Air pollution and hospital admissions for diseases of the circulatory system in three U.S. metropolitan areas

Generalized additive models were used to analyze the time series of daily hospital admissions for cardiovascular and cerebrovascular diseases over the period of 1987-1995 in three major metropolitan areas--Cook County, IL; Los Angeles County, CA; and Maricopa County, AZ--in the United States. In Cook and Maricopa Counties, admissions information was only available for the elderly (ages 65 and over), while in Los Angeles County, admissions information was available for all ages. In Cook County, daily monitoring information was available on PM10, CO, SO2, NO2, and O3. In Los Angeles and Maricopa Counties, monitoring information was available daily on the gases, and information on PM10 was available every sixth day. In Los Angeles County, information on PM2.5 was also available every sixth day. In Cook and Los Angeles Counties, associations were found between each pollutant, with the exception of O3, and admissions for cardiovascular disease, with the gases showing the strongest associations. In two-pollutant models with PM and one of the gases, the effect of the gases remained stable, while the effect of PM became unstable and insignificant. In Maricopa County, the gases, with the exception of O3, were weakly associated with hospital admissions for cardiovascular disease, while PM was not. In two-pollutant models with two of CO, SO2, and NO2, the pattern of results is heterogeneous in the three counties. In all three counties, only weak evidence of any association between air pollution and cerebrovascular admissions was found.