Ambient carbon monoxide and the risk of cardiovascular disease emergency room visits: a time-series study in Lanzhou, China

Until now, the epidemiological evidence on the association between short-term exposure to ambient carbon monoxide (CO) and cardiovascular diseases (CVDs) is relatively lacking and controversial. This study aims to examine the relationship between ambient CO and daily emergency room visits (ERVs) for total and cause-specific CVD in Lanzhou, China. A distributed lag nonlinear model was used to examine the association. For every 1 mg/m 3 increase in the CO concentration, the relative risks of daily ERVs were 1.041 (95% CI: 1.017, 1.065) for total CVD, 1.065 (95% CI: 1.018, 1.114) for ischemic heart disease (IHD), 1.083 (95% CI: 1.020, 1.149) for heart rhythm disturbances (HRD), 1.062 (95% CI: 1.011, 1.115) for heart failure (HF), and 1.057 (95% CI: 1.017, 1.098) for cerebrovascular diseases (CD). For the two different gender subgroups, the short-term impact of CO on total CVD, IHD, and CD was relatively stronger for the females than for the males, while the opposite was true for HRD and HF. In the age subgroup analyses, the effect of ambient CO on total CVD and IHD appeared to be greater for the age ≥ 65 years group, while the opposite was true for HRD, HF, and CD. The associations for all disease categories were stronger in cold seasons than in warm seasons. We also observed a nearly linear correlation between CO and CVD ERVs. In conclusion, the study showed that exposure to ambient CO may increase the risks of ERVs for total and cause-specific CVD. Besides, CO-ERVs associations may vary by gender and age.