Associations of short-term exposure to traffic-related air pollution with cardiovascular and respiratory hospital admissions in London, UK

Evangelia Samoli, Richard W Atkinson, Antonis Analitis, Gary W Fuller, David C Green, Ian Mudway, H Ross Anderson, Frank J Kelly, Evangelia Samoli, Richard W Atkinson, Antonis Analitis, Gary W Fuller, David C Green, Ian Mudway, H Ross Anderson, Frank J Kelly

Abstract

Objectives: There is evidence of adverse associations between short-term exposure to traffic-related pollution and health, but little is known about the relative contribution of the various sources and particulate constituents.

Methods: For each day for 2011-2012 in London, UK over 100 air pollutant metrics were assembled using monitors, modelling and chemical analyses. We selected a priori metrics indicative of traffic sources: general traffic, petrol exhaust, diesel exhaust and non-exhaust (mineral dust, brake and tyre wear). Using Poisson regression models, controlling for time-varying confounders, we derived effect estimates for cardiovascular and respiratory hospital admissions at prespecified lags and evaluated the sensitivity of estimates to multipollutant modelling and effect modification by season.

Results: For single day exposure, we found consistent associations between adult (15-64 years) cardiovascular and paediatric (0-14 years) respiratory admissions with elemental and black carbon (EC/BC), ranging from 0.56% to 1.65% increase per IQR change, and to a lesser degree with carbon monoxide (CO) and aluminium (Al). The average of past 7 days EC/BC exposure was associated with elderly (65+ years) cardiovascular admissions. Indicated associations were higher during the warm period of the year. Although effect estimates were sensitive to the adjustment for other pollutants they remained consistent in direction, indicating independence of associations from different sources, especially between diesel and petrol engines, as well as mineral dust.

Conclusions: Our results suggest that exhaust related pollutants are associated with increased numbers of adult cardiovascular and paediatric respiratory hospitalisations. More extensive monitoring in urban centres is required to further elucidate the associations.

Keywords: Hospital Admissions; Short-term exposure; Time series analysis; Traffic-related pollution.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Figures

Figure 1
Figure 1
Per cent change (and 95% CIs) in cardiovascular (A) and respiratory (B) hospital admissions associated with an IQR increase in traffic pollutants after single day exposure (lag 1 for cardiovascular and lag 2 for respiratory diagnoses) in London, UK for 2011–2012 during the warm (April–September) and cool (October–March) period of the year. EC/BC and metals are adjusted for particle mass.

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