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1 1394/1/24 : 1393/1/19 : 1394 /3 / : SO 2 - :. PM 10 CO O 3 NO Stata. :. 10. :. :..(1)..(1) sadegh.ghazanfari@gmail.com : : : 1394 / 3 / 4 190

2 .....(4) ) JICA ( 1379.(5).. ) (.(6) (United States Environmental Protection Agency).. (CO) (PM 10 ) (NO 2 ). (SO 2 ).(2) (O 3 ) 2012.(3) (3) / 3 / 4

3 .. CO SO 2 PM 10 NO 2 O3..(10).(7)...(11-16).(7) ( ).(8) (9) ) 1386 ( /3 / 4 192

4 5.(17). 12 Stata ( 47) ( 1) 2890 ( 52) ( ) ().... O 3 PM 10 NO 2 SO 2 CO. ) ( :1 16/25 49/ CO, 24h (ppm) 18/39 42/ NO 2,, 24h (ppm ) 10/54 40/ SO 2, 24h ( ppm) 20/54 45/ O 3, 8h (ppm) 18/32 63/ PM 10, 24h (µg/m 3 ) / 3 / 4

5 :1 3.. NO 2.(2 ).. :3 ( ) :2 P-Value ( ) 0/0012-0/ ( ) 0/0061-0/ () 0/9511-0/ () 0/6296 0/ ( ) 0/0658-0/ (%) 4 P-Value 0/ 23 CO 0/ 12 O 3-0/ 19 NO 2 0/ 30 SO 2 0/001 0/ 09 PM /3 / 4 194

6 :4 P-Value Adjusted IRR 95% CI P-Value Crude IRR 95% CI 1/ / (1/ / (1/ /001347) 1/00162) 0/005 1 / (1/ /00162) 0/ (0/ / / (0/ / ) 0/225 0/ (0/ /000022) 1/ (1/ /002581) 1/ (1/ /00151) 1/ (1/ /002758) 1/ (1/ /000963) 1/ (1/ /000414) 1/ (1/ / / (1/ /000391) 0/003 1/ (1/ /000132) 0/002 1/ (1/ /000611) (1/ / /00072) (1/ /001597) 0/82 1/ (0/ /000549) 0/ (0/ / ) 0/009 0/ (0/ / ) 0/882 0/ (0/ /0004) 1/ (1/ /003817) 0/001 1/ (1/ / ) 1/ (1/ /003443) 0/013 1/ (1/ /000896) 0/138 1/ (0/ /000803) 0/01 1/ (1/ /001229) 0/046 1/ (0/ /000565) 0/632 1/ (0/ /000395) 1/ (1/ /000866) PM / 3 / 4

7 () :4 0/ (0/ / / (0/ /999432) 0/ (0/ / ) 1/ (1/ /593 1/ (0/ /001 1/ (1/ /00169) 0/000572) 1/003866) 0/ (0/ / (0/ / (0/ / (0/ / (0/ / (0/ / (0/ /002 0/ (0/ / (0/ /995992) 0/ ) 0/ ) 0/ ) 0/995041) 0/ ) 0/996184) 0/ ) 0/ ) 0/165 1/ (0/ /000207) 0/049 0/ (0/ /000027) 0/165 0/ (0/ /000207) 0/417 1/ (0/ /981 0/ (0/ /032 1/ (1/ /776 0/ /004086) 1/003187) 1/006578) (0/ / ) 0/022 0/ (0/ / ) 0/831 0/ (1/ /005 0/ (0/ /005 0/ (0/ / (0/ / (0/ / /005097) 0/ ) 0/ ) 0/996786) 0/ ) (0/ / ) 0/ (0/ / ).(18).(19) /3 / 4 196

8 (20) 10 1/3 1/22 1/49 10 Finnbjornsdottir.(21) 1/096 1/094 1/ (22) D'Ippoliti 10.(23).(24) / 3 / 4

9 References 1. Kampa M, Castanas E. Human health effect of air pollution. Environmental Pollution. 2008;151(2): Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, JAMA Mar 10;291(10): Naddafi K, Hassanvand MS, Yunesian M, Momeniha F, Nabizadeh R. Faridi S, et al. Health impact assessment of air pollution in megacity of Tehran, Iran. Iranian Journal of Environmental Health Sciences & Engineering. 2012; Safavi SY, Alijani B. Tehran air pollution. Geography Research Quarterly. 2006;58: Persian. 5. Armstrong B. Models for the relationship between ambient temperature and daily mortality. Epidemiology Nov;17(6): Basu R, Samet JM. Relation between elevated ambient temperature and mortality: a review of the epidemiologic evidence. Epidemiol Rev. 2002;24(2): Spencer FA, Goldberg RJ, Becker RC, Gore JM. Seasonal distribution of acute myocardial infarction in the second National Registry of Myocardial Infarction. J Am Coll Cardiol May;31(6): Kalkstein LS. A new approach to evaluate the impact of climate on human mortality. Environ Health Perspect Dec; 96: Gholizadeh MH, Farajzadeh M, Darand M. The correlation between air pollution and human mortality in Tehran. Hakim. 2009;12(2): Persian. 10. Ahmadi S, Najafi A, Roshani M. Tehran air quality report. Air Quality Control Company [cited 2014 May 20]. Available from: n/new/17.pdf 11. Peng RD, Bell ML, Geyh AS, McDermott A, Zeger SL, Samet JM, et al. Emergency admissions for cardiovascular and respiratory diseases and the chemical composition of fine particle air pollution. Environ Health Perspect Jun;117(6): Halonen JI, Lanki T, Yli-Tuomi T, Tiittanen P, Kulmala M, Pekkanen J. Particulate air pollution and acute cardiorespiratory hospital admissions and mortality among the elderly. Epidemiology Jan;20(1): Peel JL, Tolbert PE, Klein M, Metzger KB, Flanders WD, Todd K, et al. Ambient air pollution and respiratory emergency department visits. Epidemiology Mar;16(2): Oftedal B, Nafstad P, Magnus P, Bjørkly S, Skrondal A. Traffic related air pollution and acute hospital admission for respiratory diseases in Drammen, Norway Eur J Epidemiol. 2003;18(7): Wellenius GA, Schwartz J, Mittleman MA. Air pollution and hospital admissions for ischemic and hemorrhagic stroke among medicare beneficiaries. Stroke Dec;36(12): Lee SL, Wong WH, Lau YL. Association between air pollution and asthma admission among children in Hong Kong. Clin Exp Allergy Sep;36(9): Stock JH, Watson MW. A Simple Estimator of Cointegrating Vectors in Higher Order Integrated Systems. Econometrica. 1993; 61(4): Hashemi Y, Khanjani N, Soltaninejad Y, Momenzadeh R. Air Pollution and Cardiovascular Mortality in Kerman from 2006 to American Journal of Cardiovascular Disease Research. 2014;2(2): Hosseinpoor AR, Forouzanfar MH, Yunesian M, Asghari F, Naieni KH, Farhood D. Air pollution and hospitalization due to angina pectoris in Tehran, Iran: a time-series study. Environ Res Sep;99(1): Franck U, Leitte AM, Suppan P. Multiple exposures to airborne pollutants and hospital admissions due to diseases of the circulatory system in Santiago de Chile. Sci Total Environ Jan 15; : Shahi A, Omraninava A, Goli M, Soheilarezoomand HR, Mirzaei N. The effects of air pollution on cardiovascular and respiratory causes of emergency admission. Emergency. 2014;2(3): Finnbjornsdottir RG, Zoëga H, Olafsson O, Thorsteinsson T, Rafnsson V. Association of air pollution and use of glyceryl trinitrate against angina pectoris: a population-based case-crossover study. Environ Health Apr 30;12: D'Ippoliti D, Forastiere F, Ancona C, Agabiti N, Fusco D, Michelozzi P, et al. Air pollution and myocardial infarction in Rome: a case-crossover analysis. Epidemiology Sep;14(5): Mohammadi H. Relationship between climate factors and air pollutants in Tehran death from heart disease. Quarterly Geographical Research. 2006;58: Persian /3 / 4 198

10 Journal of Health & Development Original Article Vol. 4, No. 3, Autumn 2015 Received: Accepted: The Impact of Air Pollution on Emergency Admissions of Heart Attack Cases in Tehran: Abstract Sara Emamgholipoor Sefiddashti, Ali Akbari Sari, Sadegh Ghazanfari Introduction: Tehran is one of the most polluted cities in the world and the result is the incidence of different diseases. In this study data on the number of heart attacks, air pollutants and climatic factors during 2007 to 2011 were gathered to analyse the association between air pollution and heart attack. Methods: In this analytic-descriptive ecological study the effect of mean daily concentration of CO, O 3, NO 2, SO 2 and PM 10 on the daily number of heart attack admissions was investigated. Emergency admission data for heart attack was obtained from Tehran Emergency Center, pollutants data were inquired from Tehran Air Quality Control Corp and data for climatic factors were inquired from Tehran Meteorological Organization. Statistical analysis was performed using negative binominal regression and through Stata 12. Results: Results showed significant correlations between the number of heart attacks and daily concentrations of CO, NO 2, SO 2, O 3 and PM 10. Air pressure and mean minimum temperature were also significantly associated with the number of heart attacks admissions. Conclusion: With regard to the relationship between elevated air pollution and number of heart attacks in Tehran, immediate measures to control air pollutants in Tehran are recommended. Keywords: Emergency admission, Heart attack, Air pollutants, Tehran 1- Assistant Professor, Department of Management and Health Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran 2- Associate Professor, Department of Management and Health Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran 3- MSc Student, Department of Management and Health Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran Corresponding Author: Sadegh Ghazanfari sadegh.ghazanfari@gmail.com Adress: School of Public Health, Tehran University of Medical Science, Tehran Tel/Fax: /3 / 4