DOI: 10.1161/circ.148.suppl_1.13295 ISSN: 0009-7322

Abstract 13295: The Effects of Short-Term Exposure to Fine Particulate Matter and Ozone on Attending Outpatient Clinic Visit Appointments Among Patients With Depressive Symptoms

Heidi T May, Daniel Bride, Tami L Bair, Viet T Le, Stacey Knight, Jeffrey L Anderson, Kirk U Knowlton, Elizabeth A Joy, Benjamin D Horne
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine
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Background: Air pollution is increasingly recognized as an environmental risk factor for mental health. However, data regarding the short-term influence on depressive symptoms are limited. It is known that depressed patients (pts) tend to be less adherent to prescribed medical regimens, including appointments. Therefore, we sought to determine how depression during times of increased particulate matter (PM 2.5 ) and ozone during winter inversion (Nov-Mar) and wildfire seasons (June-Oct) affected pt behavior of attending clinic visit appointments.

Methods: Pts (n=142,930) who completed a PHQ-9 as an outpatient between Mar 2003-Apr 2022 and resided on Utah’s Wasatch Front were studied. PHQ-9 results were used to classify depression by no depressive symptoms (<10) or any depressive symptoms (

>
10), with further stratification into severe (
>
20). A case-crossover design was used with odd ratios computed by Poisson regression.

Results: A total of 43% (n=60,724) of pts had depressive symptoms, with 25% (n=15,278) being severe. Depressed pts were younger (37 vs. 45 yrs), female (62% vs. 56%), more often smoked (24% vs. 17%), and had fewer comorbidities. The likelihood of attending clinic visits was decreased when the moving average (mAvg) of PM 2.5 was increased in the 2 days and week prior among those with depression, particularly when severe (Figure a). Levels of PM 2.5 on lag day 0 did not affect visit attendance. Increases in ozone were associated with a decrease in clinic attendance (Figure b). Air pollution levels >7 to 28 days prior were not associated with clinic attendance.

Conclusion: Short-term increases in air pollution, particularly in average PM 2.5 during inversion season, in the days and week prior were associated with a decrease in attending clinic visit appointments among depressed pts. These results could have healthcare delivery implications since people with depression were less likely to show up to non-emergent medical visits when the air has been polluted.

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