Abstract
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.
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References
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
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
Barnett AG, Fraser JF, Munck L (2012) The effects of the 2009 dust storm on emergency admissions to a hospital in Brisbane, Australia. Int J Biometeorol 56(4):719–726. https://doi.org/10.1007/s00484-011-0473-y
Bell ML, Son JY, Peng RD, Wang Y, Dominici F (2015) Ambient PM2.5 and risk of hospital admissions: do risks differ for men and women? Epidemiology 26(4):575–579. https://doi.org/10.1097/EDE.0000000000000310
Brunekreef B, Holgate ST (2002) Air pollution and health. Lancet 360(9341):1233–1242. https://doi.org/10.1016/s0140-6736(02)11274-8
Burns EA (2004) Effects of aging on immune function. J Nutr Health Aging 8(1):9–18 https://www.ncbi.nlm.nih.gov/pubmed/14730363
Cao J, Li W, Tan J, Song W, Xu X, Jiang C, Chen G, Chen R, Ma W, Chen B, Kan H (2009) Association of ambient air pollution with hospital outpatient and emergency room visits in Shanghai, China. Sci Total Environ 407(21):5531–5536. https://doi.org/10.1016/j.scitotenv.2009.07.021
Capraz O, Deniz A, Dogan N (2017) Effects of air pollution on respiratory hospital admissions in Istanbul, Turkey, 2013 to 2015. Chemosphere 181:544–550. https://doi.org/10.1016/j.chemosphere.2017.04.105
Denton M, Prus S, Walters V (2004) Gender differences in health: a Canadian study of the psychosocial, structural and behavioural determinants of health. Soc Sci Med 58(12):2585–2600. https://doi.org/10.1016/j.socscimed.2003.09.008
DeVries R, Kriebel D, Sama S (2017) Outdoor air pollution and COPD-related emergency department visits, hospital admissions, and mortality: a meta-analysis. COPD 14(1):113–121. https://doi.org/10.1080/15412555.2016.1216956
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(10):1127–1134. https://doi.org/10.1001/jama.295.10.1127
Gasparrini A (2011) Distributed lag linear and non-linear models in R: the package dlnm. J Stat Softw 43(8):1–20
Gasparrini A, Armstrong B, Kenward MG (2010) Distributed lag non-linear models. Stat Med 29(21):2224–2234. https://doi.org/10.1002/sim.3940
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
Guarnieri M, Balmes JR (2004) Outdoor air pollution and asthma. Lancet 383(9928):1581–1592. https://doi.org/10.1016/S0140-6736(14)60617-6
Hansel NN, McCormack MC, Kim V (2016) The effects of air pollution and temperature on COPD. COPD 13(3):372–379. https://doi.org/10.3109/15412555.2015.1089846
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
Ko FWS, Tam W, Wong TW, Chan DPS, Tung AH, Lai CKW, Hui DSC (2007) Temporal relationship between air pollutants and hospital admissions for chronic obstructive pulmonary disease in Hong Kong. Thorax 62(9):780–785. https://doi.org/10.1136/thx.2006.076166
Larrieu S, Lefranc A, Gault G, Chatignoux E, Couvy F, Jouves B, Filleul L (2009) Are the short-term effects of air pollution restricted to cardiorespiratory diseases? Am J Epidemiol 169(10):1201–1208. https://doi.org/10.1093/aje/kwp032
Li MH, Fan LC, Mao B, Yang JW, Choi AMK, Cao WJ, Xu JF (2016) Short-term exposure to ambient fine particulate matter increases hospitalizations and mortality in COPD: a systematic review and meta-analysis. Chest 149(2):447–458. https://doi.org/10.1378/chest.15-0513
Lokys HL, Junk J, Krein A (2018) Short-term effects of air quality and thermal stress on non-accidental morbidity-a multivariate meta-analysis comparing indices to single measures. Int J Biometeorol 62(1):17–27. https://doi.org/10.1007/s00484-017-1326-0
McCullagh P, Nelder JA (1989) Generalized linear models, 2nd edn. Chapman and Hall, London
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
Mitsakou C, Housiadas C, Eleftheriadis K, Vratolis S, Helmis C, Asimakopoulos D (2007) Lung deposition of fine and ultrafine particles outdoors and indoors during a cooking event and a no activity period. Indoor Air 17(2):143–152. https://doi.org/10.1111/j.1600-0668.2006.00464.x
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
Park M, Luo S, Kwon J, Stock T, Delclos G, Kim H, Yun-Chul H (2013) Effects of air pollution on asthma hospitalization rates in different age groups in metropolitan cities of Korea. Air Qual Atmos Health 6(3):543–551. https://doi.org/10.1007/s11869-013-0195-x
Peng RD, Dominici F, Pastor-Barriuso R, Zeger SL, Samet JM (2005) Seasonal analyses of air pollution and mortality in 100 US cities. Am J Epidemiol 161(6):585–594. https://doi.org/10.1093/aje/kwi075
Qiu H, Yu ITS, Tian LW, Wang XR, Tse LA, Tam W, Wong TW (2012) Effects of coarse particulate matter on emergency hospital admissions for respiratory diseases: a time-series analysis in Hong Kong. Environ Health Perspect 120(4):572–576. https://doi.org/10.1289/ehp.1104002
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
Schwela D (2000) Air pollution and health in urban areas. Rev Environ Health 15(1–2):13–42. https://doi.org/10.1515/REVEH.2000.15.1-2.13
Seaton A, Godden D, MacNee W, Donaldson K (1995) Particulate air pollution and acute health effects. Lancet 345(8943):176–178. https://doi.org/10.1016/S0140-6736(95)90173-6
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
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
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
Tao Y, Mi S, Zhou S, Wang S, Xie X (2014) Air pollution and hospital admissions for respiratory diseases in Lanzhou, China. Environ Pollut 185:196–201. https://doi.org/10.1016/j.envpol.2013.10.035
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
Xu Z, Crooks JL, Davies JM, Khan AF, Hu W, Tong S (2018) The association between ambient temperature and childhood asthma: a systematic review. Int J Biometeorol 62:1–11. https://doi.org/10.1007/s00484-017-1455-5
Zanobetti A, Schwartz J, Dockery DW (2000) Airborne particles are a risk factor for hospital admissions for heart and lung disease. Environ Health Perspect 108(11):1071–1077. https://doi.org/10.1289/ehp.001081071
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This research was supported by the National Natural Science Foundation of China (grant no. 71571176).
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Xie, J., Teng, J., Fan, Y. et al. The short-term effects of air pollutants on hospitalizations for respiratory disease in Hefei, China. Int J Biometeorol 63, 315–326 (2019). https://doi.org/10.1007/s00484-018-01665-y
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DOI: https://doi.org/10.1007/s00484-018-01665-y