¹ Unit of Epidemiology and Statistics, Valencian School of Health Studies (EVES), Spain
² Grup de Recerca en Estadística, Economia Aplicada i Salut (GRECS), Universitat de Girona. Spain
³ Escuela Andaluza de Salud Pública, Spain
⁴ DG Salud Pública. Comunidad de Madrid, Spain
⁵ Universidad de Santiago. Facultad de Medicina, Spain
⁶ Departamento de Sanidad Aragón, Spain
⁷ Centro Salud Pública, Castelló, Spain
⁸ Department of Health, Basque Government, Basque Country
⁹ Dirección Regional de Salud Pública, Asturias, Spain
¹⁰ Centro de Área, Cartagena, Murcia, Spain
¹¹ Universidad Pública de Navarra, Spain
¹² DG Salud Pública, Canarias, Spain

Correspondence to:
Correspondence to:
Dr F Ballester
Epidemiology and Statistics Unit, Escola Valenciana d’Estudis en Salut-EVES (Valencian School of Health Studies), c/Joan de Garay 21, 46017 Valencia, Spain; ballester_fer{at}gva.es

Objective: To evaluate the short term effect of air pollution on cardiovascular admissions in 14 Spanish cities

Methods: The period under study was from 1995 to 1999. Daily emergency admissions for all cardiovascular diseases (CVD) and heart diseases (HD) were obtained from hospital records, and the corresponding daily levels of particulates, SO₂, NO₂, CO, and ozone were recorded. The magnitude of association was estimated using Poisson generalised additive models controlling for confounding and overdispersion. For each cause, lagged effects, up to three days, of each pollutant were examined and combined estimates were obtained. For ozone the analyses were restricted to the warm period. One and two pollutant models were performed.

Results: Associations were more consistent in lag 0 (concurrent day) and 1 (lag 0–1), except in the case of ozone where there was a more delayed relation (lag 2–3). For combined estimates an increase of 10 µg/m³ in the PM₁₀ levels in lag 0–1 was associated with an increase of 0.9% (95% CI: 0.4 to 1.5%) in the number of hospital admissions for CVD, and 1.6% (0.8 to 2.3%) for HD. For ozone the corresponding estimates for lag 2–3 were 0.7% (0.3 to 1.0) for CVD, and 0.7% (0.1 to 1.2) for HD. An increase of 1 mg/m³ in CO levels was associated with an increase of 2.1% (0.7 to 3.5%) in CVD admissions, and 4.2% (1.3 to 7.1%) in HD admissions. SO₂ and NO₂ estimates were more sensitive in two pollutant models

Conclusions: A short term association between increases in daily levels of air pollutants and the number of daily admissions for cardiovascular diseases, with specificity for heart diseases, has been described in Spanish cities.

Abbreviations: CVD, cardiovascular disease; HD, heart disease; O₃, ozone; TSP, total suspended particle; BS, black smoke; CO, carbon monoxide; SO₂, sulphur dioxide; NO₂, nitrogen dioxide

Keywords: air pollution; cardiovascular diseases; hospital admissions; multicentre study

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