Montreal, Quebec, among persons 65 years of age and older, for an additional 10 years (1990–2003) to assess whether these associations persisted and to investigate new health conditions.

Methods and results

We created subgroups of subjects diagnosed with major health conditions one year before death using billing and prescription data from the Quebec Health Insurance Plan. We used parametric log-linear Poisson models within the distributed lag non-linear models framework, that were adjusted for long-term temporal trends and daily maximum temperature, for which we assessed associations with NO2, O3, CO, SO2, and particles with aerodynamic diameters 2.5 μm in diameter or less (PM2.5). We found positive associations between daily non-accidental mortality and all air pollutants but O3 (e.g., for a cumulative effect over a 3-day lag, with a mean percent change (MPC) in daily mortality of 1.90% [95% confidence interval: 0.73, 3.08%] for an increase of the interquartile range (17.56 μ gm 3) of NO2). Positive associations were found amongst persons having cardiovascular disease (cumulative MPC for an increase equal to the interquartile range of NO2 = 2.67%), congestive heart failure (MPC = 3.46%), atrial fibrillation (MPC = 4.21%), diabetes (MPC = 3.45%), and diabetes and cardiovascular disease (MPC = 3.50%). Associations in the warm season were also found for acute and chronic coronary artery disease, hypertension, and cancer. There was no persuasive evidence to conclude that there were seasonal associations for cerebrovascular disease, acute lower respiratory disease (defined within 2 months of death), airways disease, and diabetes and airways disease.

Conclusions

These data indicate that individuals with certain health conditions, especially those with diabetes and cardiovascular disease, hypertension, atrial fibrillation, and cancer, may be susceptible to the short-term effects of air pollution.

Introduction

There is considerable evidence that increases in levels of ambient air pollution are associated with daily mortality (Bell et al., 2004, Brook et al., 2007, Dominici, 2004, Katsouyanni et al., 2009, Ma et al., 2011, Pope et al., 1995, Samet et al., 2000, Samoli et al., 2008, Tao et al., 2011). Over the last 15 years, we (Goldberg, 1996, Goldberg et al., 2000, Goldberg et al., 2001a, Goldberg et al., 2003, Goldberg and Burnett, 2003, Goldberg et al., 2001c, Goldberg et al., 2006) and others (Annesi-Maesano et al., 2003, Bates, 1992, Forastiere et al., 2005, Frank and Tankersley, 2002, Schwartz, 1994, Zanobetti et al., 2000a) postulated or found that certain subgroups of people with specific health conditions were at increased risk, presumably because of a reduced physiological capacity to deal with episodes of air pollution. Of considerable interest were the findings of increased risks among persons with diabetes and cardiovascular disease (Bateson and Schwartz, 2004, Goldberg et al., 2000, Goldberg et al., 2006, Zanobetti and Schwartz, 2001, Zanobetti and Schwartz, 2002) and congestive heart failure (Goldberg et al., 2003, Kwon et al., 2001, Lee et al., 2007, Morris and Naumova, 1998, Wellenius et al., 2005).

Our previous analyses comprised data from the period 1984–1993 (Goldberg et al., 2001a, Goldberg et al., 2003, Goldberg and Burnett, 2003, Goldberg et al., 2001b, Goldberg et al., 2001c, Goldberg et al., 2006). We present herein an update to these analyses in which we modified our algorithms used to define health conditions, and we used a new method of analysis that accounts for the delayed and possibly non-linear effects of air pollution and weather on daily mortality (Armstrong, 2006, Gasparrini et al., 2010). As our new algorithms make use of discharges from hospital and, as these data were only available since 1990, this report covers the period 1990–2003, inclusive. Thus, the objective of this study was to determine whether there were associations between daily non-accidental mortality and daily exposure to criteria pollutants in subgroups of the general population of Montreal, age 65 years and above, having selected health conditions for the period 1990–2003, inclusive.

Section snippets

The study population

Details of the study design have been presented previously (Goldberg et al., 2001a, Goldberg et al., 2003, Goldberg et al., 2001b, Goldberg et al., 2001c, Goldberg et al., 2006). Briefly, the target population comprised all individuals 65 years of age and older who died and were resident in Montreal during the period 1990–2003, inclusive, and who were registered with the universal Quebec Health Insurance Plan (Régie de l'assurance maladie du Québec). Only deceased subjects were included in the

Results

Table 2 shows the distribution of pollutants and selected weather variables for the study period 1990–2003. The average maximum daily temperature was 11.6 °C (average mean daily temperature was 6.9 °C), varying from − 23.9 to 36.2 °C (interquartile range of 20.6 °C). Mean daily concentrations were: O3, 32.3 μg/m3; NO2, 37.9 μg/m3; CO, 6.0 μg/m3; SO2, 13.5 μg/m3; and PM2.5 from the TEOMs of 8.7 μg/m3 (from 1997 to 2003 only), respectively.

Table 3 shows the distributions of deaths by each subgroup among

Discussion

Conclusions for each subgroup according to each pollutant can always be made, and the graphs that we presented in the results can be used for that purpose, but we will not attempt such a summary here. Rather, an important public health question is if a statement can be made as to whether each of these subgroups appears to be “susceptible” to the effects of air pollution. Given that most of the criteria pollutants that we investigated derive from combustion sources, excess risks for one or more

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  • Cited by (0)

    Sources of support: This study was supported financially through a contract with Health Canada.

    ☆☆

    Study approval: The McGill University Faculty of Medicine Institutional Review Board and the Commission d'accèss à l'information de Québec approved this study.

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