Cardiovascular Impacts of Air Pollution in a Coal-Burning Region: A Decade of Hospital Data from Western Macedonia, Greece

Air pollution constitutes a major environmental determinant of cardiovascular morbidity and mortality worldwide. Western Macedonia, Greece, has historically hosted the largest lignite mining and combustion complex in Southeastern Europe, creating a unique exposure environment. This study investigates the relationship between air pollutant concentrations and cardiovascular hospital admissions over a ten-year period in this lignite-dependent region. Daily concentrations of particulate matter (PM10), sulfur dioxide (SO2), nitric oxide (NO), nitrogen dioxide (NO2), and total nitrogen oxides (NOx) were collected from regional monitoring stations for the winters of 2011–2021, while corresponding daily cardiovascular hospital admissions were obtained from the regional hospitals of Kozani, Ptolemaida, Florina, and Grevena. Spearman’s rank correlations and Friedman’s non-parametric tests were applied to assess temporal and spatial associations between pollutant levels and hospital admissions. A marked decline in air pollutant concentrations, particularly PM10 and SO2, was observed across the decade, coinciding with a significant reduction in cardiovascular hospitalizations. Specifically, PM10 levels fell from ~75 μg/m3 to ~30 μg/m3 in Florina and from ~53 μg/m3 to ~11 μg/m3 in Ptolemaida, while SO2 concentrations decreased by more than 90% across all sites. Cardiovascular admissions declined by 20–40% depending on the region over the same period. Significant but modest positive correlations were detected between PM10 and admissions in Florina (ρ = 0.138, p = 0.017), SO2 in Ptolemaida (ρ = 0.122, p = 0.034), and NO2 in Kozani (ρ = 0.115, p = 0.045). Regions located near lignite combustion sites consistently exhibited higher pollutant levels and hospitalization rates. The study provides quantitative evidence linking air pollution from lignite combustion to adverse cardiovascular outcomes. The parallel decline in both pollution levels and hospital admissions underscores the cardiovascular benefits of emission reduction and the ongoing energy transition in Western Macedonia. Continuous air quality monitoring and preventive public health measures remain essential for safeguarding cardiovascular health in former coal-based regions.