Associations between long-term fine particulate matter exposure and hospital procedures in heart failure patients
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Background and Aim Airborne particulate matter smaller than 2.5 µm in diameter (PM2.5) contributes to global morbidity and mortality. Changes in observed hospital procedures may indicate worsening health and drive healthcare costs. However, there are few studies which quantify PM2.5 impacts through the lens of hospital procedures. Methods We examined associations between annual average PM2.5 and hospital procedures observed among heart failure (HF) patients after HF diagnosis. Annual (365 day) averge PM2.5 was estimated at 1x1 km resolution, and the 365 days leading up to the HF diagnosis were averaged to estimate annual average PM2.5 exposure. The final study cohort was composed of 15,979 HF patients seen at the University of North Carolina Healthcare System from 2004-2016 with an average follow-up time of 2.94 years. We used quasipoisson models to model the percent change in the number of observed procedures over the follow-up time while adjusting for age at HF diagnosis, race, sex, year of visit, short-term PM2.5 exposure, and socioeconomic status. Results We examined 56 hospital procedures and observed significant (P < 0.05/56) associations between annual average PM2.5 exposure and 15 hospital procedures. We observed increases in procedures such as two view chest x-rays (6.99% change; 95% confidence interval = 5.47%, 8.54%) and echocardiograms (5.71% change; 95% confidence interval = 3.29%, 8.19%). Decreases were observed in stress test related procedures such as stress imaging tests involving regadenoson injections (-12.46% change; 95% confidence interval = -18.02%, -6.51%) and Technetium sestamibi radiological imaging which is used in myocardial perfusion scintigraphy in conjunction with exercise stress tests (-13.47% change; 95% confidence interval = -18.90%, -7.68%). Conclusions Long-term PM2.5 exposure is associated with significant changes in hospital procedures in HF patients. Overall, these associations give a unique lens into patient morbidity and hospital system operations and healthcare costs linked to PM2.5 exposure. These results to not necessarily represent EPA policy.