Air Pollution and Emergency Hospital Admissions—Evidences from Lisbon Metropolitan Area, Portugal

Franco, Pedro; Gordo, Cristina; Costa, Eduarda Marques da; Lopes, António

doi:10.3390/app10227997

Cited by 6 publications

(5 citation statements)

References 102 publications

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“…This is considered a non-problem because despite no particular care being taken on lag selection in this review, studies appeared not to vary significantly. The main takeaway in lag-related information seen in Table 2 was that fewer associations were found in day models [84]. This delayed effect of O 3 is recurrent, with most studies in this review reporting that lags between day 1 and day 3 are the most prevalent for the correlation of O 3 and health, yielding the strongest associations (Table 2).…”

Section: Resultsmentioning

confidence: 92%

Review of Ground-Level Ozone Impact in Respiratory Health Deterioration for the Past Two Decades

Soares

Silva

2022

Atmosphere

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Background: Ground-level ozone has been gaining notoriety with increasing evidence of its nefarious effects on health, especially respiratory diseases. Where do we stand on the solidity of this data and is there room for improvement? Objectives: Evaluate this evidence for incongruities or heterogeneity in this field of research. How is the exposure assessment conducted, where does Portugal stand in this field, and what can be improved? Health deterioration concerning asthma, chronic obstructive pulmonary disease (COPD), and acute respiratory distress syndrome (ARDS) are analysed. Methods: A review of 1735 studies was conducted through PubMed and Google Scholar engines for the past two decades. We identified 59 eligible studies and included an array of variables, including O3 measurements, number of air-quality monitoring stations used, relative risks, odds ratios, hazard ratios, number of hospital admissions, visits, or mortality, and size of population dataset used. Results: Approximately 83% of data in this review presents significant correlations of ozone with asthma, COPD, and ARDS. Studies that report negative or not significant associations mention a lack of data or topographic differences as the main issue with these divergent results. Studies consistently report summer as a period of particular concern. Portuguese data in this field is lacking. Conclusions: This research field is growing in interest and there is evidence that ozone plays a non-negligible role in health deterioration. The few Portuguese studies in this field seem aligned with the literature reviewed but more research is needed. Suggested improvements are more and better data through denser air-quality networks to accurately depict personal exposure to ozone. Homogenization of the exposure assessment concerning averaging times of ozone to daily maximum 8 h averages whenever possible. Risk increments based on 10 ppb instead of interquartile ranges. Lastly, contrary to some studies in this review, the topographic effect on concentrations and health deterioration should not be underestimated and seasonality should always be checked.

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Section: Resultsmentioning

confidence: 92%

Review of Ground-Level Ozone Impact in Respiratory Health Deterioration for the Past Two Decades

Soares

Silva

2022

Atmosphere

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“…There is a substantial body of epidemiologic literature showing a clear and consistent association between concentrations of ambient PM 2.5 , PM 10 , and NO 2 and CVD (Gold et al 2000;Ballester et al 2006;Miller et al 2007; Pope Cesaroni et al 2014;Santurtun et al 2017;Liu et al 2015;Vahedian et al 2017;Collart et al 2018;Sanyal et al 2018;Liu et al 2019;Phosri et al 2019;Amsalu et al 2019;Franco et al 2020). The association between these pollutants and CVD was reported worldwide for high levels of pollutants or even in a setting where pollutant levels were within ambient air quality standards European Directive 2008/50/EC or WHO guideline (WHO 2016), such as in our work.…”

Section: Discussionmentioning

confidence: 99%

Effects of air pollution on daily hospital admissions for cardiovascular diseases in Castilla-La Mancha, Spain: a region with moderate air quality

Rodrı́guez

Cobo-Cuenca

Quiles

2022

Air Qual Atmos Health

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Adverse impacts of air pollution on human health have been well documented in Spain; however, very few have been conducted in the Spanish region of Castilla-La Mancha (CLM). CLM is an extensive region with a low population density, little industrial production, and moderate air pollution level. The aim of the study was to assess the relationship between the risk of hospital admission for cardiovascular disease (CVD) and exposure to PM2.5, PM10, and NO2 in CLM during 2006–2015. Daily air pollution concentration, temperature, and relative humidity were monitored from the air quality monitoring stations in CLM. A time-series analysis with generalized linear model was used to examine the effects of air pollution on hospital admissions by controlling for long-term trend and other potential confounders. The effect modifications by sex and age (15–64; ≥ 65 years) were examined. Lagging exposure concept was used to analyze a possible latency period in cumulative exposure-pollution analyses. Relative risks (RR) of CVD admissions at the same day (lag 0) and to 7 days after exposure (lag 7) were calculated. Relative risks of CVD admissions (for an increase of 10 µg m−3 in concentration of air pollutant) were calculated. The elderly group (≥ 65 years) were the most susceptible group to the effect of air pollution, whereas the estimated effect by sex was significantly different depending on the age group. The potential utility of these results may help for syndromic surveillance during future similar air pollutant concentrations, where an increase in the use of health services among the vulnerable groups could be unexpected by the emergency department.

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“…al (2016) found a significant association between the pollutants PM 10 /PM 2.5 and respiratory diseases for ages below 15 years. The recent study by Franco et. al (2020), restricted to the Lisbon metropolitan area, used ordinary least regression and found significant associations between several air pollutants (PM 10 , NO 2 , NO, O 3 , CO) and respiratory hospital admissions [10].…”

Section: Introductionmentioning

confidence: 96%

“…Hence, it is of the utmost importance to assess the impact of the current levels of air pollution on populations' health. Yet, in some countries, including Portugal, research on the effect of air pollution on health, either on mortality or morbidity (i.e., hospital admissions), has been scarce [6][7][8][9][10]. The few studies performed have found some associations between health outcomes and air quality, even though, results are not consistent throughout studies.…”

Section: Introductionmentioning

confidence: 99%

“…The recent study by Franco et. al (2020), restricted to the Lisbon metropolitan area, used ordinary least regression and found significant associations between several air pollutants (PM 10 , NO 2 , NO, O 3 , CO) and respiratory hospital admissions [ 10 ]. Notwithstanding, even tough these research studies are somewhat recent, the data used are 15–20 years old and may not reflect the current impact of air pollution on health.…”

Section: Introductionmentioning

confidence: 99%

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Association between respiratory hospital admissions and air quality in Portugal: A count time series approach

et al. 2021

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Although regulatory improvements for air quality in the European Union have been made, air pollution is still a pressing problem and, its impact on health, both mortality and morbidity, is a topic of intense research nowadays. The main goal of this work is to assess the impact of the exposure to air pollutants on the number of daily hospital admissions due to respiratory causes in 58 spatial locations of Portugal mainland, during the period 2005-2017. To this end, INteger Generalised AutoRegressive Conditional Heteroskedastic (INGARCH)-based models are extensively used. This family of models has proven to be very useful in the analysis of serially dependent count data. Such models include information on the past history of the time series, as well as the effect of external covariates. In particular, daily hospitalisation counts, air quality and temperature data are endowed within INGARCH models of optimal orders, where the automatic inclusion of the most significant covariates is carried out through a new block-forward procedure. The INGARCH approach is adequate to model the outcome variable (respiratory hospital admissions) and the covariates, which advocates for the use of count time series approaches in this setting. Results show that the past history of the count process carries very relevant information and that temperature is the most determinant covariate, among the analysed, for daily hospital respiratory admissions. It is important to stress that, despite the small variability explained by air quality, all models include on average, approximately two air pollutants covariates besides temperature. Further analysis shows that the one-step-ahead forecasts distributions are well separated into two clusters: one cluster includes locations exclusively in the Lisbon area (exhibiting higher number of one-step-ahead hospital admissions forecasts), while the other contains the remaining locations. This results highlights that special attention must be given to air quality in Lisbon metropolitan area in order to decrease the number of hospital admissions.

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Air Pollution and Emergency Hospital Admissions—Evidences from Lisbon Metropolitan Area, Portugal

Cited by 6 publications

References 102 publications

Review of Ground-Level Ozone Impact in Respiratory Health Deterioration for the Past Two Decades

Review of Ground-Level Ozone Impact in Respiratory Health Deterioration for the Past Two Decades

Effects of air pollution on daily hospital admissions for cardiovascular diseases in Castilla-La Mancha, Spain: a region with moderate air quality

Association between respiratory hospital admissions and air quality in Portugal: A count time series approach

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