Abstract
Many studies have examined the impact of air pollution on cardiovascular hospitalization (CVH), but few have looked at the delayed effects of air pollution on CVH. Additionally, there has been no research on the spatial and temporal differences in how environmental pollutants affect CVH. This study seeks to identify spatial heteroscedasticity in the relation between PM2.5 and CVH by developing a Generalized Additive Distributed Lag (GADL) model. Data on hospitalization due to cardiovascular disease were collected from the Hospital Information System (HIS) of Mashhad University of Medical Science from 2017 to 2020. Air pollution data from 22 air quality monitoring (AQM) stations were obtained from the Environmental Pollution Monitoring Center of Mashhad administrates. Markov Random Field (MRF) smoother was utilized in the GADL model to account for spatial heteroscedasticity in the observations. This developed model is a Spatial Heteroscedastic Generalized Additive Distributed Lag (SHGADL) model. Our use of GADL allowed us to discover a significant relationship between PM2.5 exposures and the risk of CVH at lags 0 and 1 in all districts. Our results reveal heteroscedasticity in the Relative Risks (RR) of PM2.5 on CVH across different districts. After accounting for this spatial heteroscedasticity, we found that the RR of PM2.5 on CVH at lags 0 and 1 were 1.0102 (95% CI: 1.0034, 1.0170) and 1.0043 (95% CI: 1.0009, 1.0078) respectively. The central and southeastern districts showed higher RR for CVH. The developed SHGADL model provides evidence of a significant lagged effect of PM2.5 exposures on CVH, and identifies low- and high-risk districts for CVH in Mashhad. This finding can assist decision-makers in allocating resources and planning strategically, with a focus on local interventions to manage ambient air pollution and providing emergency care for CVH.