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Leveraging Telemedicine to Assess Associations between Acute
Cardiovascular Events and Ambient Particulate Air Pollution in the Tel Aviv
and Haifa Metropolitan Areas
Multi-Year Research Grants
Research problem: Particulate matter (PM) air pollution in Israel is a major concern.
Annual mean concentrations of PM in the Tel Aviv and Haifa areas are higher than
in larger European cities. Cardiovascular morbidity is common in Israel. In 2009
there were more than 70,000 cardiac-related visits to the emergency room of subjects
over 45 years old. Numerous studies have pointed to adverse cardiovascular effects
due to PM air pollution, indicating a causal relationship between PM exposure and
cardiovascular morbidity. It has been shown that the acute event onset time is essential
for risk estimation, though this information is not yet broadly available. So far, there
is only scarce scientific data regarding this association in Israel.
Objectives: To utilize a large and internationally unique telemedicine dataset in order
to characterize the short term effects of PM on the cardiovascular system in two large
Israeli cities. We also expect to better characterize the critical window of exposure
to the incident cardiac events and subclinical changes, and explore how different
weather conditions impact the intensity of the relationships with PM.
Expected contribution to environment and health: The proposed research will help to
better understand the impacts of PM on cardiovascular disease on Israelis, for the first
time. By leveraging a telemedicine service, this work will elucidate the critical timing
of exposure to PM. Our work will identify sub-populations at increased risk and
weather events that confer additional risk. This will help target prevention programs,
create guidelines for susceptible individuals, and create efficient policies for managing
air quality.
Methods: The study population is comprised of telemedicine subscribers living in
the Tel Aviv and Haifa areas who called in relation to a cardiac event between 2002
and 2013. Cardiac events include phone calls for cardiac-related symptoms. Exposure
to PM is assessed for time periods ranging from a half-hour to several days prior to
the time of event. This study is a case-crossover design with time-stratified referent
selection. Distinct weather conditions are explored as effect modifiers. We also
explore relationships between air pollution levels and subclinical endpoints such as
arrhythmias using mixed effects models.
Ronit Nirel
1
| Alon Peretz
2
Uri Dayan
1
| Sara D. Adar
3
1. The Hebrew University
of Jerusalem
2. Rabin Medical Center
3. University of Michigan, USA
2012-