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Background: Several studies reported a link between increases of particulate matter (PM) air pollution and cardiovascular diseases. However, only few reported consistent associations with Venous Thromboembolism (VTE), i.e., Pulmonary Embolism (PE) and Deep Vein Thrombosis (DVT), the third most frequent cardiovascular disease. Our aim was to estimate the association between hospital admissions for these clinical manifestation of VTE and PM concentrations at the national level in Italy.
Methods: We collected all hospital discharges during 2006-2015 from the Italian Ministry of Health. Daily counts of VTE, PE and DVT admissions in all the 8,094 municipalities were merged with daily and concentrations estimated by a satellite-based spatiotemporal model. First, we applied multivariate Poisson regression models at province level; then, we aggregated results by random-effects meta-analysis and obtained the overall effect at national level. We analyzed each outcome at different temporal latencies (lags), in the warm period (defined as April to September) and in the main urban areas.
Results: Analysis were conducted on 432,245 VTE hospitalizations (PE= 219,952; DVT= 275,506). National daily mean (standard deviation) concentrations of and were 23 (14) and 17 (12) , respectively. Meta-analytical results showed weak associations between PM concentrations and the study outcomes in the full year analysis. During the warm season and in the main urban areas, the daily relative increase of VTE admissions per 10 increment in same day was 3.4% (95% Confidence Intervals [CI]: -0.01; 6.93). Corresponding estimate for PE and DVT were 3.9% (95% CI: -0.51; 8.68) and 1.4% (95% CI: -2.61; 5.50).
Conclusions: This is the first study conducted in Europe to investigate the association between air pollutants and PE-DVT at national level. We found an immediate effect of on VTE only during the warm months and in the main urban areas.