Intensive care admissions and outcomes associated with short-term exposure to ambient air pollution: a time series analysis

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Abstract
Purpose Short-term exposure to outdoor air pollution has been positively associated with numerous measures of acute morbidity and mortality, most consistently as excess cardiorespiratory disease associated with fine particulate matter (PM2.5), particularly in vulnerable populations. It is unknown if the critically ill, a vulnerable population with high levels of cardiorespiratory disease, is affected by air pollution. Methods We performed a time series analysis of emergency cardiorespiratory, stroke and sepsis intensive care (ICU) admissions for the years 2008-2016, using data from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS-APD). Case-crossover analysis was conducted to assess the relationship between air pollution and the frequency and severity of ICU admissions having adjusted for temperature, humidity, public holidays and influenza activity. Results 46,965 episodes in 87 separate ICUs were analysed. We found no statistically significant associations with admission counts. However, ICU admissions ending in death within 30 days were significantly positively associated with short-term exposure to PM2.5 [RR 1.18, 95% confidence interval (CI) 1.02-1.37, per 10 mu g/m(3) increase]. This association was more pronounced in those aged 65 and over (RR 1.33, 95% CI 1.11-1.58, per 10 mu g/m(3)). Conclusions Increased ICU mortality was associated with higher levels of PM2.5. Larger studies are required to determine if the frequency of ICU admissions is positively associated with short-term exposure to air pollution.

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