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Intensive care admissions and outcomes associated with short-term exposure to ambient air pollution: a time series analysis

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Abstract

Purpose

Short-term exposure to outdoor air pollution has been positively associated with numerous measures of acute morbidity and mortality, most consistently as excess cardiorespiratory disease associated with fine particulate matter (PM2.5), particularly in vulnerable populations. It is unknown if the critically ill, a vulnerable population with high levels of cardiorespiratory disease, is affected by air pollution.

Methods

We performed a time series analysis of emergency cardiorespiratory, stroke and sepsis intensive care (ICU) admissions for the years 2008–2016, using data from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS-APD). Case-crossover analysis was conducted to assess the relationship between air pollution and the frequency and severity of ICU admissions having adjusted for temperature, humidity, public holidays and influenza activity.

Results

46,965 episodes in 87 separate ICUs were analysed. We found no statistically significant associations with admission counts. However, ICU admissions ending in death within 30 days were significantly positively associated with short-term exposure to PM2.5 [RR 1.18, 95% confidence interval (CI) 1.02–1.37, per 10 µg/m3 increase]. This association was more pronounced in those aged 65 and over (RR 1.33, 95% CI 1.11–1.58, per 10 µg/m3).

Conclusions

Increased ICU mortality was associated with higher levels of PM2.5. Larger studies are required to determine if the frequency of ICU admissions is positively associated with short-term exposure to air pollution.

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Acknowledgements

We acknowledge the Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resources Evaluation (CORE) Centre, the Environment Protection Authority of Victoria, the Office of Environment and Heritage of NSW and the Australian Bureau of Meteorology for providing the data used in the study. The authors and the ANZICS CORE management committee would like to thank clinicians, data collectors and researchers at all contributing sites (S9).

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Authors and Affiliations

  1. Department of Intensive Care, Royal North Shore Hospital, Sydney, NSW, Australia

    Christopher P. Groves & Anthony P. Delaney

  2. Population Health Research Institute, St George’s, University of London, London, UK

    Barbara K. Butland & Richard W. Atkinson

  3. Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia

    David V. Pilcher

  4. Australia and New Zealand Intensive Care Society (ANZICS), Centre for Outcomes and Resource Evaluation (CORE), Carlton, VIC, Australia

    David V. Pilcher

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  1. Christopher P. Groves
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Contributions

All authors contributed to study conception and design. Data collection and preparation was performed by CPG. Analysis was performed by BKB. The manuscript was written by CPG and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Christopher P. Groves.

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Conflicts of interest

Ms Butland owns shares in Royal Dutch Shell and Scottish and Southern Energy, and her spouse has a deferred Shell pension. All other authors declare no conflicts of interest.

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Groves, C.P., Butland, B.K., Atkinson, R.W. et al. Intensive care admissions and outcomes associated with short-term exposure to ambient air pollution: a time series analysis. Intensive Care Med 46, 1213–1221 (2020). https://doi.org/10.1007/s00134-020-06052-z

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