Effects of ambient carbon monoxide on daily hospitalizations for cardiovascular disease: a time-stratified case-crossover study of 460,938 cases in Beijing, China from 2013 to 2017

Haibin Li, Jingwei Wu, Anxin Wang, Xia Li, Songxi Chen, Tianqi Wang, Endawoke Amsalu, Qi Gao, Yanxia Luo, Xinghua Yang, Wei Wang, Jin Guo, Yuming Guo, Xiuhua Guo

Research output: Contribution to journalArticleResearchpeer-review

5 Citations (Scopus)


Background: Evidence focused on exposure to ambient carbon monoxide (CO) and the risk of hospitalizations for cardiovascular diseases (CVD) is lacking in developing countries. This study aimed to examine the effect of CO exposure on hospitalizations for CVD in Beijing, China. Methods: A total of 460,938 hospitalizations for cardiovascular diseases were obtained from electronic hospitalization summary reports from 2013 to 2017. A time-stratified case-crossover design was conducted to investigate the association between CO exposure and hospitalizations for total and cause-specific CVD, including coronary heart disease (CHD), atrial fibrillation (AF), and heart failure (HF). Stratified analysis was also conducted by age group (18-64 years and ≥ 65 years) and sex. Results: Linear exposure-response curves for the association between ambient CO exposure and hospitalizations for CVD was observed. Ambient CO was positively associated with hospitalizations for total CVD and CHD. However, the observed increased risk was not statistically significant for hospitalizations for AF and HF. The strongest effect of CO concentration was observed on the current- and previous-day of exposure (lag 0-1 day). For a 1 mg/m3 increase in a 2-day moving average CO concentration, an increase of 2.8% [95% confidence interval (CI): 2.2 to 3.3%] and 3.0% (95% CI: 2.4 to 3.6%) in daily hospital admissions for CVD and CHD were estimated, respectively. This association was robust after adjusting for other copollutants and did not vary by age group and sex. Conclusions: Ambient CO exposure increased the risk of hospitalizations for CVD, especially for CHD in Beijing. Further studies are warranted to explore the association between ambient CO and hospitalizations for AF and HF.

Original languageEnglish
Article number82
Number of pages11
JournalEnvironmental Health: A Global Access Science Source
Issue number1
Publication statusPublished - 26 Nov 2018


  • Carbon monoxide
  • Cardiovascular disease
  • Hospitalizations

Cite this