This reinforces the importance of the AQMAs set up within the

county in response to high-NOx levels. Road traffic is a large contributor to air pollution selleck chemical within Warwickshire. Diesel engines are responsible for a large part of the NOx component of these emissions. An unexpected result also appeared within our analysis. Particulate matter air pollution became significantly negatively correlated with heart failure morbidity and also mortality when incorporated into our model, with all risk factors taken into account and controlled for in this study. This would imply some sort of unexpected ‘protective influence’ from Pm air pollution on heart failure patients. This clearly contradicts our expectations and is at odds with

a wealth of existing evidence that indicates that Pm air pollution contributes risk to and exacerbates cardiovascular disease.4 We offer a possible explanation for this based on the following four observations: The aforementioned negative correlation of Pm air pollution with heart failure morbidity and mortality in our model. Pm air pollution actually varied very little across the county compared to the other types of air pollution. All types of air pollution tended to decrease in rural areas, but Pm tended to decrease much less compared to the other components of air pollution. Consequently, in rural areas of the county where most types of air pollution are significantly lower, Pm pollution was relatively higher compared to NOx, Benzene and SO2. There seems to be a high risk of heart failure deaths in urban centres (particularly Nuneaton, Bedworth, Warwick, Royal Leamington Spa and Kenilworth), higher than can be explained by our model. Conversely, there seems to be a particularly low risk of heart failure deaths in some rural areas within the western part of Stratford-on-Avon, lower than can be explained by our model. A possible hypothesis based on these observations is that there is an additional factor influencing

the morbidity and mortality of heart failure not looked at in this study, namely the urban/rural nature of a patient’s living environment. It could be the case that living in an urban environment contributed risk Dacomitinib and living in a rural area provided protection against heart failure morbidity and mortality. This would be an effect in addition to any increase in air pollution or social deprivation within urban settings compared to rural settings. This could certainly be plausible in principle, with people in rural areas perhaps doing more physical activity, eating more healthily, etc. If this were the case it would explain the excess deaths in urban centres found in this study. It could also be responsible for the unexpected protective factor attributed to Pm air pollution in our analysis.