Association of change in air quality with hospital admission for acute exacerbation of chronic obstructive pulmonary disease in Guangdong, China: A province-wide ecological study

The effect of air pollutants on COPD-hospitalized patients in Lanzhou, China (2015-2019)

Background

Lanzhou is the largest heavy industrial city in northwest China and it is a typical geographical valley-like city. However, there are few studies on the relationship between air pollutants and COPD, and their respective sample sizes are small, resulting in inconsistent results. The aim of this study is to analyze the effects of air pollutants on COPD hospitalizations in Lanzhou, China.

Methods

An ecological time series study with distributed lag non-linear model (DLNM) was used for analysis. Daily COPD hospitalization data in Lanzhou from 1 January 2015 to 31 December 2019 were collected from 25 hospitals, as well as air pollutant data and meteorological data.

Results

A total of 18,275 COPD hospitalizations were enrolled. For 10 μg/m3 increase in PM2.5, PM10, SO2, NO2, and 1 mg/m3 increase in CO at lag 07 day, the RR95%CI of COPD hospitalizations were 1.048 (1.030, 1.067), 1.008 (1.004, 1.013), 1.091 (1.048, 1.135), 1.043 (1.018, 1.068), and 1.160 (1.084, 1.242), respectively. The exposure-response curves between air pollutants (except O3-8h) and COPD hospitalizations were approximately linear with no thresholds. Female, and the harmful effect of PM on aged <65 years, the effect of gaseous pollutant on those aged ≥65 years, were stronger, particularly in the cold season. Exposure to air pollutants (except O3-8h) might increase the risk of COPD hospitalizations. O3-8h has a weak and unstable effect on COPD.

Conclusion

Exposure to air pollutants (except O3-8h) increases the risk of COPD hospitalizations. O3-8h has a weak and unstable effect on COPD hospital admissions. The harmful effect of gaseous pollutants (except O3-8h) on COPD-hospitalized patients was stronger than that of PM.

Associations Between Air Pollution and the Onset of Acute Exacerbations of COPD: A Time-Stratified Case-Crossover Study in China

BACKGROUND

Associations between air pollution and the acute exacerbations (AEs) of COPD have been established primarily in time-series studies in which exposure and case data were at the aggregate level, limiting the identification of susceptible populations.

RESEARCH QUESTION

Are air pollutants associated with the onset of AEs of COPD in China? Who is more susceptible to the effects of air pollutants?

STUDY DESIGN AND METHODS

Data regarding AEs of COPD were obtained from the Acute Exacerbation of Chronic Obstructive Pulmonary Disease Registry study, and air pollution data were assigned to individuals based on their residential address. We adopted a time-stratified case-crossover study design combined with conditional logistic regression models to estimate the associations between six air pollutants and AEs of COPD. Stratified analyses were performed by individual characteristics, disease severity, COPD types, and the season of exacerbations.

RESULTS

A total of 5,746 patients were included. At a 2-day lag, for each interquartile range increase in fine particulate matter (PM2.5) and inhalable particulate matter (PM10) concentrations, ORs for AEs of COPD were 1.054 (95% CI, 1.012-1.097) and 1.050 (95% CI, 1.009-1.092), respectively. The associations were more pronounced in participants who were younger than 65 years, had experienced at least one severe AE of COPD in the past year, received a diagnosis of COPD between 20 and 50 years of age, and experienced AEs of COPD in the cool seasons. By contrast, significant associations for nitrogen dioxide, sulfur dioxide, and carbon monoxide lost significance when excluding patients collected before 2020 or with larger distance from the monitoring station, and no significant association was observed for ozone.

INTERPRETATION

This study provides robust evidence that short-term exposure to PM2.5 and PM10 was associated with higher odds of AEs of COPD onset. Individuals who are young, have severe COPD, or whose first diagnosis of COPD was made when they were between 20 and 50 years of age and experience an exacerbation during the cooler seasons may be particularly susceptible.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT2657525; URL: www.

CLINICALTRIALS

gov.

Association between short-term ambient air pollution and outpatient visits for acute exacerbation of chronic obstructive pulmonary disease in Lanzhou, 2013-19

Evidence between air pollution and hospital visits for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is inconsistent and limited in China. In this study, we constructed a time-series study to evaluate the association between air pollution and AECOPD outpatient visits. Daily hospital outpatient visits for AECOPD in three top level hospitals in Lanzhou from January 2013 to December 2019, as well as the air pollutants and meteorological data in the same period, were collected. Then, generalized additive models with quasi-Poisson regression were utilized to estimate the associations with single-day lags from lag0 to lag7 and cumulative-day lag from lag01 to lag07. For example, lag0 referred to the concentration of air pollutants at the current day and lag1 referred to the previous-day air pollutant concentration and so on. Lag01 meant the average concentration of air pollutants at the current and previous day, and lag07 corresponded to the eight-day moving average value of the current and previous 7 days. In addition, stratified analyses were performed by gender, age, and season. The risk estimates were expressed in terms of the percentage changes (PC) in AECOPD outpatient visits per 10 µg/m³ increment of air pollutants (except that CO was per 1 mg/m³) and their respective 95% confidence intervals (CIs). The strongest effect on AECOPD morbidity was found lag07 for PM_2.5 (PC = 1.96, 95% CI 1.07, 2.86 per 10 μg/m³), lag03 for PM₁₀ (PC = 0.25, 95% CI 0.01, 0.49 per 10 μg/m³), lag05 for SO₂ (PC = 1.67, 95% CI 0.54, 3.93 per 10 μg/m³), and lag03 for NO₂ (PC = 1.37, 95% CI 0.25, 2.51 per 10 μg/m³). No significant association of O₃ and CO with AECOPD onset was found. In the subgroup analyses, the associations of PM_2.5 and SO₂ were more pronounced on males than female, the patients aged < 65 years were more vulnerable to PM_2.5 and NO₂, but 65-74 years old were more vulnerable to PM_2.5, SO₂, and NO₂. Patients aged ≥ 75 years suffered more from PM_2.5, PM₁₀, and SO₂. The associations between PM_2.5, PM₁₀, SO₂, NO₂, and AECOPD outpatients were stronger in the cold season than those in the hot season. From exposure-response curves, we observe linear relationships of PM_2.5, SO₂, NO₂, O₃8h, and CO with hospital outpatient visits for AECOPD. The increase in PM_2.5, PM₁₀, SO₂, and NO₂ concentration will lead to an increase in the number of outpatient visits for AECOPD and have different influence patterns in different genders, ages, and seasons.

Short-Term Effects of Carbon Monoxide on Morbidity of Chronic Obstructive Pulmonary Disease With Comorbidities in Beijing

The association between CO and chronic obstructive pulmonary disease (COPD) has been widely reported; however, the association among patients with type 2 diabetes mellitus (T2DM) or hypertension has remained largely unknown in China. Over-dispersed generalized additive model was adopted to quantity the associations between CO and COPD with T2DM or hypertension. Based on principal diagnosis, COPD cases were identified according to the International Classification of Diseases (J44), and a history of T2DM and hypertension was coded as E12 and I10-15, O10-15, P29, respectively. A total of 459,258 COPD cases were recorded from 2014 to 2019. Each interquartile range uptick in CO at lag 03 corresponded to 0.21% (95%CI: 0.08%-0.34%), 0.39% (95%CI: 0.13%-0.65%), 0.29% (95%CI: 0.13%-0.45%) and 0.27% (95%CI: 0.12%-0.43%) increment in admissions for COPD, COPD with T2DM, COPD with hypertension and COPD with both T2DM and hypertension, respectively. The effects of CO on COPD with T2DM (Z = 0.77, P = 0.444), COPD with hypertension (Z = 0.19, P = 0.234) and COPD with T2DM and hypertension (Z = 0.61, P = 0.543) were insignificantly higher than that on COPD. Stratification analysis showed that females were more vulnerable than males except for T2DM group (COPD: Z = 3.49, P < 0.001; COPD with T2DM: Z = 0.176, P = 0.079; COPD with hypertension: Z = 2.48, P = 0.013; COPD with both T2DM and hypertension: Z = 2.44, P = 0.014); No statistically significant difference could be found between age groups (COPD: Z = 1.63, P = 0.104; COPD with T2DM: Z = 0.23, P = 0.821; COPD with hypertension: Z = 0.53, P = 0.595; COPD with both T2DM and hypertension: Z = 0.71, P = 0.476); Higher effects appeared in cold seasons than warm seasons on COPD (Z = 0.320, P < 0.001). This study demonstrated an increased risk of COPD with comorbidities related to CO exposure in Beijing. We further provided important information on lag patterns, susceptible subgroups, and sensitive seasons, as well as the characteristics of the exposure-response curves.

Environmental pollution in North-Eastern Italy and its influence on chronic obstructive pulmonary disease: time series modelling and analysis using visibility graphs

The impact on human health from environmental pollution is receiving increasing attention. In the case of respiratory diseases such as chronic obstructive pulmonary disease (COPD), the relationship is now well documented. However, few studies have been carried out in areas with low population density and low industrial production, such as the province of Belluno (North-Eastern Italy). The aim of the study was to analyze the effect of exposure to certain pollutants on the temporal dynamics of hospital admissions for COPD in the province of Belluno. Daily air pollution concentration, humidity, precipitations, and temperature were collected from the air monitoring stations in Belluno. Generalized additive mixed models (GAMM) and visibility graphs were used to determine the effects of the short-term exposure to environmental agents on hospital admissions associated to COPD. In the case of the city of Belluno, the GAMM showed that hospital admissions were associated with NO₂, PM₁₀, date, and temperature, while for the city of Feltre, GAMM produced no associated variables. Several visibility graph indices (average edge overlap and interlayer mutual information) showed a significant overlap between environmental agents and hospital admission for both cities. Our study has shown that visibility graphs can be useful in establishing associations between environmental agents and COPD hospitalization in sparsely populated areas.

Air pollution and risk of respiratory and cardiovascular hospitalizations in a large city of the Mekong Delta Region

It is important to explore air pollution and health effects in developing cities for early prevention rather than waiting for conditions to deteriorate as in the current megacities. This study aims to investigate the short-term health effects of air pollution in a large city in the Mekong Delta Region (MDR) of Vietnam. Air pollution data from January 2015 to December 2018 were collected from the Environmental Monitoring Centre of Can Tho City. The data of respiratory and cardiovascular disease (CVD) admissions in 18 hospitals and medical centers were collected. A time-series regression analysis was conducted using distributed lag models to examine the relationship between the air pollutants and hospitalizations including the delayed effect up to 7 days. The research findings reveal that a 10 μg increase in PM₁₀ was associated with an increase of 2.5% in the risk of respiratory admission for all people and 2.2% in the risk of CVD admission for the elderly on the same day. The analysis stratified by age and sex indicates that PM10 resulted in a higher risk of respiratory admission among children (0-5 years old) and males compared with other groups. PM10 and NO₂ were significantly associated with CVD admission among the elderly at lag 4 and 6 days. The effects of other air pollutants (SO₂, O₃) were not observed in this study. As development continues in this region, there is an urgent need for intervention measures to minimize the health impacts associated with the expected increases in air pollution in the MDR.

Has the Risk of Outpatient Visits for Allergic Rhinitis, Related to Short-Term Exposure to Air Pollution, Changed over the Past Years in Beijing, China?

A number of studies have found associations between the short-term exposure to ambient air pollution and hospital admissions. However, little is known about the temporal variations in ambient air pollution associated with health exposure, especially in China. We evaluated whether the risks of allergic rhinitis (AR) outpatient visits from short-term exposure to air pollution varied over time (2014-2020) in Beijing, China. A quasi-Poisson generalized additive model was used to evaluate the relative risks (RRs) and 95% confidence intervals (CIs) associated with the pollutant concentrations during the entire study period and three specific periods. We also analyzed the temporal variations of the period-specific associations and tested the trend of change using the Mann-Kendall test. The concentration-response relationships for the specific periods were further investigated. The RRs (95%CI) for an interquartile range (IQR) increased in PM₁₀ (70 μg/m³) and CO (0.5 mg/m³) decreased from period 1 to period 3. However, The RRs (95%CI) of PM_2.5 (55 μg/m³), SO₂ (7 μg/m³) and NO₂ (27 μg/m³) increased from 1.015 (0.978, 1.054), 1.027 (1.009, 1.044) and 1.086 (1.037, 1.137) in period 1 to 1.069 (1.005, 1.135), 1.074 (1.003, 1.149) and 1.214 (1.149, 1.282) in period 3, respectively. A statistically significant temporal change and the stable effects were observed between the NO₂ exposure and AR visits over time. Despite a substantial reduction in ambient air pollution, the short-term effects on AR outpatient visits remained significant. Our findings provide a rationale for continued air pollution control efforts in the future to minimize air pollution and to protect the public.

Ambient air pollutants relate to hospital admissions for chronic obstructive pulmonary disease in Ganzhou, China

OBJECTIVE

To evaluate the relationship between ambient air pollutants and chronic obstructive pulmonary disease in relatively low-polluted areas in China.

METHODS

Atmospheric pollutants levels and meteorological data were obtained from January 2016 to December 2020. The medical database including daily hospital admissions for chronic obstructive pulmonary disease (ICD10: J44) was derived from the First Affiliated Hospital of Gannan Medical University. The generalized additive model was used to analyze the percentage change with 95% confidence interval in daily hospital admissions for chronic obstructive pulmonary disease associated with a 10 µg/m3 increase in atmospheric pollutants levels.

RESULTS

In total, occurred 4,980 chronic obstructive pulmonary disease hospital admissions (not including emergency department visits) during 2016-2020. The mean concentrations of daily PM2.5, PM10, SO2, NO2, O3, and CO were 37.5 μg/m3, 60.1 μg/m3, 18.7 μg/m3, 23.5 μg/m3, 70.0 μg/m3, and 1.2 mg/m3 in Ganzhou. Each 10 µg/m3 increment of PM2.5, PM10, NO2, and O3 were significantly associated with 2.8% (95%CI: 1.0-4.7), 1.3% (95%CI: 0.3-2.4), 2.8% (95%CI: 0.4-5.4), and 1.5% (95%CI: 0.2-2.7) elevation in daily chronic obstructive pulmonary disease hospital admissions. The estimates of delayed effects of PM2.5, PM10, NO2, and O3 were observed at lag6, lag6, lag8, lag1, respectively. The health effects of particulate pollutants (PM2.5 and PM10) may be independent of other pollutants. The adverse effects of air pollutants were more evident in the warm season (May-Oct) than in the cold season (Nov-Apr).

CONCLUSION

Our study demonstrated that elevated concentrations of atmospheric pollutant (PM2.5, PM10, NO2, and O3), especially particulate pollutants, can be associated with increased daily count of hospital admissions for chronic obstructive pulmonary disease , which may promote further understanding of the potential hazards of relatively low levels of air pollution on chronic obstructive pulmonary disease and other respiratory disorders.

Broiler responses to copper levels and sources: growth, tissue mineral content, antioxidant status and mRNA expression of genes involved in lipid and protein metabolism

BACKGROUND

Five hundred 8-d old male broilers Cobb500 were randomly allotted into 10 treatments in factorial arrangement with 5 Cu levels (0, 4, 8, 12, and 16 mg/kg), and 2 sources (Cu proteinate, CuPro and Cu sulphate, CuSO4.5H2O) for a 10-d-experiment.

RESULTS

Feed conversion ratio (FCR) was better (P < 0.05) in CuPro fed chicks compared with CuSO4.5H2O group. Average daily feed intake (ADFI) decreased linearly (P < 0.05) as dietary Cu increased. A quadratic response (P < 0.05) to Cu levels was found for FCR, being optimized at 9.87 and 8.84 mg Cu/kg in CuPro and CuSO4.5H2O diets, respectively. Copper supplementation linearly increased liver Cu content (P < 0.05) and tended to linearly increase (P = 0.07) phosphorus (P) and copper in tibia. Manganese and zinc were higher (P < 0.05) in tibia of CuPro fed birds. Broilers fed CuPro exhibited lower liver iron (P < 0.05) content, lower activities of Cu, Zn superoxide dismutase (CuZnSOD) in breast muscle and liver, and glutathione peroxidase in liver. Glutathione peroxidase reduced linearly (P < 0.05) with CuPro levels and increased linearly (P < 0.05) with CuSO4.5H2O levels and were lower (P < 0.05) in all CuPro levels in breast muscle. Breast muscle malondialdehyde concentration tended to be higher (P = 0.08) in broilers fed CuSO4.5H2O. Copper levels linearly increased (P < 0.05) metallothionein (MT) and malate dehydrogenase (MDH) expression in liver, and six-transmembrane epithelial antigen of the prostate-1 (STEAP-1) in the intestine. Copper elicited a quadratic response (P < 0.050) in AKT-1 and mammalian target of rapamycin (mTOR) in breast muscle, CuZnSOD in liver and antioxidant 1 copper chaperone (ATOX 1) in intestine. Broilers fed CuPro exhibited higher mRNA expression of mTOR in muscle breast and lower CuZnSOD in liver and ATOX 1 in intestine. Interaction (P < 0.05) between levels and sources was found in mRNA expression for GSK-3β, MT, and CuZnSOD in breast muscle, FAS and LPL in liver and MT and CTR1 in intestine.

CONCLUSIONS

CuPro showed beneficial effects on feed conversion and bone mineralization. Organic and inorganic Cu requirements are 9.87 and 8.84 mg Cu/kg, respectively.

Association of PM2.5 and PM10 with Acute Exacerbation of Chronic Obstructive Pulmonary Disease at lag0 to lag7: A Systematic Review and Meta-Analysis

This study aimed to conduct a meta-analysis to investigate whether short-term exposure to fine (PM_2.5) and coarse (PM₁₀) particulate matter was associated with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) hospitalization, emergency room visit, and outpatient visit at different lag values. PubMed, Embase, and the Cochrane Library were searched for relevant papers published up to March 2021. For studies reporting results per 1-µg/m³ increase in PM_2.5, the results were recalculated as per 10-µg/m³ increase. We manually calculated the RRs for these two studies and transferred the RRs to estimate 10 µg/m³ increases in PM_2.5. Automation tools were initially used to remove ineligible studies. Two reviewers independently screened the remaining records and retrieved reports. Twenty-six studies (28 datasets; 7,018,419 patients) were included. There was a significant association between PM_2.5 and AECOPD events on lag0 (ES = 1.01, 95%CI: 1.01-1.02, p < 0.001; I²=88.6%, P_{heterogeneity}<0.001), lag1 (ES = 1.00, 95%CI: 1.00-1.01, p < 0.001; I²=82.5%, P_{heterogeneity}<0.001), lag2 (ES = 1.01, 95%CI: 1.01-1.01, p < 0.001; I²=90.6%, P_{heterogeneity}<0.001), lag3 (ES = 1.01, 95%CI: 1.00-1.01, p < 0.001; I²=88.9%, P_{heterogeneity}<0.001), lag4 (ES = 1.00, 95%CI: 1.00-1.01, p < 0.001; I²=83.7%, P_{heterogeneity}<0.001), and lag7 (ES = 1.00, 95%CI: 1.00-1.00, p < 0.001; I²=0.0%, P_{heterogeneity}=0.743). The subgroup analyses showed that PM_2.5 influenced the rates of hospitalization, emergency room visits, and outpatient visits. Similar trends were observed with PM₁₀. The risk of AECOPD events (hospitalization, emergency room visit, and outpatient visit) was significantly increased with a 10-µg/m³ increment in PM_2.5 and PM₁₀ from lag0 to lag7.List Of Abbreviations: particulate matter (PM_2.5 and PM₁₀); acute exacerbation of chronic obstructive pulmonary disease (AECOPD); Chronic obstructive pulmonary disease (COPD); Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA); Effect sizes [48]; confidence intervals (CIs).

Air Pollution Exposure as a Relevant Risk Factor for Chronic Obstructive Pulmonary Disease Exacerbations in Male and Female Patients

Chronic obstructive pulmonary disease (COPD) is a multifactorial lung inflammatory disease that affects 174 million people worldwide, with a recently reported increased incidence in female patients. Patients with COPD are especially vulnerable to the detrimental effects of environmental exposures, especially from air particulate and gaseous pollutants; exposure to air pollution severely influences COPD outcomes, resulting in acute exacerbations, hospitalisations, and death. Here, a literature review of the recent work addressing air pollution-induced acute exacerbations of COPD (AECOPD) was conducted in order to determine whether sex was considered as a biological variable in these studies, and whether air pollution exposure affected patients with COPD in a sex-specific manner. It was found that, while the majority of studies enrolled both male and female patients, only a few reported results were disaggregated by sex. Most studies had a higher enrolment of male patients, only four compared AECOPD outcomes between sexes, and only one study identified sex differences in AECOPD, with females displaying higher rates. Overall, this analysis of the literature confirmed that air pollution exposure is a trigger for AECOPD hospitalisations and revealed a significant gap in the knowledge of sex-specific effects of air pollutants on COPD outcomes, highlighting the need for more studies to consider sex as a biological variable.

Short-Term Air Pollution Exposure and Risk of Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Korea: A National Time-Stratified Case-Crossover Study

We investigated the association between short-term exposure to air pollution and the risk of acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) in seven metropolitan cities in Korea. We used national health insurance claims data to identify AE-COPD cases in 2015. We estimated short-term exposure to particulate matter (PM) with a diameter of ≤2.5 μm (PM_2.5), PM with diameters of ≤10 μm (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and ozone (O₃) obtained from the Ministry of Environment. We conducted a time-stratified, case-crossover study to evaluate the effect of short-term exposure to air pollution on hospital visits for AE-COPD, using a conditional logistic regression model. The risk of hospital visits for AE-COPD was significantly associated with interquartile range increases in PM₁₀ in a cumulative lag model (lag 0–2, 0.35%, 95% confidence interval (CI) 0.06–0.65%; lag 0–3, 0.39%, 95% CI 0.01–0.77%). The associations were higher among patients who were men, aged 40–64 years, with low household income, and with a history of asthma. However, other air pollutants were not significantly associated with the risk of hospital visits for AE-COPD. Short-term exposure to air pollution, especially PM₁₀, increases the risk of hospital visits for AE-COPD.

Acute effect of particulate matter pollution on hospital admissions for cause-specific respiratory diseases among patients with and without type 2 diabetes in Beijing, China, from 2014 to 2020

BACKGROUND

Scientific studies have identified various adverse effects of particulate matter (PM) on respiratory disease (RD) and type 2 diabetes (T2D). However, whether short-term exposure to PM triggers the onset of RD with T2D, compared with RD without T2D, has not been elucidated.

METHODS

A two-stage time-series study was conducted to evaluate the acute adverse effects of PM on admission for RD and for RD with and without T2D in Beijing, China, from 2014 to 2020. District-specific effects of PM_2.5 and PM₁₀ were estimated using the over-dispersed Poisson generalized addictive model after adjusting for weather conditions, day of the week, and long-term and seasonal trends. Meta-analyses were applied to pool the overall effects on overall and cause-specific RD, while the exposure-response (E-R) curves were evaluated using a cubic regression spline.

RESULTS

A total of 1550,154 admission records for RD were retrieved during the study period. Meta-analysis suggested that per interquartile range upticks in the concentration of PM_2.5 corresponded to 1.91% (95% CI: 1.33-2.49%), 2.16% (95% CI: 1.08-3.25%), and 1.92% (95% CI: 1.46-2.39%) increments in admission for RD, RD with T2D, and RD without T2D, respectively, at lag 0-8 days, lag 8 days, and lag 8 days. The effect size of PM_2.5 was statistically significantly higher in the T2D group than in the group without T2D (z = 3.98, P < 0.01). The effect sizes of PM₁₀ were 3.86% (95% CI: 2.48-5.27%), 3.73% (95% CI: 1.72-5.79%), and 3.92% (95% CI: 2.65-5.21%), respectively, at lag 0-13 days, lag 13 days, and lag 13 days, respectively, and no statistically significant difference was observed between T2D groups (z = 0.24, P = 0.81). Significant difference was not observed between T2D groups for the associations of PM and different RD and could be found between three groups for effects of PM₁₀ on RD without T2D. The E-R curves varied by sex, age and T2D condition subgroups for the associations between PM and daily RD admissions.

CONCLUSIONS

Short-term PM exposure was associated with increased RD admission with and without T2D, and the effect size of PM_2.5 was higher in patients with T2D than those without T2D.

Ambient air pollution and hospitalization for chronic obstructive pulmonary disease: Benefits from Three-Year Action Plan

BACKGROUND

Chronic obstructive pulmonary disease (COPD) hospitalization has been linked with ambient air pollution. However, the evidence on respiratory health benefits from air pollution control policy in China is limited.

OBJECTIVE

To investigate benefits from the Three-Year Action Plan to Win the Battle for a Blue Sky (TYAP) for tackling COPD hospitalization due to ambient air pollution.

METHODS

We conducted a time-stratified case-crossover study of 138,015 COPD hospitalizations aged ≥ 60 years in Guangdong province, China during 2016-2019 to investigate respiratory health benefits from TYAP. Inverse distance weighting method was used to assess daily individual-level exposures to ambient air pollutants including particulate matter with an aerodynamic diameter ≤ 2.5 µm (PM2.5), particulate matter with an aerodynamic diameter ≤ 10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3). Conditional logistic regression model was applied to analyze the associations between ambient air pollutants and COPD hospitalization.

RESULTS

TYAP can modify the associations. Each 10 μg/m3 increase of exposure to PM2.5, PM10, and NO2 and 1 mg/m3 increase of exposure to CO were significantly associated with 2.5%, 2.0%, 3.0%, and 14.4% increase in odds of COPD hospitalization before TYAP, respectively; while 1.0%, 0.9%, 1.5%, and 5.8% increase in odds during TYAP. We found prominent declines in health burden of COPD hospitalizations due to air pollution among the elderly after TYAP implication when compared with that before TYAP.

CONCLUSION

Reduced levels of ambient air pollutants by TYAP can effectively lower the risk for COPD hospitalization among the elderly, which provides evidence on the respiratory health benefits from consistent and effective air pollution control policy.

Association between short-term ambient air pollution exposure and depression outpatient visits in cold seasons: a time-series analysis in northwestern China

Depression is known to be one of the most common mental disorders raising global concerns. However, evidence regarding the association between short-term air pollution exposure and risk of development of depression is limited. The aim of this was to assess the relationship between short-term ambient air pollution exposure and depression in outpatient visits in Xi'an, a northwestern Chinese metropolis. Data for air pollutants including particulate matter (PM₁₀), sulfur dioxide (SO₂), and nitrogen dioxide (NO₂) levels from October 1, 2010 to December 31, 2013 and number of daily depression outpatient visits (92,387 in total) were collected. A time-series quasi-Poisson regression model was adopted to determine the association between short-term air pollutant concentrations and frequency of outpatient visits for depression with different lag models. Consequently, 10 μg/m³ increase of SO₂ and NO₂ levels corresponded to significant elevation in number of outpatient-visits for depression on concurrent days (lag 0), and this relationship appeared stronger in cool seasons (October to March). However, the association of PM₁₀ was only significant in males aged 30-50 at lag 0. Evidence indicated that short-term exposure to ambient air pollutants especially in cool seasons might be associated with increased risk of outpatient visits for depression.

How atmospheric pollutants impact the development of chronic obstructive pulmonary disease and lung cancer: A var-based model

The impact of air pollution on humans is a worrisome factor that has gained prominence over the years due to the importance of the topic to society. Lung cancer and chronic obstructive pulmonary disease are among the diseases associated with pollution that increase the mortality rate in Brazil and worldwide. Therefore, this study aimed to determine the impacts of air pollutants on mortality rates from chronic obstructive pulmonary disease (COPD) and lung cancer (LC) using vector autoregressive (VAR) modeling. The adjusted model was a VAR(1) and, according to the Granger causality test, the air pollutants selected were PM₁₀, O₃, CO, NO₂, and SO₂. The shocks applied to the variables O₃, using the impulse response function, negatively impacted COPD; in the eighth period, which is stabilized. The LC variable suffered more significant variations from O₃ and after a shock in this variable, an initially negative response in LC occurred and the series stabilized in period nine. After one year, 20.19% of COPD variance was explained by O₃. After twelve months, the atmospheric pollutant O₃ represented 5.00% and NO₂ represented 4.02% of LC variance. Moreover, the variables that caused the highest impact on COPD and LC mortality rates were O₃ and NO₂, indicating that air pollution influences the clinical state of people who have these diseases and even contributes to their development. The VAR model was able to identify the air pollutants that have the most significant impact on the diseases analyzed and explained the interrelationship between them.