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Risk factors for sudden death from fine particulate exposure
Citation:
Rappazzo, K., N. Egerstrom, S. Thota, A. Capone, S. Chen, G. Joodi, W. Cascio, AND R. Simpson. Risk factors for sudden death from fine particulate exposure. American Heart Association Scientific Sessions 2020, Dallas, TX, November 14 - 16, 2020.
Impact/Purpose:
To investigate potential modifiers of the PM2.5 sudden death association
Description:
Sudden death accounts for approximately 10% of deaths among working age adults and is associated with poor air quality. To identify high risk groups, we explored previously established associations of fine particulate matter (PM2.5) and sudden death stratified by potential risk factors for sudden death. Sudden death victims in Wake County, NC from 3/1/2013 – 2/28/2015 were identified by screening EMS reports and adjudicated based on EMS, medical, and death records (n=399). Daily PM2.5 concentrations for Wake County from the Air Quality Data Mart were linked to event and control periods for each individual. Using a case-crossover design, conditional logistic regression estimated OR (95%CI) for sudden death for a 5µg/m3 increase in PM2.5 with a 1-day lag, adjusted for temperature and humidity, across risk factor strata. Sensitivity analysis assessed consistency of main effects. Left ventricular hypertrophy (LVH) and neutrophil to lymphocyte ratio (NLR) were included as estimates of arrhythmic potential and inflammation, respectively. Low concentrations of PM2.5 are potential risk factors for sudden death (Table 1). However, no clear high-risk groups for PM2.5 exposure were identified. LVH and NLR, in contrast to presence of traditional risk factors, are associated PM2.5 and sudden death. Sensitivity analysis had no effect on the direction and minimal effect on the magnitude of the associations. Left ventricular hypertrophy and inflammation may be the final step in the mechanism whereby poor air quality and traditional risk factors trigger arrhythmia or myocardial ischemia and sudden death. This abstract does not necessarily reflect EPA policy.