Emergency hospital admissions for cardiovascular diseases attributed to air pollution in Tehran during 2016-2019

The burden of five main air pollutants, including CO, O3, NO2, SO2, and PM2.5, on the emergency department visits (EDVs) during January 2016-December 2019 due to all cardiovascular diseases was assessed in Tehran by using a time-series model. The pollutants data were collected from Iran Department of Environment including 10 air pollution monitoring stations for the period of our study. Cumulative relative risk and attributable number/fraction were calculated for each pollutants by a Quasi-Poisson time-series regression and distributed lag non-linear model (DLNM). The maximum lag was set to 14 days because harvesting effect is more likely happened during few days. We used percentile 25 as reference value in order to calculate cumulative relative risk and attributable fraction. About 69,000 patients with cardiovascular symptoms have been admitted into the hospital during 4 years. The cumulative relative risk during the 14 days was 1.13 (1.01, 1.26), 1.15 (1.02, 1.29), and 1.08 (1.01, 1.18) for CO, NO2, and PM2.5, respectively. The numbers attributed to all values of CO were more than others; about 3800 EDVs were significantly attributed to CO, of which over 3000 were significantly attributed to high values of the pollutant. Low values of all pollutants were, not surprisingly, responsible for low number of EDVs. PM2.5, CO, and NO2 were responsible to considerable attributable number of EDVs. Our study emphasizes the need for local authorities to establish a program to reduce the air pollution in Tehran.