Air pollution and social deprivation as the risk factors of cardiovascular diseases in Poland

Abstract

Abstract Background The prevalence of cardiovascular diseases (I00-I99; ICD-10) is known to be higher in deprived and polluted areas. This Polish district-level study focuses on a possible synergistic effect of deprivation and PM-10 concentration on mortality and hospitalised morbidity due to I00-I99 in 2015-2017. Methods This study concerns all 141 districts where PM-10 has been monitored by the Chief Inspectorate of Environmental Protection. The Generalized Linear Model method was used to assess the contribution of PM-10 concentration, the deprivation index (DI, a published synthetic measure of district's social status), the percentage of urban dwellers in the district, and their interactions with PM-10 to age-standardised mortality and hospitalisation rates. Demographic data come from Statistics Poland, and the hospitalisation ones from NIPH-NIH. The analysis was conducted for males, females, their 65+ aged subcohorts, and general population. Results For all cohorts, PM-10 pollution significantly contributes to the increase in both hospitalisation and mortality rates (e.g. for males 7% [95%CI: 2-12%] and 12% [3-21%] per 10μg/m3, respectively). The deprivation impact is also significant (e.g. for males p = 0.004 and 0.006), the DI standardised regression coefficients exceed 2-3-fold these of PM-10. The PM-10 effect was found stronger in rural areas than in the urban ones. In the case of hospitalisation, no synergy was found between PM-10 and DI, while negative synergy effect was observed for mortality (e.g. p = 0.030 for males, 0.011 for males aged 65+). Conclusions Both deprivation and PM-10 concentration increase hospitalised morbidity and mortality due to I00-I99, however, only for hospitalisation is the effect additive. Unexpectedly, the impact of air pollution on mortality is lower in deprived areas. This effect is even stronger for older population. Key messages The impact of social status on mortality and hospitalised morbidity due to cardiovascular diseases in Poland exceeds that of the environmental factor (PM-10 concentration). The negative synergic effect of deprivation index and PM-10 concentration on mortality was identified - the impact of air pollution is lower in deprived areas.