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APHA Scientific Session and Event Listing

Recorded presentation

Michael Huerta, MD, MPH¹, Haim Bibi, MD², Jacob Haviv¹, Shimon Scharf¹, and Michael Gdalevich³. (1) Ben Gurion University - Barzilai Medical Center Campus, Ashkelon District Health Office, Ashkelon, 78306, Israel, +972-8-6745153, mhuerta@netvision.net.il, (2) Carmel Medical Center, Department of Pediatrics, Haifa, Israel, (3) Tel-Aviv University; Sackler Medical School, Barzilai Medical Center, Ashkelon District Health Office, Ashkelon, 78306, Israel

Background: The association between nitrogen oxides (NOx) in ambient air and acute health effects is well established. However, few studies have quantified the impact of NOx in Israel. Objective: To measure the effects of ambient NOx on cardiac emergency department (ED) patient load. Methods: We studied all consecutive 12-hour periods between January 2000 and April 2004. Half-hourly mean values were recorded for NOx and SO₂ concentration, temperature, barometric pressure, precipitation, and wind direction. Outcome data were based on ICD-9 codes representing acute cardiac syndromes presenting to a regional medical center. Cases/controls were periods with the highest/lowest ED patient volumes. For each 12-hour period, maximum and total NOx values were introduced as independent exposure variables. We compared mean NOx measurements during case and control periods, and constructed logistic regression models to estimate the effect of NOx on the risk of high-volume ED periods, while adjusting for additional air quality parameters. Results: Mean NOx concentrations were higher during case periods than during control periods. A 10 microgram/m³ increase in maximum NOx concentration was associated with an increased risk of high-volume cardiac patient load (OR 1.065, 95%CI 1.009-1.124). No association between NOx and cardiac ED outcomes was observed after 12-36 hour lag periods. Conclusion: The increased cardiac patient load associated with peak NOx concentrations is a marker of this pollutant's substantial impact on population health in Israel. The effects of NOx on cardiac syndromes are immediate and short-lived. Analysis using half-daily exposure periods facilitates a more refined analysis than do 24-hour windows.

Learning Objectives: At the end of this session the participant will be able to

(
• Cite methods for the study of the association between ambient NOx levels and acute health outcomes; (
• Identify potential confounders of this association; (
• Quantify the effects of ambient NOx on cardiac emergency department patient load.

Keywords: Air Pollutants, Environmental Health

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation