Climatological variations in daily hospital admissions for acute coronary syndromes
Introduction
Hippocrates (430 BC), in his treatise “Of Airs, Waters and Places”, pointed out that environmental conditions play a role in the pathogenesis of disease. In recent years, several studies indicated that variations in ambient temperature correlated with mortality and morbidity rates [1], [2], [3], [4], [5], [6], [7], [8], [9]. In general, increased death rates occur principally in the elderly [1], [2], with the lowest death rates occurring on days of moderate temperature and highest rates at either end of the temperature range [10]. However, the strength of the association as well as the potential mechanisms to explain the association between climatological variations and human health is still under investigation, with both physiological and psychological mechanisms being suggested.
We examined the relationship between climatological indices (average, maximum and minimum daily temperature, relative humidity, wind speed, and barometric pressure) and admissions due to non-fatal acute coronary syndromes (ACS) in cardiology emergency units in the greater Athens area.
Section snippets
Study population
Between 1 January 2001 and 31 August 2002 we obtained the daily counts of admissions for non-fatal ACS in the emergency units from the five major Hospitals' (Hippokration, Evangelismos, Tzaneio, Alexandras and Red Cross) in the greater Athens area. The population in the investigated area is about 3.5 million (National Statistical Services, census 2001) and the selected hospitals cover about 77–80% of hospital admissions for cardiac events (personal information provided by the Ministry of
Daily hospital admissions
During the study period 5458 subjects were admitted for a non-fatal ACS in the selected hospitals, 4093 (75%) of them were males and 1365 (25%) were females. Approximately one half (n=2823, 51%) were over 65-years-old and 55 (1%) were below 35-years-old. The mean number of daily admissions was 9.3±3.5 persons per day, averaging 6.9±2.8 male (74%) and 2.4±1.5 female (26%). 55.7±2.4 were admitted due to unstable angina (61%) and 3.6±1.5 due to acute myocardial infarction (39%). Fig. 1 illustrates
Discussion
We evaluated the association between several climatologic parameters (temperature, humidity, wind speed and barometric pressure) and hospital admissions for non-fatal ACS (unstable angina or acute myocardial infarction) in the greater Athens area. Time-series analysis revealed a statistically significant association between ambient temperature and relative humidity and hospital admissions for ACS. This relationship was more marked in females and the elderly.
Several observational studies
Competing interests
None.
Authors' contributions
Demosthenes B. Panagiotakos, design of the study, statistical analysis and drafted the manuscript; Christina Chrysohoou, drafted the manuscript; Christos Pitsavos, design of the study and drafted the manuscript; Athanasios Paliatsos, editing; Panagiotis Nastos, climatological evaluation; Aggelos Anadiotis, design of the study and data collection; Constatninos Tentolouris, editing; Christodoulos Stefanadis, editing; and Pavlos Toutouzas, editing.
Acknowledgments
We thank the Hellenic Heart Foundation for financial support (research grant 11/2002).
References (28)
- et al.
Effects of a heat-wave on mortality-rates in elderly inpatients
Lancet
(1977) - et al.
The 1987 Athens heat wave
Lancet
(1988) Heart disease and the environment
J. Am. Coll. Cardiol.
(1993)- et al.
Mortality related to cold and air pollution in London after allowance for effects of associated weather patterns
Environ. Res.
(2001) - et al.
Increased winter mortality from acute myocardial infarction and stroke: the effect of age
J. Am. Coll. Cardiol.
(1999) - et al.
Cold weather and myocardial infarction
Int. J. Cardiol.
(1987) - et al.
The effect of ambient temperature and barometric pressure on ambulatory blood pressure variability
Am. J. Hypertens.
(2002) - et al.
Heat wave morbidity and mortality in old age
Age Ageing
(1985) - et al.
The effects of different vertical air temperatures on mental performance
Am. Ind. Hyg. Assoc. J.
(1987) Geomagnetic storms: association with incidence of depression as measured by hospital admission
Br. J. Psychiatry
(1994)
Climate change and human health
Science
Excess mortality in England and Wales, and in Greater London, during the 1995 heat wave
J. Epidemiol. Community Health
The urban environment and health in a world of increasing globalization: issues for developing countries
Bull. Who
Impact of hot temperatures on death in London: a time series approach
J. Epidemiol. Community Health
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