Ambient air pollution and daily hospital admissions for respiratory system–related diseases in a heavy polluted city in Northeast China

  • Qing Chang
  • Hehua Zhang
  • Yuhong ZhaoEmail author
Research Article


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 



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.

Authors’ contributions

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.

Funding information

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.

Competing interests

The authors declare that they have no competing interests.

Supplementary material

11356_2020_7678_MOESM1_ESM.doc (77 kb)
ESM 1 (DOC 77 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of Graduate Medical TrainingShengjing Hospital of China Medical UniversityShenyangChina
  2. 2.Clinical Research CenterShengjing Hospital of China Medical UniversityShenyangChina
  3. 3.Clinical Research CenterShenjing Hospital of China Medical UniversityShenyangChina

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