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Pollution de l'air et arrêts cardiaques hors hôpital en Nord-Pas-de-Calais, France : approche principale en étude de cas-croisé stratifiée sur le temps

Abstract : Cardiac arrest is an important public issue. It refers to the sudden, unexpected loss of heart function, breathing and consciousness and usually results from an electrical disturbance in the heart. More than 85% of cardiac arrests are out-of-hospital cardiac arrests (OHCA). Overall survival rates remain low in most countries but vary widely across the world (range: 2–20%). In the general population, sudden cardiac death rates range from 4 to 5 million cases per year. Outdoor air pollution is a major environmental health problem. In 2013, it ranked as the fourth risk factor for global mortality and was estimated to cause 5,5 million deaths worldwide per year. Short-term exposure to air pollution especially with regard to fine particulate matter is increasingly associated in the literature with cardiovascular morbidity and mortality. A positive association can be found between fine particulate matter with an aerodynamic diameter under 2.5 μm (PM2.5) and OHCA in several studies, though the association remains insignificant in others. With respect to PM smaller than 10 microns (PM10), nitrogen dioxide (NO2), ozone (O3) and sulfur dioxide (SO2), the evaluation of risk of OHCA brings out inconsistent results. The way ambient air pollution and OHCA are related is still unclear. It might involve electrical disturbances and inflammatory reactions. The aim of our study is to investigate the effect of exposure to air pollution, on an hourly and daily scale, on the incidence of OHCA in Nord-Pas-de-Calais, France. Additional objectives were to investigate, among OHCA occurring during non-holiday periods, susceptible subgroups by sex, age, cause of the OHCA, diabetes status. The study included OHCA that occurred in the Nord-Pas-de-Calais region, France, in 2015. A time-stratified casecrossover study design coupled with a conditional logistic regression was primarily used to evaluate the association between OHCA and air pollutants (PM2,5, PM10, NO2, O3, SO2) measured within the hour of the arrest up to 5 days before. In all, 1039 cases were included. Most of the significant positive associations were found for PM2,5 and PM10 exposures and for OHCA during non-holiday periods. For the smallest p-value, the largest OR was : for all OHCA and within the subgroup of men, for the cumulative average twelve hours before the arrest of PM10 (OR=1,33, p<0,001 and OR=1,34, p=0,001 respectively) ; within the subgroup of age 50 to 75 years old, for the average on the day of the arrest of PM2,5 (OR=1,27, p<0,001) ; within the subgroup of arrests of cardiac cause, for the average four days before the arrest of PM2,5 (OR=1,26, p<0,001) ; within the subgroup of cases with diabetes, for the cumulative average four hours before the arrest of PM2,5 (OR=1,55, p=0,002).The findings show significant links between short-term exposure to particulate matter and OHCA during non-holiday periods, with susceptible subgroups (men, age 50 to 75 years old, OHCA of cardiac cause, and diabetics). Investigation of susceptible subgroups becomes especially important in epidemiological studies of air pollutants because of the small population-wide relative risks that are usually observed. The results of this study could encourage public authorities to implement specific policy recommendations aimed at vulnerable subgroups.
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Marie Albert Thananayagam. Pollution de l'air et arrêts cardiaques hors hôpital en Nord-Pas-de-Calais, France : approche principale en étude de cas-croisé stratifiée sur le temps. Médecine humaine et pathologie. Université du Droit et de la Santé - Lille II, 2018. Français. ⟨NNT : 2018LIL2S010⟩. ⟨tel-01997101⟩

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