Spatial analysis of ambient air pollution and cardiovascular disease (CVD) hospitalization across Sweden

The associations of multiple pollutants and cardiovascular disease (CVD) morbidity, and the spatial variations of these associations have not been nationally studied in Sweden. The main aim of this study was, thus, to spatially analyze the associations between ambient air pollution (black carbon, carbon monoxide, particulate matter (both <10 µm and <2.5 µm in diameter) and Sulfur oxides considered) and CVD admissions while controlling for neighborhood deprivation across Sweden from 2005 to 2010. Annual emission estimates across Sweden along with admission records for coronary heart disease, ischemic stroke, atherosclerotic and aortic disease were obtained and aggregated at Small Areas for Market Statistics level. Global associations were analyzed using global Poisson regression and spatially autoregressive Poisson regression models. Spatial non-stationarity of the associations was analyzed using Geographically Weighted Poisson Regression. Generally, weak but significant associations were observed between most of the air pollutants and CVD admissions. These associations were non-homogeneous, with more variability in the southern parts of Sweden. Our study demonstrates significant spatially varying associations between ambient air pollution and CVD admissions across Sweden and provides an empirical basis for developing healthcare policies and intervention strategies with more emphasis on local impacts of ambient air pollution on CVD outcomes in Sweden.