Long‐Term Exposure to Particulate Air Pollution Is Associated With 30‐Day Readmissions and Hospital Visits Among Patients With Heart Failure
Background Long‐term air pollution exposure is a significant risk factor for inpatient hospital admissions in the general population. However, we lack information on whether long‐term air pollution exposure is a risk factor for hospital readmissions, particularly in individuals with elevated readmis...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.019430 |
| _version_ | 1797301682927828992 |
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| author | Cavin K. Ward‐Caviness, Mahdieh Danesh Yazdi, Joshua Moyer, Anne M. Weaver, Wayne E. Cascio, Qian Di, Joel D. Schwartz, David Diaz‐Sanchez, |
| author_facet | Cavin K. Ward‐Caviness, Mahdieh Danesh Yazdi, Joshua Moyer, Anne M. Weaver, Wayne E. Cascio, Qian Di, Joel D. Schwartz, David Diaz‐Sanchez, |
| author_sort | Cavin K. Ward‐Caviness, |
| collection | DOAJ |
| description | Background Long‐term air pollution exposure is a significant risk factor for inpatient hospital admissions in the general population. However, we lack information on whether long‐term air pollution exposure is a risk factor for hospital readmissions, particularly in individuals with elevated readmission rates. Methods and Results We determined the number of readmissions and total hospital visits (outpatient visits+emergency room visits+inpatient admissions) for 20 920 individuals with heart failure. We used quasi‐Poisson regression models to associate annual average fine particulate matter at the date of heart failure diagnosis with the number of hospital visits and 30‐day readmissions. We used inverse probability weights to balance the distribution of confounders and adjust for the competing risk of death. Models were adjusted for age, race, sex, smoking status, urbanicity, year of diagnosis, short‐term fine particulate matter exposure, comorbid disease, and socioeconomic status. A 1‐µg/m3 increase in fine particulate matter was associated with a 9.31% increase (95% CI, 7.85%–10.8%) in total hospital visits, a 4.35% increase (95% CI, 1.12%–7.68%) in inpatient admissions, and a 14.2% increase (95% CI, 8.41%–20.2%) in 30‐day readmissions. Associations were robust to different modeling approaches. Conclusions These results highlight the potential for air pollution to play a role in hospital use, particularly hospital visits and readmissions. Given the elevated frequency of hospitalizations and readmissions among patients with heart failure, these results also represent an important insight into modifiable environmental risk factors that may improve outcomes and reduce hospital use among patients with heart failure. |
| first_indexed | 2024-03-07T23:26:05Z |
| format | Article |
| id | doaj.art-c902c226f21940c9b077583d89a0e6ef |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T23:26:05Z |
| publishDate | 2021-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-c902c226f21940c9b077583d89a0e6ef2024-02-21T04:33:36ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-05-01101010.1161/JAHA.120.019430Long‐Term Exposure to Particulate Air Pollution Is Associated With 30‐Day Readmissions and Hospital Visits Among Patients With Heart FailureCavin K. Ward‐Caviness,0Mahdieh Danesh Yazdi,1Joshua Moyer,2Anne M. Weaver,3Wayne E. Cascio,4Qian Di,5Joel D. Schwartz,6David Diaz‐Sanchez,7Center for Public Health and Environmental Assessment US Environmental Protection Agency Chapel Hill NCDepartment of Environmental Health Harvard TH Chan School of Public Health Boston MACenter for Public Health and Environmental Assessment US Environmental Protection Agency Chapel Hill NCCenter for Public Health and Environmental Assessment US Environmental Protection Agency Chapel Hill NCCenter for Public Health and Environmental Assessment US Environmental Protection Agency Chapel Hill NCVanke School of Public Health Tsinghua University Beijing ChinaDepartment of Environmental Health Harvard TH Chan School of Public Health Boston MACenter for Public Health and Environmental Assessment US Environmental Protection Agency Chapel Hill NCBackground Long‐term air pollution exposure is a significant risk factor for inpatient hospital admissions in the general population. However, we lack information on whether long‐term air pollution exposure is a risk factor for hospital readmissions, particularly in individuals with elevated readmission rates. Methods and Results We determined the number of readmissions and total hospital visits (outpatient visits+emergency room visits+inpatient admissions) for 20 920 individuals with heart failure. We used quasi‐Poisson regression models to associate annual average fine particulate matter at the date of heart failure diagnosis with the number of hospital visits and 30‐day readmissions. We used inverse probability weights to balance the distribution of confounders and adjust for the competing risk of death. Models were adjusted for age, race, sex, smoking status, urbanicity, year of diagnosis, short‐term fine particulate matter exposure, comorbid disease, and socioeconomic status. A 1‐µg/m3 increase in fine particulate matter was associated with a 9.31% increase (95% CI, 7.85%–10.8%) in total hospital visits, a 4.35% increase (95% CI, 1.12%–7.68%) in inpatient admissions, and a 14.2% increase (95% CI, 8.41%–20.2%) in 30‐day readmissions. Associations were robust to different modeling approaches. Conclusions These results highlight the potential for air pollution to play a role in hospital use, particularly hospital visits and readmissions. Given the elevated frequency of hospitalizations and readmissions among patients with heart failure, these results also represent an important insight into modifiable environmental risk factors that may improve outcomes and reduce hospital use among patients with heart failure.https://www.ahajournals.org/doi/10.1161/JAHA.120.01943030‐day readmissionsair pollutionelectronic health recordsheart failurehospital usePM2.5 |
| spellingShingle | Cavin K. Ward‐Caviness, Mahdieh Danesh Yazdi, Joshua Moyer, Anne M. Weaver, Wayne E. Cascio, Qian Di, Joel D. Schwartz, David Diaz‐Sanchez, Long‐Term Exposure to Particulate Air Pollution Is Associated With 30‐Day Readmissions and Hospital Visits Among Patients With Heart Failure Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease 30‐day readmissions air pollution electronic health records heart failure hospital use PM2.5 |
| title | Long‐Term Exposure to Particulate Air Pollution Is Associated With 30‐Day Readmissions and Hospital Visits Among Patients With Heart Failure |
| title_full | Long‐Term Exposure to Particulate Air Pollution Is Associated With 30‐Day Readmissions and Hospital Visits Among Patients With Heart Failure |
| title_fullStr | Long‐Term Exposure to Particulate Air Pollution Is Associated With 30‐Day Readmissions and Hospital Visits Among Patients With Heart Failure |
| title_full_unstemmed | Long‐Term Exposure to Particulate Air Pollution Is Associated With 30‐Day Readmissions and Hospital Visits Among Patients With Heart Failure |
| title_short | Long‐Term Exposure to Particulate Air Pollution Is Associated With 30‐Day Readmissions and Hospital Visits Among Patients With Heart Failure |
| title_sort | long term exposure to particulate air pollution is associated with 30 day readmissions and hospital visits among patients with heart failure |
| topic | 30‐day readmissions air pollution electronic health records heart failure hospital use PM2.5 |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.019430 |
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