Risk and economic cost of hospitalization due to atrial fibrillation caused by air pollution: a multi-city time series analysis

Abstract

Background: Atrial fibrillation (AF) is the most common arrhythmia, resulting in serious cardiovascular diseases. Air pollution may cause heart rate disturbance, but there is no clear or consistent evidence that short-term exposure to air pollution leads to an increased risk of hospitalisation for symptomatic episodes of AF. This study aimed to assess the impact of short-term exposure to air pollution on inpatient numbers. Methods: The inpatient records of AF cases in nine cities of the Sichuan Province, China and air pollution and meteorological data from 183 monitoring stations from 2017 to 2018 were collected. The impact of short-term exposure to air pollution on AF inpatients was evaluated using a time-stratified crossover case study design. The economic burden of AF attributable to air pollution was also estimated. Results: A total of 5,958 patients with AF from 123 medical institutions were included in the analysis. Air pollutants had a significant impact on the number of patients with AF. The number increased by 2.5% (95% confidence interval [CI] = 1.006 to 1.044) and 1.8% (95% CI = 1.003–1.033) for every 10 µg/m3 increase in PM2.5, PM10, concentration, respectively. Moreover, the number increased by 12.7% (95% CI = 1.006 to 1.262) for every 10 µg/m3 increase of SO2 concentration. For every 0.1 μg/m3 increase in CO concentration, the number of inpatients with AF increased by 3.9% (95% CI = 1.010–1.070). People aged 65 years or older and women were more likely to be affected by air pollutants. The AF in 430 and 209 inpatients were attributable to PM2.5 and PM10, respectively. The total hospitalization expenses attributed to excessive exposure to PM2.5 and PM10 were 13.98 million CNY and 6.68 million CNY, respectively. Furthermore, the out-of-pocket expenses were 6.81 million CNY and 3.28 million CNY, respectively. Conclusions: This study showed a strong correlation between air pollution and AF. Hence, there is a need to reduce air pollution to control health risks.