The short-term effects of air pollutants on hospitalizations for respiratory disease in Hefei, China
Previous studies have shown that ambient air pollution is associated with respiratory morbidity. However, the effects of air pollutants on health have rarely been studied in China. Our study aimed to estimate the short-term effects of particulate air pollutants on hospitalizations for three types of respiratory disease: pneumonia, chronic obstructive pulmonary disease (COPD), and asthma. We collected data on daily admissions for patients with each disease from the New Rural Cooperative Medical System (NRCMS) in Hefei, China. Daily records of air pollutants and meteorological data from January 2014 to March 2016 were also obtained. Distributed lag nonlinear models were employed in the analysis to evaluate the association between daily air pollutants and admissions. The highest effect of each pollutant on COPD hospital admission was observed with PM2.5 at lag 12 (RR = 1.068, 95% CI 1.017 to 1.121) and PM10 at lag 10 (RR = 1.031, 95% CI 1.002 to 1.060), for an increase of 10 μg/m3 in concentrations of the pollutants. The short-term effects of PM10 on asthma hospital admissions peaked at lag 12 (RR = 1.057, 95% CI 1.010 to 1.107). According to our stratified analysis, we found that the effects on COPD admission were more pronounced in the warm season than in the cold season, and the elderly (≥ 65 years) and females were more vulnerable to air pollution.
KeywordsAir pollution Respiratory disease Patient admission Short-term effects Distributed lag nonlinear models
This research was supported by the National Natural Science Foundation of China (grant no. 71571176).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- Anderson HR, Spix C, Medina S, Schouten JP, Castellsague J, Rossi G, Zmirou D, Touloumi G, Wojtyniak B, Ponka A, Bacharova L, Schwartz J, Katsouyanni K (1997) Air pollution and daily admissions for chronic obstructive pulmonary disease in 6 European cities: results from the APHEA project. Eur Respir J 10(5):1064–1071. https://doi.org/10.1183/09031936.97.10051064 Google Scholar
- Armstrong B (2006) Models for the relationship between ambient temperature and daily mortality. Epidemiology 17(6):624–631. https://doi.org/10.1097/01.ede.0000239732.50999.8f Google Scholar
- Gasparrini A (2011) Distributed lag linear and non-linear models in R: the package dlnm. J Stat Softw 43(8):1–20Google Scholar
- Greenpeace (2014) Bad to worse: ranking 74 Chinese cities by air pollution. http://www.greenpeace.org/eastasia/news/blog/bad-to-worse-ranking-74-chinese-cities-by-air/blog/48181/. Accessed 19 February 2014
- Katsouyanni K, Touloumi G, Samoli E, Gryparis A, Le Tertre A, Monopolis Y, Rossi G, Zmirou D, Ballester F, Boumghar A (2001) Confounding and effect modification in the short-term effects of ambient particles on total mortality: results from 29 European cities within the APHEA2 project. Epidemiology 12(5):521–531. https://doi.org/10.1097/00001648-200109000-00011 Google Scholar
- McCullagh P, Nelder JA (1989) Generalized linear models, 2nd edn. Chapman and Hall, LondonGoogle Scholar
- Ministry of Ecology and Environment of the People’s Republic of China (2012) Ambient Air Quality Standards (in Chinese). GB 3095–2012. http://kjs.mep.gov.cn/hjbhbz/bzwb/dqhjbh/dqhjzlbz/201203/W020120410330232398521.pdf. Accessed 29 February 2012
- Murray CS, Poletti G, Kebadze T, Morris J, Woodcock A, Johnston SL, Custovic A (2006) Study of modifiable risk factors for asthma exacerbations: virus infection and allergen exposure increase the risk of asthma hospital admissions in children. Thorax 61(5):376–382. https://doi.org/10.1136/thx.2005.042523 Google Scholar
- Samet JM, Dominici F, Curriero FC, Coursac I, Zeger SL (2000) Fine particulate air pollution and mortality in 20 US Cities, 1987–1994. N Engl J Med 343(24):1742–1749. https://doi.org/10.1056/nejm200012143432401
- Song QK, Christiani DC, Wang XR, Ren J (2014) The global contribution of outdoor air pollution to the incidence, prevalence, mortality and hospital admission for chronic obstructive pulmonary disease: a systematic review and meta-analysis. Int J Environ Res Public Health 11(11):11822–11832. https://doi.org/10.3390/ijerph111111822 Google Scholar
- Stafoggia M, Zauli-Sajani S, Pey J, Samoli E, Alessandrini E, Basagana X, Cernigliaro A, Chiusolo M, Demaria M, Diaz J, Faustini A, Katsouyanni K, Kelessis AG, Linares C, Marchesi S, Medina S, Pandolfi P, Perez N, Querol X, Randi G, Ranzi A, Tobias A, Forastiere F, Group M-PS (2016) Desert dust outbreaks in southern Europe: contribution to daily PM10 concentrations and short-term associations with mortality and hospital admissions. Environ Health Perspect 124(4):413–419. https://doi.org/10.1289/ehp.1409164 Google Scholar
- Stieb DM, Szyszkowicz M, Rowe BH, Leech JA (2009) Air pollution and emergency department visits for cardiac and respiratory conditions: a multi-city time-series analysis. Environ Health-Glob 8. https://doi.org/10.1186/1476-069X-8-25
- Sun SZ, Tian LW, Qiu H, Chan KP, Tsang H, Tang R, Lee RSY, Thach TQ, Wong CM (2016) The influence of pre-existing health conditions on short-term mortality risks of temperature: evidence from a prospective Chinese elderly cohort in Hong Kong. Environ Res 148:7–14. https://doi.org/10.1016/j.envres.2016.03.012 Google Scholar
- Weinmayr G, Romeo E, De Sario M, Weiland SK, Forastiere F (2009) Short-term effects of PM10 and NO2 on respiratory health among children with asthma or asthma-like symptoms: a systematic review and meta-analysis. Environ Health Perspect 118(4):449–457. https://doi.org/10.1289/ehp.0900844 Google Scholar