Association of air pollution and atmospheric conditions on pulmonary embolism incidence and severity

Pulmonary embolism (PE) is a major cause of morbidity and mortality. In addition to traditional risk factors, environmental exposures such as air pollution and atmospheric conditions may influence PE risk, although existing evidence is inconsistent.

We aimed to investigate the association between particulate matter (PM), air temperature, and barometric pressure with PE incidence and severity.

In this cohort study, we included all PE cases diagnosed at the Vienna General Hospital, Austria, during a 4-year period. Daily averages of PM_2.5, PM₁₀, barometric pressure, and air temperature were obtained from local monitoring stations. A 10-day moving average (lag, 0-9 days) was calculated for each environmental parameter prior to PE diagnosis. Poisson regression was used to analyze associations with weekly PE incidence, and ordinal logistic regression assessed associations with PE severity, classified according to European Society of Cardiology guidelines.

Among 969 patients (median age, 64 years; 50.3% women), higher levels of PM_2.5, PM₁₀, and barometric pressure were significantly associated with increased PE incidence. Specifically, weekly PE incidence increased by 0.8% (95% CI, 0.0%-1.6%) per 1-μg/m³ PM_2.5, 0.9% (95% CI, 0.1%-1.6%) per 1-μg/m³ PM₁₀, and 1.8% (95% CI, 0.4%-3.1%) per 1-hPa increase. Associations were stronger in patients without known PE risk factors. Air temperature, modeled using a quadratic term, was not significantly associated with PE incidence (P = .052). None of the environmental parameters were linked to PE severity.

Our findings indicate that air pollution and atmospheric pressure are associated with increased PE incidence, emphasizing the potential contribution of environmental exposures to PE risk.