Respiratory disease admission has been increasing in the recent 5 years due to heavy air pollutions and bad weather conditions in China. We investigated the short-term association of ambient air pollution with daily counts of hospital admissions due to respiratory infection diseases with stratified analysis by age (0–18, 19–65, and > 65 years old), gender (male, female), season (spring, summer, autumn, winter), and disease type (lung infections, asthma, COPD (chronic obstructive disease), URI (upper respiratory infections)) in heavy polluted city of Shenyang in China. Daily ambient air pollution concentrations, weather conditions, and hospital admission counts for 53 months (from November 1, 2013 to March 25, 2018) were extracted from related authorities in electronic databases. Associations between outdoor air pollution levels and hospital admissions were estimated for time lags of 0–7 days using quasi-Poisson additive regression models, adjusted for meteorological variables, holidays, day of week, and season, as well as eliminating autocorrelations. Single pollutant analysis results showed lung infection diseases were related to all pollutant concentration change with no lag effects. After adjusting for other pollutants and confounding factors, we found NO2 was associated with daily admissions of lung infections (ER = 6.75%, 95% CI 1.24, 12.55), asthma (ER = 20.36%, 95% CI 4.26, 38.95; lag day 5, ER = 18.48%, 95% CI 2.83, 36.51), and COPD (ER = 13.27%, 95% CI 0.46, 27.71); CO was associated with lung infections and asthma with lag effects on lag days 1 and 4; and PM2.5 was associated with COPD admissions on lag day 6. Respiratory hospital admissions in female over 65 years old and autumn were more associated with increased air pollutant levels. Our study results might add more detail evidences for relationship studies between air pollution exposure and respiratory diseases and contribute to the precise respiratory disease prevention and air pollution control strategies.
Air pollution Lung infection COPD Asthma Hospital admission Time series analysis
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We acknowledgement for the data support from the Shenyang Environmental Monitoring Center and Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences.
Hehua Zhang and Qing Chang did all the data processing and paper writing work, and Yuhong Zhao designed the entire study process and review work.
This work was financially supported by the National Key Research and Development Project of China ([grant numbers 2017YFC0907402, 2017]).
Compliance with ethical standards
Ethics approval and consent to participate
This study did not involve any human or animal data and was qualified as negligible risk research and exempt from the ethical review of the Human Research Ethics Committee of the Shengjing Hospital of China Medical University; no consent was required.
The authors declare that they have no competing interests.
Atkinson RW, Kang S, Anderson HR, Mills IC, Walton HA (2014) Epidemiological time series studies of PM2.5 and daily mortality and hospital admissions: a systematic review and meta-analysis[J]. Thorax 69(7):660–665CrossRefGoogle Scholar
Baskaran K, Gasparrini A, Hajat S et al (2013) Time series regression studies in environmental epidemiology[J]. Int J Epidermiol 42(4):1187–1195CrossRefGoogle Scholar
Capraz O, Deniz A, Dogan N (2017) Effects of air pollution on respiratory hospital admissions in Istanbul, Turkey, 2013 to 2015[J]. Chemosphere 181:544–550CrossRefGoogle Scholar
Cheng Y, Kan H (2012) Effect of the interaction between outdoor air pollution and extreme temperature on daily mortality in Shanghai, China[J]. J Epidemiol 22(1):28–36CrossRefGoogle Scholar
Cirera L, Garcia-Marcos L, Gimenez J et al (2012) Daily effects of air pollutants and pollen types on asthma and COPD hospital emergency visits in the industrial and Mediterranean Spanish city of Cartagena[J]. Allergol Immunopathol (Madr) 40(4):231–237CrossRefGoogle Scholar
Cui J, Halbrook RS, Zang S et al (2018) Metal concentrations in homing pigeon lung tissue as a biomonitor of atmospheric pollution[J]. Ecotoxicology 27(2):169–174CrossRefGoogle Scholar
de Freitas CU, de Leon AP, Juger W et al (2016) Air pollution and its impacts on health in Vitoria, Espirito Santo, Brazil[J]. Rev Saude Publica 50:4CrossRefGoogle Scholar
Ferreira TM, Forti MC, de Freitas CU et al (2016) Effects of particulate matter and its chemical constituents on elderly hospital admissions due to circulatory and respiratory diseases[J]. Int J Environ Res Public Health:13(10)CrossRefGoogle Scholar
Gleason JA, Fagliano JA (2015) Associations of daily pediatric asthma emergency department visits with air pollution in Newark, NJ: utilizing time-series and case-crossover study designs[J]. J Asthma 52(8):815–822Google Scholar
Guo J, Ma M, Xiao C, Zhang C, Chen J, Lin H, du Y, Liu M (2018a) Association of air pollution and mortality of acute lower respiratory tract infections in Shenyang, China: a time series analysis study[J]. Iran J Public Health 47(9):1261–1271Google Scholar
Guo P, Feng W, Zheng M et al (2018b) Short-term associations of ambient air pollution and cause-specific emergency department visits in Guangzhou, China[J]. Sci Total Environ 613-614:306–313CrossRefGoogle Scholar
Jiang XQ, Mei XD, Feng D (2016) Air pollution and chronic airway diseases: what should people know and do?[J]. J Thorac Dis 8(1):E31–E40Google Scholar
Lee MK, Xu CJ, Carnes MU, Nichols CE, Ward JM, BIOS consortium, Kwon SO, Kim SY, Kim WJ, London SJ (2019) Genome-wide DNA methylation and long-term ambient air pollution exposure in Korean adults[J]. Clin Epigenetics 11(1):37CrossRefGoogle Scholar
Li D, Wang JB, Zhang ZY et al (2018) Effects of air pollution on hospital visits for pneumonia in children: a two-year analysis from China[J]. Environ Sci Pollut Res IntGoogle Scholar
Lindgren A, Stroh E, Montnemery P, et al. Traffic-related air pollution associated with prevalence of asthma and COPD/chronic bronchitis. A cross-sectional study in Southern Sweden[J]. Int J Health Geogr, 2009, 8:2CrossRefGoogle Scholar
Nhung N, Amini H, Schindler C, Kutlar Joss M, Dien TM, Probst-Hensch N, Perez L, Künzli N (2017) Short-term association between ambient air pollution and pneumonia in children: a systematic review and meta-analysis of time-series and case-crossover studies[J]. Environ Pollut 230:1000–1008CrossRefGoogle Scholar
Nhung N, Schindler C, Dien TM, Probst-Hensch N, Perez L, Künzli N (2018) Acute effects of ambient air pollution on lower respiratory infections in Hanoi children: an eight-year time series study[J]. Environ Int 110:139–148CrossRefGoogle Scholar
Park M, Luo S, Kwon J, et al. Effects of air pollution on asthma hospitalization rates in different age groups in metropolitan cities of Korea[J]. Air Qual Atmos Health, 2013,6(3)CrossRefGoogle Scholar
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[J]. Thorax 66(7):591–596CrossRefGoogle Scholar
Pearce JL, Neelon B, Bozigar M et al (2018) Associations between multipollutant day types and select cardiorespiratory outcomes in Columbia, South Carolina, 2002 to 2013[J]. Environ Epidemiol:2(4)CrossRefGoogle Scholar
Phung D, Hien TT, Linh HN, Luong LM, Morawska L, Chu C, Binh ND, Thai PK (2016) Air pollution and risk of respiratory and cardiovascular hospitalizations in the most populous city in Vietnam[J]. Sci Total Environ 557-558:322–330CrossRefGoogle Scholar
Pun VC, Yu IT, Qiu H et al (2014) Short-term associations of cause-specific emergency hospitalizations and particulate matter chemical components in Hong Kong[J]. Am J Epidemiol 179(9):1086–1095CrossRefGoogle Scholar
Rodopoulou S, Chalbot MC, Samoli E, Dubois DW, San Filippo BD, Kavouras IG (2014) Air pollution and hospital emergency room and admissions for cardiovascular and respiratory diseases in Dona Ana County, New Mexico[J]. Environ Res 129:39–46CrossRefGoogle Scholar
Rodopoulou S, Samoli E, Chalbot MC et al (2015) Air pollution and cardiovascular and respiratory emergency visits in Central Arkansas: a time-series analysis[J]. Sci Total Environ 536:872–879CrossRefGoogle Scholar
Slama A, Sliwczynski A, Woznica J et al (2019) Impact of air pollution on hospital admissions with a focus on respiratory diseases: a time-series multi-city analysis[J]. Environ Sci Pollut Res IntGoogle Scholar
Souza LS, Nascimento LF (2016) Air pollutants and hospital admission due to pneumonia in children: a time series analysis[J]. Rev Assoc Med Bras (1992) 62(2):151–156CrossRefGoogle Scholar
Vahedian M, Khanjani N, Mirzaee M et al (2017) Associations of short-term exposure to air pollution with respiratory hospital admissions in Arak, Iran[J]. J Environ Health Sci Eng 15:17CrossRefGoogle Scholar
Weissman DN (2015) Role of chest computed tomography in prevention of occupational respiratory disease: review of recent literature[J]. Semin Respir Crit Care Med 36(3):433–448CrossRefGoogle Scholar
Zhang Y, Wang SG, Ma YX, Shang KZ, Cheng YF, Li X, Ning GC, Zhao WJ, Li NR (2015) Association between ambient air pollution and hospital emergency admissions for respiratory and cardiovascular diseases in Beijing: a time series study[J]. Biomed Environ Sci 28(5):352–363Google Scholar
Zhang S, Li G, Tian L, Guo Q, Pan X (2016) Short-term exposure to air pollution and morbidity of COPD and asthma in east Asian area: a systematic review and meta-analysis[J]. Environ Res 148:15–23CrossRefGoogle Scholar
Zhang Z, Chai P, Wang J et al (2019) Association of particulate matter air pollution and hospital visits for respiratory diseases: a time-series study from China[J]. Environ Sci Pollut Res IntGoogle Scholar
Zhu L, Ge X, Chen Y et al (2017) Short-term effects of ambient air pollution and childhood lower respiratory diseases[J]. Sci Rep 7(1):4414CrossRefGoogle Scholar