Environmental Science and Pollution Research

, Volume 26, Issue 30, pp 30866–30875 | Cite as

The hospitalization attributable burden of acute exacerbations of chronic obstructive pulmonary disease due to ambient air pollution in Shijiazhuang, China

  • Fangfang Qu
  • Feifei Liu
  • Huiran Zhang
  • Lingshan Chao
  • Jitao Guan
  • Rongqin Li
  • Fengxue Yu
  • Xixin YanEmail author
Research Article


Few studies have investigated the acute exacerbations of chronic obstructive pulmonary disease (AECOPD)-associated attributable burden under exposure to high levels of air pollution among Asians. Data on hospitalization for AECOPD, air pollution and meteorological factors from 1 January 2013 to 31 December 2016 were collected in Shijiazhuang, China. We used a Poisson generalized linear regression model combined with a distributed lag nonlinear model (DLNM) to evaluate the relative cumulative risk for a lag of 0–7 days and examined the potential effect modifications by age and sex via stratification analyses, controlling for long-term trends, seasonal patterns, meteorological factors, and other possible confounders. Then, we computed hospitalization percentages attributable to air pollutants. The AECOPD-associated relative cumulative risks for PM2.5, PM10, NO2, SO2, and CO for a lag of 0–7 days were significantly positively correlated with hospitalization. The associations were stronger in females and retired patients. The NO2 Cum RR of AECOPD admission was the greatest. A 10μg/m3 increase in daily NO2 concentration was associated with 6.7% and 5.7% increases in COPD hospitalizations in the retired and female groups, respectively. The results showed that 13%, 9.4%, 1.7%, 9.7%, and 8.8% of AECOPD hospitalizations were attributable to exposure to PM2.5, PM10, SO2, NO2, and CO, respectively. If the air pollutant concentration was reduced to the 24-h average grade II levels of NAAQS of China, the AECOPD attributable percentage for PM2.5 and PM10 would decrease by 80%. The air pollutants PM2.5, PM10, SO2, NO2, and CO were significantly relevant to AECOPD-associated hospitalization. The associations differed by individual characteristics. The retired and female populations were highly vulnerable.


Ambient air pollution AECOPD hospitalization Distributed lag nonlinear model Attributable percentage Concentration-response relation 



The authors thank the database of the Health Insurance Center of Shijiazhuang City for providing population support; we appreciate the Shijiazhuang Environmental Protection Department for providing air pollution monitoring data and Shijiazhuang Meteorological Bureau for providing meteorological data.

Funding information

This work is supported by the National Natural Science Foundation of China (81770020 to XY).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Fangfang Qu
    • 1
    • 2
  • Feifei Liu
    • 1
    • 2
  • Huiran Zhang
    • 1
    • 2
  • Lingshan Chao
    • 1
    • 2
  • Jitao Guan
    • 1
    • 2
  • Rongqin Li
    • 3
  • Fengxue Yu
    • 3
  • Xixin Yan
    • 1
    • 2
    Email author
  1. 1.Department of Respiratory and Critical Care MedicineThe Second Hospital of Hebei Medical UniversityShijiazhuangChina
  2. 2.Hebei Institute of Respiratory DiseaseShijiazhuangChina
  3. 3.Department of Central LaboratoryThe Second Hospital of Hebei Medical UniversityShijiazhuangChina

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