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Wang H, Matusik M, Wunderlich R, Hanson SE, Babich K, Samad L, Qian AM, McMillin SE, Ye X, Zhang S, Liu Y, Chen X, Li Z, Lin H, Zhu H, Wang X. Short-Term Ambient Air Pollution and Urticaria in Guangzhou, China: Estimating the Association and Population Attributable Fraction. TOXICS 2023; 11:949. [PMID: 38133350 PMCID: PMC10747676 DOI: 10.3390/toxics11120949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023]
Abstract
Limited evidence is available regarding the association between acute exposure to ambient air pollutants and the risk of urticaria, even though the skin is an organ with direct contact with the external environment. This study utilized generalized additive models to investigate the association between particulate matter with an aerodynamic diameter smaller than 10 μm (PM10) and 2.5 μm (PM2.5), nitrogen dioxide (NO2) and sulfur dioxide (SO2), and daily outpatient visits for urticaria in Guangzhou, China from 2013 to 2017. We also estimated the attributable fraction of urticaria outpatient visits due to air pollution. A total of 216,648 outpatient visits due to urticaria occurred during the study period. All air pollutants were significantly associated with an increased excess risk of urticaria. Each 10 μg/m3 increase in PM2.5, PM10, NO2, and SO2 was associated with an increase of 1.23% (95% CI: 0.42%, 2.06%), 0.88% (95% CI: 0.28%, 1.49%), 3.09% (95% CI: 2.16%, 4.03%), and 2.82% (95% CI: 0.93%, 4.74%) in hospital visits for urticaria at lag05, respectively. It was estimated that 3.77% (95% CI: 1.26%, 6.38%), 1.91% (95% CI: 0.60%, 3.26%), 6.36% (95% CI: 4.38%, 8.41%), and 0.08% (95% CI: 0.03%, 0.14%) of urticaria outpatient visits were attributable to PM2.5, PM10, NO2, and SO2 using the World Health Organization's air quality guideline as the reference. Relatively stronger associations were observed during the cold season. This study indicates that short-term air pollution may play a significant role in outpatient visits for urticaria, and that such relationships could be modified by season.
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Affiliation(s)
- Huanli Wang
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou 510095, China
- Institute of Dermatology, Guangzhou Medical University, Guangzhou 510095, China
| | - Morgan Matusik
- University of New Mexico Hospital, Albuquerque, NM 87106, USA
| | | | - Sarah E. Hanson
- Bureau of Communicable Disease Control and Prevention, Missouri Department of Health and Senior Services, Jefferson City, MO 63103, USA
| | - Kelly Babich
- Connecticut Department of Public Health, Office of Public Health Preparedness and Response, Hartford, CT 06134, USA
| | - Lilianne Samad
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO 63104, USA
| | - Aaron M. Qian
- Department of Psychology, College of Arts and Sciences, Saint Louis University, Saint Louis, MO 63108, USA
| | | | - Xingdong Ye
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou 510095, China
- Institute of Dermatology, Guangzhou Medical University, Guangzhou 510095, China
| | - Sanquan Zhang
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou 510095, China
- Institute of Dermatology, Guangzhou Medical University, Guangzhou 510095, China
| | - Yumei Liu
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou 510095, China
- Institute of Dermatology, Guangzhou Medical University, Guangzhou 510095, China
| | - Xiaoyin Chen
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou 510095, China
- Institute of Dermatology, Guangzhou Medical University, Guangzhou 510095, China
| | - Zhenjie Li
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou 510095, China
- Institute of Dermatology, Guangzhou Medical University, Guangzhou 510095, China
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Huilan Zhu
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou 510095, China
- Institute of Dermatology, Guangzhou Medical University, Guangzhou 510095, China
| | - Xiaojie Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
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Zhang Z, Xu D, Chen J, Meng Q, Liang Z, Zhang X. Daily diurnal temperature range associated with outpatient visits of acute lower respiratory infection in children: A time-series study in Guangzhou, China. Front Public Health 2022; 10:951590. [PMID: 36339182 PMCID: PMC9632279 DOI: 10.3389/fpubh.2022.951590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/23/2022] [Indexed: 01/24/2023] Open
Abstract
Background Diurnal temperature range (DTR) has been increasingly recognized as a risk factor for mortality and morbidity, but the association between DTR and acute lower respiratory infection (ALRI) outpatient visits has not been examined among children in China. Methods A total of 79,416 ALRI outpatient visits among children were obtained from the Guangdong Second Provincial General Hospital between 2013 and 2019. DTR was calculated by taking the difference between the maximum and the minimum temperatures. Generalized additive models using a quasi-Poisson distribution were used to model the relationship between DTR and ALRI outpatient visits. Results Diurnal temperature range was significantly associated with elevated risks of ALRI outpatient visits: the excess risks (ERs) and 95% confidence intervals (CIs) were 2.31% (1.26, 3.36%) for ALRI, 3.19% (1.86, 4.54%) for pneumonia, and 1.79% (0.59, 3.01%) for bronchiolitis, respectively. Subgroup analyses suggested that the associations were significantly stronger during rainy seasons (ER for ALRI: 3.02%, 95% CI: 1.43, 4.64%) than those in dry seasons (ER for ALRI: 2.21%, 95% CI: 0.65, 3.81%), while no significant effect modifications were found in sex and age groups. Conclusion Diurnal temperature range may elevate the risk of ALRI outpatient visits among children in China, especially during rainy seasons. Public health policies are needed to mitigate the adverse health impacts of DTR on children.
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Affiliation(s)
| | | | | | | | - Zhenyu Liang
- Department of Pediatrics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Xiao Zhang
- Department of Pediatrics, Guangdong Second Provincial General Hospital, Guangzhou, China
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Xiao D, Guo W, Xu D, Chen J, Liang Z, Zhang X. Three Exposure Metrics for Fine Particulate Matter Associated With Outpatient Visits for Acute Lower Respiratory Infection Among Children in Guangzhou, China. Front Public Health 2022; 10:876496. [PMID: 35757648 PMCID: PMC9218103 DOI: 10.3389/fpubh.2022.876496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022] Open
Abstract
Ambient fine particulate matter (PM2.5) is associated with an elevated risk of acute lower respiratory infections (ALRI). However, this association has not been examined using alternative exposure metrics. We collected outpatient data of patients with ALRI aged <14 years from the administrative database of a large tertiary hospital in Guangzhou, China, from 2013 to 2019. Ambient PM2.5 was measured using three metrics: (a) daily mean, (b) daily excessive concentration hours (DECH), and (c) hourly peak. Generalized additive models were fitted to estimate the excess risk (ER) associated with PM2.5. A total of 105,639 ALRI (35,310 pneumonia and 68,218 bronchiolitis) outpatient visits were identified during the study period. An interquartile range increment in PM2.5 DECH was consistently associated with the highest ER of ALRI-related outpatient visits: 12.30% (95% confidence interval [CI]: 9.49–15.18%), compared with 11.20% (95% CI: 8.34–14.13%) for daily mean and 9.73% (95% CI: 6.97–12.55%) for hourly peak. The associations between the three metrics of PM2.5 and ALRI-related outpatient visits were stronger in the cold season than in the warm season. Future studies should consider PM2.5 DECH as an alternative method of exposure measurement, in addition to daily mean and hourly peak concentrations of PM2.5.
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Affiliation(s)
- Danxia Xiao
- Department of Pediatrics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Wenchun Guo
- Department of Pediatrics, Guangdong Second Provincial General Hospital, Guangzhou, China.,Department of Pediatrics, The First Clinical of College, Guangdong Medical University, Zhanjiang, China
| | - Debo Xu
- Department of Pediatrics, Guangdong Second Provincial General Hospital, Guangzhou, China.,Department of Pediatrics, The First Clinical of College, Guangdong Medical University, Zhanjiang, China
| | - Jiamin Chen
- Department of Pediatrics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Zhenyu Liang
- Department of Pediatrics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Xiao Zhang
- Department of Pediatrics, Guangdong Second Provincial General Hospital, Guangzhou, China
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Michikawa T, Sasaki J, Yamazaki S, Takami A, Asakura K, Imamura H, Ueda K, Saito S, Hoshi J, Yoshino A, Sugata S, Nitta H, Nishiwaki Y. A Case-Crossover Analysis of the Association between Exposure to Total PM 2.5 and Its Chemical Components and Emergency Ambulance Dispatches in Tokyo. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:7319-7327. [PMID: 35608996 DOI: 10.1021/acs.est.1c08219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A limited number of studies have investigated the association between short-term exposure to PM2.5 components and morbidity. The present case-crossover study explored the association between exposure to total PM2.5 and its components and emergency ambulance dispatches, which is one of the indicators of morbidity, in the 23 Tokyo wards. Between 2016 and 2018 (mean mass concentrations of total PM2.5 13.5 μg/m3), we obtained data, from the Tokyo Fire Department, on the daily cases of ambulance dispatches. Fine particles were collected at a fixed monitoring site and were analyzed to estimate the daily mean concentrations of carbons and ions. We analyzed 1038301 cases of health-based all-cause ambulance dispatches by using a conditional logistic regression model. The average concentrations of total PM2.5 over one and the previous day were positively associated with the number of ambulance dispatches. In terms of PM2.5 components, the percentage increase per interquartile range (IQR) increase was 0.8% for elemental carbon (IQR = 0.8 μg/m3; 95% CI = 0.3-1.3%), 0.9% for sulfate (2.1 μg/m3; 0.5-1.4%), and 1.1% for ammonium (1.3 μg/m3; 0.4-1.8%) in the PM2.5-adjusted models. This is the first study to find an association between some specific components in PM2.5 and ambulance dispatches.
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Affiliation(s)
- Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo143-8540, Japan
- Health and Environmental Risk Division, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo160-8582, Japan
| | - Shin Yamazaki
- Health and Environmental Risk Division, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan
| | - Akinori Takami
- Regional Environment Conservation Division, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan
| | - Keiko Asakura
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo143-8540, Japan
| | - Haruhiko Imamura
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo143-8540, Japan
| | - Kayo Ueda
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan
- Environmental Health Sciences, Kyoto University Graduate School of Global Environmental Studies, Kyoto Daigaku Katsura, Nishikyo-ku, Kyoto 615-8540, Japan
| | - Shinji Saito
- Tokyo Metropolitan Research Institute for Environmental Protection, 1-7-5 Shinsuna, Koto-ku, Tokyo136-0075, Japan
| | - Junya Hoshi
- Tokyo Metropolitan Research Institute for Environmental Protection, 1-7-5 Shinsuna, Koto-ku, Tokyo136-0075, Japan
| | - Ayako Yoshino
- Regional Environment Conservation Division, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan
| | - Seiji Sugata
- Regional Environment Conservation Division, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan
| | - Hiroshi Nitta
- Health and Environmental Risk Division, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan
| | - Yuji Nishiwaki
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo143-8540, Japan
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Heo S, Son JY, Lim CC, Fong KC, Choi HM, Hernandez-Ramirez RU, Nyhan K, Dhillon PK, Kapoor S, Prabhakaran D, Spiegelman D, Bell ML. Effect modification by sex for associations of fine particulate matter (PM 2.5) with cardiovascular mortality, hospitalization, and emergency room visits: systematic review and meta-analysis. ENVIRONMENTAL RESEARCH LETTERS : ERL [WEB SITE] 2022; 17:053006. [PMID: 35662857 PMCID: PMC9162078 DOI: 10.1088/1748-9326/ac6cfb] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Particulate matter with aerodynamic diameter no larger than 2.5 μm (PM2.5) has been linked to cardiovascular diseases (CVDs) but evidence for vulnerability by sex remains unclear. We performed systematic review and meta-analysis to synthesize the state of scientific evidence on whether cardiovascular risks from PM2.5 differ for men compared to women. The databases Pubmed, Scopus, Embase, and GreenFILE were searched for studies published Jan. 1995 to Feb. 2020. Observational studies conducting subgroup analysis by sex for impacts of short-term or long-term exposure to PM2.5 on target CVDs were included. Data were independently extracted in duplicate and pooled with random-effects meta-regression. Risk ratios (RRs) for long-term exposure and percent changes in outcomes for short-term exposure were calculated per 10 μg/m3 PM2.5 increase. Quality of evidence of risk differences by sex was rated following Grading of Recommendations Assessment, Development and Evaluation (GRADE). A total of 12,502 articles were screened, with 61 meeting inclusion criteria. An additional 32 studies were added from citation chaining. RRs of all CVD mortality for long-term PM2.5 for men and women were the same (1.14; 95% CI: 1.09, 1.22) indicating no statistically different risks. Men and women did not have statistically different risks of daily CVD mortality, hospitalizations from all CVD, ischemic heart disease, cardiac arrest, acute myocardial infarction, and heart failure from short-term PM2.5 exposure (difference in % change in risk per 10 μg/m3 PM2.5: 0.04 (95% CI, -0.42 to 0.51); -0.05 (-0.47 to 0.38); 0.17 (-0.90, 1.24); 1.42 (-1.06, 3.97); 1.33 (-0.05, 2.73); and -0.48 (-1.94, 1.01), respectively). Analysis using GRADE found low or very low quality of evidence for sex differences for PM2.5-CVD risks. In conclusion, this meta-analysis and quality of evidence assessment of current observational studies found very limited evidence of the effect modification by sex for effects of PM2.5 on CVD outcomes in adults, which can inform clinical approaches and policies.
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Affiliation(s)
- Seulkee Heo
- School of the Environment, Yale University, New Haven, CT, United States of America
| | - Ji-Young Son
- School of the Environment, Yale University, New Haven, CT, United States of America
| | - Chris C Lim
- School of the Environment, Yale University, New Haven, CT, United States of America
- Community, Environment & Policy Department, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Kelvin C Fong
- School of the Environment, Yale University, New Haven, CT, United States of America
| | - Hayon Michelle Choi
- School of the Environment, Yale University, New Haven, CT, United States of America
| | - Raul U Hernandez-Ramirez
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, Yale University, New Haven, CT, United States of America
| | - Kate Nyhan
- Harvey Cushing / John Hay Whitney Medical Library, Yale School of Public Health, Yale University, New Haven, CT, United States of America
- Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States of America
| | | | | | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Donna Spiegelman
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, United States of America
| | - Michelle L Bell
- School of the Environment, Yale University, New Haven, CT, United States of America
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6
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Wang R, Tian J, Li L, Liu X, Leng M, Ye Z, Li G. Relationship between diurnal temperature range and emergency ambulance dispatches due to stroke in Guangzhou, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 817:153037. [PMID: 35031377 DOI: 10.1016/j.scitotenv.2022.153037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The evidence between diurnal temperature range (DTR) and stroke remains controversial and sparse. We aimed to assess the relationship between DTR and emergency ambulance dispatches (EADs) due to stroke, and to explore whether there were effect modifications to the relationship. METHODS A Quasi-Poisson generalized linear regression combined with a distributed lag non-linear model was used to examine the relationship between DTR and EADs for stroke between January 1st 2011 and June 30th 2018 in Guangzhou, China. We estimated the effects of the low DTR and high DTR (defined as DTR below and above 10 °C respectively) on EADs. The effects of minimum, maximum, 5th, 25th, 50th, 75th, and 95th percentiles of DTR compared with the DTR of 10 °C were also analyzed. RESULTS A total of 20,275 EADs for stroke were included for analyses, among which 17,556 EADs were used in the model further adjusted for age and sex. A quasi-U-shaped relationship between DTR and EADs over lag0-2 days was observed. For the low DTR, per 1 °C decrease in DTR was significantly associated with an increase of 2.64% (RR = 1.03, 95% CI: 1.01-1.04) for EADs, while per 1 °C increase for the high DTR was non-significantly related with an increased risk of EADs (RR = 1.01, 95% CI: 0.90-1.13). Significant effects of the 5th and 25th percentiles of DTR on EADs were found when compared with the DTR of 10 °C. No significant effect modifications by age, sex or season were found to the association between DTR and EADs. CONCLUSIONS We found a quasi-U-shaped relationship between DTR and EADs due to stroke in this study, while age, sex or season did not significantly modify the association between DTR and EADs. More high-quality evidence is needed to further explore and validate the relationship between DTR and stroke.
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Affiliation(s)
- Ruoting Wang
- Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Junzhang Tian
- Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Likang Li
- Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Xintong Liu
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Meifang Leng
- Department of Cardiology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Zebing Ye
- Department of Cardiology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, China; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
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Chen L, Wang X, Qian ZM, Sun L, Qin L, Wang C, Howard SW, Aaron HE, Lin H. Ambient gaseous pollutants and emergency ambulance calls for all-cause and cause-specific diseases in China: a multicity time-series study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:28527-28537. [PMID: 34988821 DOI: 10.1007/s11356-021-18337-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
Much attention has been paid to the health effects of ambient particulate matter pollution; the effects of gaseous air pollutants have not been well studied. Emergency ambulance calls (EACs) may provide a better indicator of the acute health effects than the widely used health indicators, such as mortality and hospital admission. We estimated the short-term associations between gaseous air pollutants [nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3)] and EACs for all-cause, cardiovascular, and respiratory diseases in seven Chinese cities from 2014 to 2019. We used generalized additive models and random-effects meta-analysis to examine the city-specific and pooled associations. Stratified analyses were conducted by age, sex, and season. A total of 1,626,017 EACs were observed for all-cause EACs, including 230,537 from cardiovascular diseases, and 96,483 from respiratory diseases. Statistically significant associations were observed between NO2 and EACs for all-cause diseases, while the effects of SO2 were positive, but not statistically significant in most models. No significant relationship was found between O3 and EACs. Specifically, each 10 μg/m3 increase in the 2-day moving average concentration of NO2 was associated with a 1.07% [95% confidence interval (CI): 0.40%, 1.76%], 0.76% (95% CI: 0.19%, 1.34%) and 0.06% (95% CI: -1.57%, 1.73%) increase in EACs due to all-cause, cardiovascular and respiratory diseases, respectively. Stratified analysis showed a larger effect of NO2 on all-cause EACs in the cold season [excess relative risk (ERR): 0.33% (95% CI: 0.05%, 0.60%) for warm season, ERR: 0.77% (95% CI: 0.31%, 1.23%) for cold season]. Our study indicates that acute exposures to NO2 might be an important trigger of the emergent occurrence of all-cause, cardiovascular and respiratory diseases, and this effect should be of particular concern in the cold season. Further policy development for controlling gaseous air pollution is warranted to reduce the emergent occurrence of cardiopulmonary diseases.
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Affiliation(s)
- Lan Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xiaojie Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhengmin Min Qian
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, 63104, USA
| | - Liwen Sun
- Huairou District Center for Disease Control and Prevention, Beijing, 101400, China
| | - Lijie Qin
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, China
| | - Steven W Howard
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, 63104, USA
| | - Hannah E Aaron
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, 63104, USA
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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Lin H, Long Y, Su Y, Song K, Li C, Ding N. Air pollution and hospital admissions for critical illness in emergency department: a tertiary-center research in Changsha, China, 2016-2020. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:21440-21450. [PMID: 34761317 DOI: 10.1007/s11356-021-17295-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
We aimed to comprehensively investigate the associations of air pollutants with hospital admissions for critical illness in ED. Patients with critical illness including level 1 and level 2 of the Emergency Severity Index admitted in ED of Changsha Central Hospital from January 2016 to December 2020 were enrolled. Meteorological and air pollutants data source were collected from the National Meteorological Science Data Center. A Poisson generalized linear regression combined with a polynomial distributed lag model (PDLM) was utilized to explore the effect of air pollution on hospital admissions for critical illness in ED. Benchmarks as references (25th) were conducted for comparisons with high levels of pollutant concentrations (75th). At first, lagged effects of all different air pollutants were analyzed. Then, based on the most significant factor, analyses in subgroups were performed by gender (male and female), age (< 45, 45-65, and > 65), disorders (cardiovascular, neurological, respiratory), and seasons (spring, summer, autumn, and winter). A total of 47,290 patients with critical illness admitted in ED were included. The effects of air pollutants (PM2.5, PM10, SO2, NO2, O3 and CO) on critical illness ED visits were statistically significant. Strong collinearity between PM2.5 and PM10 (r = 0.862) was found. Both single-day lag and cumulative-day lag day models showed that PM2.5 had the strongest effects (lag 0, RR = 1.025, 95% CI 1.008-1.043, and lag 0-14, RR = 1.067, 95% CI 1.017-1.120, respectively). In both PM2.5 and PM10, the risks of critical illness in male, > 65 ages, respiratory diseases, and winter increased the most significant. Air pollutants, especially PM2.5 and PM10 exposure, could increase the risk of critical illness admission.
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Affiliation(s)
- Hang Lin
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO. 161 Shaoshan South Road, Changsha, Hunan, 410004, China
| | - Yong Long
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO. 161 Shaoshan South Road, Changsha, Hunan, 410004, China
| | - Yingjie Su
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO. 161 Shaoshan South Road, Changsha, Hunan, 410004, China
| | - Kun Song
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO. 161 Shaoshan South Road, Changsha, Hunan, 410004, China
| | - Changluo Li
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO. 161 Shaoshan South Road, Changsha, Hunan, 410004, China
| | - Ning Ding
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO. 161 Shaoshan South Road, Changsha, Hunan, 410004, China.
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9
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Liang Z, Meng Q, Yang Q, Chen N, You C. Size-Specific Particulate Matter Associated With Acute Lower Respiratory Infection Outpatient Visits in Children: A Counterfactual Analysis in Guangzhou, China. Front Public Health 2021; 9:789542. [PMID: 34926398 PMCID: PMC8674437 DOI: 10.3389/fpubh.2021.789542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
The burden of lower respiratory infections is primarily evident in the developing countries. However, the association between size-specific particulate matter and acute lower respiratory infection (ALRI) outpatient visits in the developing countries has been less studied. We obtained data on ALRI outpatient visits (N = 105,639) from a tertiary hospital in Guangzhou, China between 2013 and 2019. Over-dispersed generalized additive Poisson models were employed to evaluate the excess risk (ER) associated with the size-specific particulate matter, such as inhalable particulate matter (PM10), coarse particulate matter (PMc), and fine particulate matter (PM2.5). Counterfactual analyses were used to examine the potential percent reduction of ALRI outpatient visits if the levels of air pollution recommended by the WHO were followed. There were 35,310 pneumonia, 68,218 bronchiolitis, and 2,111 asthma outpatient visits included. Each 10 μg/m3 increase of 3-day moving averages of particulate matter was associated with a significant ER (95% CI) of outpatient visits of pneumonia (PM2.5: 3.71% [2.91, 4.52%]; PMc: 9.19% [6.94, 11.49%]; PM10: 4.36% [3.21, 5.52%]), bronchiolitis (PM2.5: 3.21% [2.49, 3.93%]; PMc: 9.13% [7.09, 11.21%]; PM10: 3.12% [2.10, 4.15%]), and asthma (PM2.5: 3.45% [1.18, 5.78%]; PMc: 11.69% [4.45, 19.43%]; PM10: 3.33% [0.26, 6.49%]). The association between particulate matter and pneumonia outpatient visits was more evident in men patients and in the cold seasons. Counterfactual analyses showed that PM2.5 was associated with a larger potential decline of ALRI outpatient visits compared with PMc and PM10 (pneumonia: 11.07%, 95% CI: [7.99, 14.30%]; bronchiolitis: 6.30% [4.17, 8.53%]; asthma: 8.14% [2.65, 14.33%]) if the air pollutants were diminished to the level of the reference guidelines. In conclusion, short-term exposures to PM2.5, PMc, and PM10 are associated with ALRI outpatient visits, and PM2.5 is associated with the highest potential decline in outpatient visits if it could be reduced to the levels recommended by the WHO.
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Affiliation(s)
- Zhenyu Liang
- Department of Pediatrics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Qiong Meng
- Department of Pediatrics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Qiaohuan Yang
- Department of Pediatrics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Na Chen
- Department of Pediatrics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Chuming You
- Department of Pediatrics, Guangdong Second Provincial General Hospital, Guangzhou, China
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Wang X, Leng M, Liu Y, Qian ZM, Zhang J, Li Z, Sun L, Qin L, Wang C, Howard SW, Vaughn MG, Yan Y, Lin H. Different sized particles associated with all-cause and cause-specific emergency ambulance calls: A multicity time-series analysis in China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 783:147060. [PMID: 34088160 DOI: 10.1016/j.scitotenv.2021.147060] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Compared with mortality and hospital admission, emergency ambulance calls (EACs) could be a more accurate outcome indicator to reflect the health effects of short-term air pollution exposure. However, such studies have been scarce, especially on a multicity scale in China. METHODS We estimated the associations of different diameter particles [i.e., inhalable particulate matter (PM10), coarse particulate matter (PMc), and fine particulate matter (PM2.5)] with EACs for all-cause, cardiovascular, and respiratory diseases in seven Chinese cities. We collected data on EACs and air pollution from 2014 to 2019. We used generalized additive models and random-effects meta-analysis to examine the city-specific and overall associations. Stratified analyses were conducted to examine the effect modifications of gender, age, and season. RESULTS Significant associations of PM10 and PM2.5 with EACs were observed, while the PMc associations were positive but not statistically significant in most analyses. Specifically, each 10 μg/m3 increase in 2-day moving average concentration of PM10 was associated with a 0.25% [95% confidence interval (CI): 0.04%, 0.47%] increase in all-cause EACs, 0.13% (95% CI: -0.01%, 0.26%) in cardiovascular EACs, and 0.35% (95% CI: 0.04%, 0.66%) in respiratory EACs. The corresponding increases in daily EACs for PM2.5 were 0.30% (95% CI, 0.03%, 0.57%), 0.13% (95% CI, -0.07%, 0.33%), and 0.46% (95% CI, 0.01%, 0.92%). Season of the year also modifies the association between particulate matter pollution and EACs. CONCLUSIONS Short-term exposure to PM10 and PM2.5 were positively associated with daily all-cause and respiratory-related EACs. The associations were stronger during warm season than cold season. Our findings suggest that the most harmful fraction of particulate matter pollution is PM2.5, which has important implications for current air quality guidelines and regulations in China.
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Affiliation(s)
- Xiaojie Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Meifang Leng
- Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yixuan Liu
- Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Zhengmin Min Qian
- College for Public Health & Social Justice, Saint Louis University, USA
| | - Junguo Zhang
- Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Ziyi Li
- Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Liwen Sun
- Huairou District Center for Disease Control and Prevention, Beijing, China
| | - Lijie Qin
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Steven W Howard
- College for Public Health & Social Justice, Saint Louis University, USA
| | - Michael G Vaughn
- College for Public Health & Social Justice, Saint Louis University, USA
| | - Yue Yan
- Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China..
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
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