Air pollution exposure tied to increased diagnostic testing in adults with heart failure
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Key takeaways:
- Long-term exposure to air pollution is linked to an increase in hospital procedures for patients with heart failure.
- Stress tests, HbA1c screenings and prothrombin time tests were the most used procedures.
Adults with HF exposed to long-term fine particulate air matter pollution are more likely to receive in-hospital procedures, including HbA1c testing, prothrombin time tests and stress tests, researchers reported.
“Quantifying the relationship between elevated concentrations of ambient particulate matter and hospital procedures would provide further evidence of the impact of poor air quality on individual health,” Cavin Ward-Caviness, a computational biologist and principal investigator with the U.S. Environmental Protection Agency, and colleagues wrote in the study background. “Since hospital procedures are an indicator of patient morbidity and a driver of medical costs, and air pollution has been found to have a close temporal association with hospitalizations, studies investigating the associations between air pollution and hospital procedures may also present a new lens into understanding air pollution-associated health effects and the impacts of environmental exposures on the economics of the health care industry.”
Data were derived from Catalano S, et al. PLOS One. 2023;doi:10.1371/journal.pone.0283759.
Ward-Caviness and colleagues analyzed electronic health records data from 15,979 patients with HF who had at least one of 53 common (frequency > 10%) procedures using U.S. EPA CARES database, a resource that merges EHRs from the University of North Carolina Healthcare System with environmental exposure data. Researchers used daily modeled fine particulate matter (PM2.5) at 1x1 km resolution to estimate the annual average PM2.5 at the time of HF diagnosis.
Researchers estimated the associations between PM2.5 and the number of performed hospital procedures during an average follow-up time of 2.94 years through December 2016 or date of death, adjusting for age at HF diagnosis, race, sex, year of visit and socioeconomic status.
The findings were published in PLOS One.
A 1 g/m3 increase in annual average PM2.5 was associated with increased use of HbA1c testing (10.8%; 95% CI, 6.56-15.1), prothrombin time tests (15.8%; 95% CI, 9.07-22.9) and stress tests (6.84%; 95% CI, 3.65-10.1). Researchers found that the associations were attenuated after further adjustments for county-level access to health care and healthy foods; however, the associations with prothrombin time tests remained significant (1.46%; 95% CI, 0.71-2.22).
In Poisson mixed-effects models with a random intercept for ZIP code, the associations with the three significant procedures remained unchanged.
“Associations were robust to a range of modeling scenarios,” the researchers wrote. “Associations with prothrombin time tests were unchanged when restricted to exposures less than the current national standards, while associations with glycosylated hemoglobin were approximately halved and associations with stress tests attenuated towards the null. As each test may point towards a different underlying biological mechanism (hemostasis, cardiovascular function and glucose metabolism), these differences may give clues as to the different mechanisms of increased morbidity that may be seen among HF patients as the concentration (and potentially composition) of ambient PM2.5 changes.”
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Catalano S, et al. PLOS One. 2023;doi:10.1371/journal.pone.0283759.
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