Estimating the impact of temperature and air pollution on cardiopulmonary and diabetic health during the TORONTO 2015 Pan Am/Parapan Am Games

Abstract

Rationale The TORONTO 2015 Pan Am/Parapan Am Games will attract an estimated 260,000 visitors to Ontario in July and August of 2015. Temperature, humidity and air pollution have been shown to be important factors in modifying health service use for certain chronic diseases, including respiratory diseases1,2,3, hypertension2 and diabetes2,3. The objectives of this study were to determine the correlation between environmental factors (temperature, humidity and air pollution) and health service use in Ontario during summer months, and to predict health service use rates during the 2015 Pan Am/Parapan Am Games. Methods Exposure data (temperature, humidity and air pollution) were obtained from Ontario's Ministry of the Environment and from Health Canada for years 2003 to 2010. Health outcomes (hospitalizations, emergency department visits and outpatient claims) for all-causes, asthma, asthma-related conditions, diabetes and hypertension were measured using data provided by the Institute for Clinical Evaluative Sciences. Using ArcGIS, the geospatial patterns of exposures were described for regions of Ontario hosting events for the 2015 Games. A general linear model was used to determine the correlation between exposures and outcomes for all diseases of interest. Day of the week was corrected for in the general linear models. Average exposure levels, 95th percentile exposure levels and 99th percentile exposure levels from summer 2010 were used to predict health outcomes for July 2015. Results All-cause daily emergency department visit rates were strongly, positively correlated with increased daily maximum temperature in Pan Am regions of Ontario (R2 = 0.78, p-value for slope estimate <0.001). Significantly more emergency department visits can be expected during the Pan Am Games on days with elevated daily maximum temperature (Figure 1). In July 2010, temperature and air pollution levels in Pan Am regions of Ontario were highest around Toronto, which is also the most densely populated area that will be hosting Pan Am events. Estimated mean number of emergency department (ED) visits for all causes in the population currently living in Pan Am regions ("Normal population") and for the population expected to reside in Pan Am regions during the games ("Pan Am population"), at temperatures of 24.1degreeC, 30.6degreeC and 32.5degreeC, presented with 95% confidence intervals. Conclusion The availability of health services - particularly of emergency health services - will need to be increased during the Pan Am and Parapan Am Games in order to meet the increased need. Organizers of Pan Am and Parapan Am events should consider strategies to mitigate the effects of elevated temperatures, such as scheduling outdoor events earlier or later in the day to avoid peak temperatures. (Figure Presented).