Atmospheric Pressure and Abdominal Aortic Aneurysm Rupture: Results From a Time Series Analysis and Case-Crossover Study

Abstract

Background:Associations between atmospheric pressure and abdominal aortic aneurysm (AAA) rupture risk have been reported, but empirical evidence is inconclusive and largely derived from studies that did not account for possible nonlinearity, seasonality, and confounding by temperature.Methods:Associations between atmospheric pressure and AAA rupture risk were investigated using local meteorological data and a case series of 358 patients admitted to hospital for ruptured AAA during the study period, January 2002 to December 2012. Two analyses were performed—a time series analysis and a case-crossover study.Results:Results from the 2 analyses were similar; neither the time series analysis nor the case-crossover study showed a significant association between atmospheric pressure (P = .627 and P = .625, respectively, for mean daily atmospheric pressure) or atmospheric pressure variation (P = .464 and P = .816, respectively, for 24-hour change in mean daily atmospheric pressure) and AAA rupture risk.Conclusion:This study failed to support claims that atmospheric pressure causally affects AAA rupture risk. In interpreting our results, one should be aware that the range of atmospheric pressure observed in this study is not representative of the atmospheric pressure to which patients with AAA may be exposed, for example, during air travel or travel to high altitudes in the mountains. Making firm claims regarding these conditions in relation to AAA rupture risk is difficult at best. Furthermore, despite the fact that we used one of the largest case series to date to investigate the effect of atmospheric pressure on AAA rupture risk, it is possible that this study is simply too small to demonstrate a causal link.

Climatic influence on the risk of abdominal aortic aneurysm rupture

“…Referring to controls, most published studies, to-date, do not specify their sources, 13,14 or use days of non-ruptured cases. [7][8][9]15,16 In our opinion, selecting controls from nonruptured days (or from non ruptured periods) only, instead of a random selection of controls from days in the study period (including ruptures and non-ruptured days) introduces potential for selection bias error.…”

“…We analyzed 717 rAAA in a multicenter study. Most previously published studies analyze single-center data [7][8][9][13][14][15][16] or, at maximum, data from two different hospitals that include a lower number of cases, except three previous meta-analyses published in recent years. 8,18,19 Again, this reinforces the statistical power of our work, since we used a national database gathering information from all public hospitals in our region with admissions of rAAA (49 centers).…”

“…[7][8][9][10][11][12] Nonetheless, other publications demonstrate no relation between the incidence of rAAA and these conditions. [10][11][12][13][14][15][16] Some authors have shown a seasonal peak in the occurrence of rAAA, mostly in autumn and winter, 6,7,11,12,[15][16][17] but others have failed to prove this association. 8,9,14,15,[18][19][20][21] As noted above, the results of these investigations show a marked disparity, mainly because of biased publications, since most of these studies were performed in countries with severe winter conditions or with few meteorological variations between seasons.…”

“…[10][11][12][13][14][15][16] Some authors have shown a seasonal peak in the occurrence of rAAA, mostly in autumn and winter, 6,7,11,12,[15][16][17] but others have failed to prove this association. 8,9,14,15,[18][19][20][21] As noted above, the results of these investigations show a marked disparity, mainly because of biased publications, since most of these studies were performed in countries with severe winter conditions or with few meteorological variations between seasons. Also, most of the investigations were based on single-center experiences, with imprecise crude meteorological data and methodological biases.…”

“…7–12 Nonetheless, other publications demonstrate no relation between the incidence of rAAA and these conditions. 10–16 Some authors have shown a seasonal peak in the occurrence of rAAA, mostly in autumn and winter, 6,7,11,12,15–17 but others have failed to prove this association. 8,9,14,15,18–21…”