Advertisement

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

Abstract

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.

Keywords

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

Notes

Acknowledgments

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.

References

  1. Ambrose JA, Barua RS (2004) The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 43:1731–1737Google Scholar
  2. Bahrami Asl F, Leili M, Vaziri Y, Salahshour Arian S, Cristaldi A, Oliveri Conti G, Ferrante M (2018) Health impacts quantification of ambient air pollutants using AirQ model approach in Hamadan, Iran. Environ Res 161:114–121Google Scholar
  3. Bayram H, Sapsford RJ, Abdelaziz MM, Khair OA (2001) Effect of ozone and nitrogen dioxide on the release of proinflammatory mediators from bronchial epithelial cells of nonatopic nonasthmatic subjects and atopic asthmatic patients in vitro. J Allergy Clin Immunol 107:287–294Google Scholar
  4. Bazargani YT, de Boer A, Leufkens HG, Mantel-Teeuwisse AK (2014) Essential medicines for COPD and asthma in low and middle-income countries. Thorax 69:1149–1151Google Scholar
  5. Belleudi V, Faustini A, Stafoggia M, Cattani G, Marconi A, Perucci CA, Forastiere F (2010) Impact of fine and ultrafine particles on emergency hospital admissions for cardiac and respiratory diseases. Epidemiology 21:414–423Google Scholar
  6. Di Q, Dai L, Wang Y, Zanobetti A, Choirat C, Schwartz JD, Dominici F (2017) Association of short-term exposure to air pollution with mortality in older adults. JAMA 318:2446–2456Google Scholar
  7. Ding PH, Wang GS, Guo YL, Chang SC, Wan GH (2017) Urban air pollution and meteorological factors affect emergency department visits of elderly patients with chronic obstructive pulmonary disease in Taiwan. Environ Pollut 224:751–758Google Scholar
  8. Dominici F, Peng RD, Bell ML, Pham L, McDermott A, Zeger SL, Samet JM (2006) Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases. JAMA 295:1127–1134Google Scholar
  9. Ferrari U, Exner T, Wanka ER, Bergemann C, Meyer-Arnek J, Hildenbrand B, Tufman A, Heumann C, Huber RM, Bittner M, Fischer R (2012) Influence of air pressure, humidity, solar radiation, temperature, and wind speed on ambulatory visits due to chronic obstructive pulmonary disease in Bavaria, Germany. Int J Biometeorol 56:137–143Google Scholar
  10. Gasparrini A (2016) Modelling lagged associations in environmental time series data: a simulation study. Epidemiology 27:835–842Google Scholar
  11. Gasparrini A, Leone M (2014) Attributable risk from distributed lag models. BMC Med Res Methodol 14:55Google Scholar
  12. Gasparrini A, Guo Y, Hashizume M, Kinney PL, Petkova EP, Lavigne E, Zanobetti A, Schwartz JD, Tobias A, Leone M, Tong S, Honda Y, Kim H, Armstrong BG (2015a) Temporal variation in heat-mortality associations: a multicountry study. Environ Health Perspect 123:1200–1207Google Scholar
  13. Gasparrini A, Guo Y, Hashizume M, Lavigne E, Zanobetti A, Schwartz J, Tobias A, Tong S, Rocklöv J, Forsberg B, Leone M, de Sario M, Bell ML, Guo YLL, Wu CF, Kan H, Yi SM, de Sousa Zanotti Stagliorio Coelho M, Saldiva PHN, Honda Y, Kim H, Armstrong B (2015b) Mortality risk attributable to high and low ambient temperature: a multicountry observational study. Lancet 386:369–375Google Scholar
  14. Ghanbari Ghozikali M, Heibati B, Naddafi K, Kloog I, Oliveri Conti G, Polosa R, Ferrante M (2016) Evaluation of chronic obstructive pulmonary disease (COPD) attributed to atmospheric O3, NO2, and SO2 using Air Q model (2011-2012 year). Environ Res 144:99–105Google Scholar
  15. Ghio AJ, Carraway MS, Madden MC (2012) Composition of air pollution particles and oxidative stress in cells, tissues, and living systems. J Toxicol Environ Health B Crit Rev 15:1–21Google Scholar
  16. Gouveia N, de Freitas CU, Martins LC, Marcilio IO (2006) Respiratory and cardiovascular hospitalizations associated with air pollution in the city of Sao Paulo, Brazil. Cad Saude Publica 22:2669–2677Google Scholar
  17. Guarascio AJ, Ray SM, Finch CK, Self TH (2013) The clinical and economic burden of chronic obstructive pulmonary disease in the USA. Clinicoecon Outcomes Res 5:235–245Google Scholar
  18. Kan H, Chen B, Zhao N, London SJ, Song G, Chen G, Zhang Y, Jiang L, Committee HEIHR (2010) Part 1. A time-series study of ambient air pollution and daily mortality in Shanghai, China. Res Rep Health Eff Inst 17-78Google Scholar
  19. Khaniabadi YO, Daryanoosh SM, Hopke PK, Ferrante M, De Marco A, Sicard P, Oliveri Conti G, Goudarzi G, Basiri H, Mohammadi MJ, Keishams F (2017) Acute myocardial infarction and COPD attributed to ambient SO2 in Iran. Environ Res 156:683–687Google Scholar
  20. Ko FW, Hui DS (2012) Air pollution and chronic obstructive pulmonary disease. Respirology 17:395–401Google Scholar
  21. Ko FW, Tam W, Wong TW, Chan DP, Tung AH, Lai CK, Hui DS (2007) Temporal relationship between air pollutants and hospital admissions for chronic obstructive pulmonary disease in Hong Kong. Thorax 62:780–785Google Scholar
  22. Lam HC, Li AM, Chan EY, Goggins WB 3rd (2016) The short-term association between asthma hospitalisations, ambient temperature, other meteorological factors and air pollutants in Hong Kong: a time-series study. Thorax 71:1097–1109Google Scholar
  23. Li J, Sun S, Tang R, Qiu H, Huang Q, Mason TG, Tian L (2016a) Major air pollutants and risk of COPD exacerbations: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 11:3079–3091Google Scholar
  24. Li MH, Fan LC, Mao B, Yang JW, Choi AMK, Cao WJ, Xu JF (2016b) Short-term exposure to ambient fine particulate matter increases hospitalizations and mortality in COPD: a systematic review and meta-analysis. Chest 149:447–458Google Scholar
  25. Li R, Jiang N, Liu Q, Huang J, Guo X, Liu F, Gao Z (2017) Impact of air pollutants on outpatient visits for acute respiratory outcomes. Int J Environ Res Public Health 14:47Google Scholar
  26. Liu S, Zhou Y, Liu S, Chen X, Zou W, Zhao D, Li X, Pu J, Huang L, Chen J, Li B, Liu S, Ran P (2017) Association between exposure to ambient particulate matter and chronic obstructive pulmonary disease: results from a cross-sectional study in China. Thorax 72:788–795Google Scholar
  27. Mirza S, Clay RD, Koslow MA, Scanlon PD (2018) COPD guidelines: a review of the 2018 GOLD Report. Mayo Clin Proc 93:1488–1502Google Scholar
  28. Morgan G, Corbett S, Wlodarczyk J (1998) Air pollution and hospital admissions in Sydney, Australia, 1990 to 1994. Am J Public Health 88:1761–1766Google Scholar
  29. Morrow PE, Utell MJ, Bauer MA, Smeglin AM, Frampton MW, Cox C, Speers DM, Gibb FR (1992) Pulmonary performance of elderly normal subjects and subjects with chronic obstructive pulmonary disease exposed to 0.3 ppm nitrogen dioxide. Am Rev Respir Dis 145:291–300Google Scholar
  30. Oliveri Conti G, Heibati B, Kloog I, Fiore M, Ferrante M (2017) A review of AirQ Models and their applications for forecasting the air pollution health outcomes. Environ Sci Pollut Res Int 24:6426–6445Google Scholar
  31. Peacock JL, Anderson HR, Bremner SA, Marston L, Seemungal TA, Strachan DP, Wedzicha JA (2011) Outdoor air pollution and respiratory health in patients with COPD. Thorax 66:591–596Google Scholar
  32. Pope CA III, Burnett RT, Krewski D, Jerrett M, Shi Y, Calle EE, Thun MJ (2009) Cardiovascular mortality and exposure to airborne fine particulate matter and cigarette smoke: shape of the exposure-response relationship. Circulation 120:941–948Google Scholar
  33. Qiu H, Tan K, Long F, Wang L, Yu H, Deng R, Long H, Zhang Y, Pan J (2018a) The burden of COPD morbidity attributable to the interaction between ambient air pollution and temperature in Chengdu, China. Int J Environ Res Public Health 15. pii: E492Google Scholar
  34. Qiu H, Yu H, Wang L, Zhu X, Chen M, Zhou L, Deng R, Zhang Y, Pu X, Pan J (2018b) The burden of overall and cause-specific respiratory morbidity due to ambient air pollution in Sichuan Basin, China: a multi-city time-series analysis. Environ Res 167:428–436Google Scholar
  35. Schikowski T, Adam M, Marcon A, Cai Y, Vierkotter A, Carsin AE, Jacquemin B, al Kanani Z, Beelen R, Birk M, Bridevaux PO, Brunekeef B, Burney P, Cirach M, Cyrys J, de Hoogh K, de Marco R, de Nazelle A, Declercq C, Forsberg B, Hardy R, Heinrich J, Hoek G, Jarvis D, Keidel D, Kuh D, Kuhlbusch T, Migliore E, Mosler G, Nieuwenhuijsen MJ, Phuleria H, Rochat T, Schindler C, Villani S, Tsai MY, Zemp E, Hansell A, Kauffmann F, Sunyer J, Probst-Hensch N, Kramer U, Kunzli N (2014) Association of ambient air pollution with the prevalence and incidence of COPD. Eur Respir J 44:614–626Google Scholar
  36. Sun Q, Liu C, Chen R, Wang C, Li J, Sun J, Kan H, Cao J, Bai H (2019) Association of fine particulate matter on acute exacerbation of chronic obstructive pulmonary disease in Yancheng, China. Sci Total Environ 650:1665–1670Google Scholar
  37. Sunyer J, Basagana X, Belmonte J, Anto JM (2002) Effect of nitrogen dioxide and ozone on the risk of dying in patients with severe asthma. Thorax 57:687–693Google Scholar
  38. Tian S, Pan Y, Liu Z, Wen T, Wang Y (2014) Size-resolved aerosol chemical analysis of extreme haze pollution events during early 2013 in urban Beijing, China. J Hazard Mater 279:452–460Google Scholar
  39. Tsai SS, Chang CC, Yang CY (2013) Fine particulate air pollution and hospital admissions for chronic obstructive pulmonary disease: a case-crossover study in Taipei. Int J Environ Res Public Health 10:6015–6026Google Scholar
  40. Wang C, Xu J, Yang L, Xu Y, Zhang X, Bai C, Kang J, Ran P, Shen H, Wen F, Huang K, Yao W, Sun T, Shan G, Yang T, Lin Y, Wu S, Zhu J, Wang R, Shi Z, Zhao J, Ye X, Song Y, Wang Q, Zhou Y, Ding L, Yang T, Chen Y, Guo Y, Xiao F, Lu Y, Peng X, Zhang B, Xiao D, Chen CS, Wang Z, Zhang H, Bu X, Zhang X, An L, Zhang S, Cao Z, Zhan Q, Yang Y, Cao B, Dai H, Liang L, He J (2018) Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study. Lancet 391:1706–1717Google Scholar
  41. Wedzicha JA, Donaldson GC (2003) Exacerbations of chronic obstructive pulmonary disease. Respir Care 48:1204–1213 discussion 1213-5Google Scholar
  42. White AJ, Gompertz S, Stockley RA (2003) Chronic obstructive pulmonary disease . 6: The aetiology of exacerbations of chronic obstructive pulmonary disease. Thorax 58:73–80Google Scholar
  43. Winquist A, Kirrane E, Klein M, Strickland M, Darrow LA, Sarnat SE, Gass K, Mulholland J, Russell A, Tolbert P (2014) Joint effects of ambient air pollutants on pediatric asthma emergency department visits in Atlanta, 1998-2004. Epidemiology 25:666–673Google Scholar
  44. Yang J, Zhou M, Ou CQ, Yin P, Li M, Tong S, Gasparrini A, Liu X, Li J, Cao L, Wu H, Liu Q (2017) Seasonal variations of temperature-related mortality burden from cardiovascular disease and myocardial infarction in China. Environ Pollut 224:400–406Google Scholar
  45. Yarahmadi M, Hadei M, Nazari SSH, Conti GO, Alipour MR, Ferrante M, Shahsavani A (2018) Mortality assessment attributed to long-term exposure to fine particles in ambient air of the megacity of Tehran, Iran. Environ Sci Pollut Res Int 25:14254–14262Google Scholar
  46. Zeger SL, Thomas D, Dominici F, Samet JM, Schwartz J, Dockery D, Cohen A (2000) Exposure measurement error in time-series studies of air pollution: concepts and consequences. Environ Health Perspect 108:419–426Google Scholar

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

Personalised recommendations