The association of daily sulfur dioxide air pollution levels with hospital admissions for cardiovascular diseases in Europe (The Aphea-II study)

The objective of this study is to assess the short-term effect of sulfur dioxide (SO2) air pollution levels on hospital admissions for cardiovascular diseases. Daily mean hospital admissions for cardiovascular diseases, ischemic heart diseases (IHDs), and stroke in seven European areas (the cities of Birmingham, London, Milan, Paris, Rome, and Stockholm, and in The Netherlands) participating in the multicenter European study of air pollution (Aphea-II), were measured. Time series analysis of daily hospital admission counts was performed using poison autoregressive models. A summary regression coefficient for all cities was provided. Daily numbers of all cardiovascular admissions except stroke, and particularly IHDs, rose significantly with an increase of daily SO2 levels of the same day and day before. After adjusting for PM10 (i.e. particles with size <10 &mu;m), the association of SO2 with IHD admissions remained significant (i.e. an increase of 0.7%; 95% confidence interval=0.1-1.3, per each 10 &mu;g/m(3) increase of SO2) among subjects younger than 65 years, but not among subjects older than 65. In the older group the increase was only significant for particles (1.3%; CI 0.7-1.8, per each increase in 10 &mu;g/m(3) of PM10). This study provides new evidence for the effects of urban air pollution on cardiac diseases in Europe, and suggests that SO2 Pollution may play an independent role in triggering ischemic cardiac events. From a Public Health perspective these results suggest that reduction in SO2 levels in European cities could imply a reduction of admissions for IHDs. (C) 2003 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.