Fine Particulate Matter Pollution and Hospital Admissions for Respiratory Diseases in Beijing, China

Ultrafine Particles and Hospital Visits for Chronic Lower Respiratory Diseases in New York State

Rationale: Exposure to particulate matter is associated with various adverse health outcomes. Ultrafine particles (UFPs; diameter <0.1 μm) are a unique public health challenge because of their size. However, limited studies have examined their impacts on human health, especially across seasons and demographic characteristics. Objectives: To evaluate the effect of UFP exposure on the risk of visiting the emergency department (ED) for a chronic lower respiratory disease (CLRD) in New York State in 2013-2018. Methods: We used a case-crossover design and conditional logistic regression to estimate how UFP exposure led to CLRD-related ED visits. GEOS-Chem Advanced Particle Microphysics, a state-of-the-art chemical transport model with a size-resolved particle microphysics model, generated air pollution simulation data. We then matched UFP exposure estimates to geocoded health records for asthma, bronchiectasis, chronic bronchitis, emphysema, unspecified bronchitis, and other chronic airway obstructions in New York State from 2013 through 2018. In addition, we assessed interactions with age, ethnicity, race, sex, meteorological factors, and season. Results: Each 1-(interquartile range [IQR]) increase in UFP exposure led to a 0.37% increased risk of a respiratory-related ED visit on lag 0-0, or the day of the ED visits, (95% confidence interval [CI], 0.23-0.52%) and a 1.81% increase on lag 0-6, or 6 days before the ED visit, (95% CI, 1.58-2.03%). The highest risk was in the emphysema subtype (lag 0-5, 4.18%; 95% CI, 0.16-8.37%), followed by asthma (lag 0-6, 2.00%), chronic bronchitis (lag 0-6, 1.78%), other chronic airway obstructions (lag 0-6, 1.60%), and unspecified bronchitis (lag 0-6, 1.49%). We also found significant interactions between UFP health impacts and season (Fall, 3.29%), temperature (<90th percentile, 2.27%), relative humidity (>90th percentile, 4.63%), age (children aged <18 yr, 3.19%), and sex (men, 2.06%) on lag 0-6. Conclusions: In this study, UFP exposure increased CLRD-related ED visits across all seasons and demographic characteristics, yet these associations varied according to various factors, which requires more research.

The Association between Short-Term Exposure to PM1 and Daily Hospital Admission and Related Expenditures in Beijing

Ambient particulate matter (PM) pollution is a leading environmental health threat worldwide. PM with an aerodynamic diameter ≤ 1.0 μm, also known as PM1, has been implicated in the morbidity and mortality of several cardiorespiratory and cerebrovascular diseases. However, previous studies have mostly focused on analyzing fine PM (PM2.5) associated with disease metrics, such as emergency department visits and mortality, rather than ultrafine PM, including PM1. This study aimed to evaluate the association between short-term PM1 exposure and hospital admissions (HAs) for all-cause diseases, chronic obstructive pulmonary disease (COPD), and respiratory infections (RIs), as well as the associated expenditures, using Beijing as a case study. Here, based on air pollution and hospital admission data in Beijing from 2015 to 2017, we performed a time-series analysis and meta-analysis. It was found that a 10 μg/m3 increase in the PM1 concentration significantly increased all-cause disease HAs by 0.07% (95% Confidence Interval (CI): [0, 0.14%]) in Beijing between 2015 and 2017, while the COPD and RI-related HAs were not significantly associated with short-term PM1 exposure. Meanwhile, we estimated the attributable number of HAs and hospital expenditures related to all-cause diseases. This study revealed that an average of 6644 (95% CI: [351, 12,917]) cases of HAs were attributable to ambient PM1, which was estimated to be associated with a 106 million CNY increase in hospital expenditure annually (95% CI: [5.6, 207]), accounting for 0.32% (95% CI: [0.02, 0.62%]) of the annual total expenses. The findings reported here highlight the underlying impact of ambient PM pollution on health risks and economic burden to society and indicate the need for further policy actions on public health.

The impact on air quality of PM10 emissions from the bus fleet of Buenos Aires City

Abstract

Automobile transport in megacities poses serious problems in the area of sustainability and environmental security. In the City of Buenos Aires (CABA) it represents 37% of GHG emissions and is an important source of pollutants dangerous to human health. As such, it is an energy consumption sector targeted for the implementation of methods that allow for sustainable urban transport. At the same time, very few previous studies about transport vehicle emissions have utilized the PM10 as an indicator of environmental contamination, considering that the negative impact of this environmental contaminant on human health is widely studied. An emission model linked to an atmospheric dispersion model, statistically validated, were used to study different scenarios of emissions generated by diesel buses. It was observed that in a scenario of zero bus emissions (E0), PM10 immission (air concentrations) concentration in CABA is reduced by half. When studying the energy transition from diesel buses to electric energy, while the rest of the vehicle fleet was maintained at the expense of fossil fuels, the local immission concentration of PM10 in CABA was of the same magnitude of that which was obtained when simulating the (E0) scenario of only private vehicle fleet. This study is relevant in the evaluation of public policy on vehicle emission mitigation that seeks to reduce health risks from poor air quality and to develop a more progressively sustainable city.

Article Highlights

Short-term effects of air pollutants on hospital admissions for acute bronchitis in children: a multi-city time-series study in Southwest China

BACKGROUND

Few studies have investigated the effects of air pollutants on children with acute bronchitis. This study aimed to explore the acute effects of four air pollutants [fine particulate matter (PM_2.5), inhalable particulate matter (PM₁₀), sulfur dioxide (SO₂), and nitrogen dioxide (NO₂)] on the daily number of children admitted to the hospital for acute bronchitis in Sichuan Province, China.

METHODS

The 49,975 records of hospitalized children with acute bronchitis from medical institutions in nine cities/prefectures, Sichuan Province, China, as well as the simultaneous meteorological data and air pollution data from 183 monitoring sites, were collected from 1 January 2017 to 31 December 2018. A generalized additive model was adopted to analyze the exposure-response and lag effects of hospitalizations of children with acute bronchitis to air pollutants. Stratified analyses were conducted based on sex, age, and season.

RESULTS

The single-pollutant model showed that a 10 µg/m³ increase at lag07 of PM_2.5, PM₁₀, SO₂, and NO₂ corresponded to an increase of 1.23% [95% confidence interval (CI) 0.21-2.26%], 1.33% (95% CI 0.62-2.05%), 23.52% (95% CI 11.52-36.81%), and 12.47% (95% CI 8.46-16.64%) in daily hospitalizations for children with acute bronchitis, respectively. Children aged 0-2 were more prone to PM_2.5 (P < 0.05). Interestingly, the effects were stronger in the warm season than in transition seasons and the cool season for PM_2.5 and PM₁₀ (P < 0.05).

CONCLUSION

The higher daily average concentrations of four pollutants in Sichuan Province can result in an increased number of children hospitalized for acute bronchitis.

Ambient sulfur dioxide and hospital expenditures and length of hospital stay for respiratory diseases: A multicity study in China

BACKGROUND

Ambient sulfur dioxide (SO2) has been associated with morbidity and mortality of respiratory diseases, however, its effect on length of hospital stays (LOS) and cost for these diagnoses remain unclear.

METHODS

We collected hospital admission information for respiratory diseases from all 11 cities in the Shanxi Province of China during 2017-2019. We assessed individual-level exposure by using an inverse distance weighting approach based on geocoded residential addresses. A generalized additive model was built to delineate city-specific effects of SO2 on hospitalization, hospital expenditure, and length of hospital stay for respiratory diseases. The overall effects were obtained by random-effects meta-analysis. We further estimated the respiratory burden attributable to SO2 by comparing different reference concentrations.

RESULTS

We observed significant effects of SO2 exposure on respiratory diseases. At the provincial level, each 10 μg/m3 increase in SO2 on lag03 was associated with a 0.63% (95% CI: 0.14-0.11) increase in hospital admission, an increase of 4.56 days (95% CI: 1.16-7.95) of hospital stay, and 3647.97 renminbi (RMB, Chinese money) (95% CI: 1091.05-6204.90) in hospital cost. We estimated about 6.13 (95% CI: 1.33-11.10) thousand hospital admissions, 65.77 million RMB (95% CI: 19.67-111.87) in hospital expenditure, and 82.13 (95% CI: 20.87-143.40) thousand days of hospital stay could have potentially been avoided had the daily SO2 concentrations been reduced to WHO's reference concentration (40 µg/m3). Variable values in correspondence with this reference concentration could reduce the hospital cost and LOS of each case by 52.67 RMB (95% CI: 15.75-89.59) and 0.07 days (95% CI: 0.02-0.117).

CONCLUSION

This study provides evidence that short-term ambient SO2 exposure is an important risk factor of respiratory diseases, indicating that continually tightening policies to reduce SO2 levels could effectively reduce respiratory disease burden in Shanxi Province.

Particle-bound PAHs induced glucose metabolism disorders through HIF-1 pathway

Vehicle exhaust, as one of the most important compositions of air pollution, induced various adverse health effects, especially diabetes, on human beings. Even though monitoring and epidemiological data indicates that particle-bound polycyclic aromatic hydrocarbons (PAHs) is an inducing factor of diabetes, the specific causative mechanisms are still unclear. In the current study, the concentration of particulate matters (PMs, including PM_1.0, PM_2.5 and PM_10.0) and PAHs was investigated at rush hour of weekday in three urban underground parking garages (UPGs). To evaluate the impacts of particle-bound PAHs on human beings, analysis of non-target metabolomics and unmetabolized PAHs were conducted for UPG and non-UPG worker urine samples. The results showed that the highest concentrations of PMs and total PAHs were found at the UPG entrance. The concentrations of unmetabolized 5-6 rings PAHs in the UPG worker urine were significantly higher than that in non-UPG worker urine samples, which induced glucose metabolism disorders through hypoxia-inducible factor 1 (HIF-1) signaling pathway. This could be a reason for particle-bound PAHs induced-diabetes on road workers, drivers and garage staff. These findings can serve as a step towards air pollution management and the pathological mechanism analysis of environmental factor induced-diseases.

Is PM2.5 associated with emergency department visits for mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease?

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) can have recurrent exacerbations and acute respiratory failure (ARF) triggered by particulate matter with a diameter of ≤2.5 μm (PM_2.5). To prevent ventilator shortages, this study investigated the short-term association between PM_2.5 concentration and emergency department visits (EDVs) among patients with acute exacerbation of COPD (AECOPD) requiring mechanical ventilation (MV).

METHODS

We conducted a time-series study to predict the PM_2.5 concentration and number of ventilators needed. Daily counts of EDVs among AECOPD patients requiring ventilation from 2015 to 2019 were obtained from a hospital. Generalized linear models extending Poisson regression were used to explore the association of AECOPD with PM_2.5 after controlling for the time trend, seasonal variations, and meteorological variables.

RESULTS

Eight hundred seventy-five AECOPD patients receiving MV were recorded, of whom 734 received noninvasive ventilation and 141 received invasive ventilatory support. EDVs for AECOPD patients with ARF significantly increased by 3.5% (95% confidence interval [CI]: 2.51%-4.42%) per 10 μg m^-3 increase in PM_2.5 concentration. Among seasons, PM_2.5 concentration had the strongest effect on AECOPD patients with ARF in spring (<24.5 °C), with a 1.64% (95% CI: -0.56% to 3.83%) increase in admissions per 10 μg m^-3 increase in same-day PM_2.5 concentration. The interquartile range increase of 20 μg m^-3 between winter and spring was associated with an average EDV increase of 48.66%.

CONCLUSION

This is the first study to predict the number of ventilators required by calculating quantitative estimates of the short-term effects of PM_2.5 on EDVs for AECOPD patients with ARF. Adverse effects of PM_2.5 on AECOPD patients requiring MV are evident, especially in the spring. Establishing protective standards and reducing the PM_2.5 concentration to below various thresholds are urgently needed.

Dust Emission Monitoring in Cement Plant Mills: A Case Study in Romania

This paper presents aspects of monitoring material dust emissions from stationary emission sources (monthly dust measurements performed on cement mill stacks-mill outlet and separator outlet). Additionally, the Portland cement mill technological process (its component parts), as well as the solutions regarding the reduction of the air emissions level, following the emission limit values (VLE), established in the integrated environmental authorization (AIM) from a cement factory in Romania, were analyzed. The paper focused on analyzing the data obtained in three different years for PM10 and dust concentrations (2018-2020). For each year, the measurements have been done in 3 months, each in a different season. The average values for each year for working conditions were: 30.22 mg/m³ (2018), 27.38 mg/m³ (2019), and 27.51 mg/m³ (2020) for working conditions and for normal conditions: 34.22 mg/m³ (2018), 30.49 mg/m³ (2019), and 30.16 mg/m³ (2020). For all 3 years, the values measured in spring were higher than the other two, both for work and normal conditions.

Respiratory Hospitalizations and Their Relationship with Air Pollution Sources in the Period of FIFA World Cup and Olympic Games in Rio de Janeiro, Brazil

Background: From 2010 onwards, the city of Rio de Janeiro has undergone changes related to the 2014 FIFA World Cup and the 2016 Olympic Games, potentially affecting the respiratory health of inhabitants. Thus, the spatial distribution of respiratory hospitalizations (2008–2017) and the relationship between this outcome and potential air pollution sources in the city of Rio de Janeiro (2013–2017) were evaluated. Methods: An ecological study was performed using the Bayesian model with multivariate Poisson regression for the period of the sporting events (2013–2017). The outcome was the ratio of hospitalizations for respiratory diseases by the population at risk. Data analysis was performed in the total population and by sex and age group. The air pollution-related variables included industrial districts, traffic density, tunnel portals, a seaport, airports, and construction/road work. Results: All explanatory variables, except tunnel portals, were associated with an increase in the outcome. Construction/road work showed a greater magnitude of association than the other pollution-related variables. Airports were associated with an increased hospitalization ratio among the ≥60 year-old group (mean = 2.46, 95% credible intervals = 1.35–4.46). Conclusion: This study allows for a better understanding of the geographical distribution of respiratory problems in the city of Rio de Janeiro. Present results may contribute to improved healthcare planning and raise hypotheses concerning exposure to air pollution and respiratory hospitalizations.

Prenatal exposure to fine particles, premature rupture of membranes and gestational age: A prospective cohort study

BACKGROUND

The associations between maternal exposure to fine particles with aerodynamic diameter ≤ 2.5 μm (PM_2.5) and gestational age as well as premature rupture of membranes (PROM) remain unclear. Few studies have focused on preconception exposure and components of fine particles in China.

METHODS

A total of 1715 pregnant women were enrolled at hospitals affiliated with Nanjing Medical University from 2014 to 2015. Personal exposure to PM_2.5 was estimated from preconception to the first trimester. Gestational age and PROM were investigated to explore their associations with PM_2.5 and its components.

RESULTS

From 12 weeks before conception to the end of the first trimester, the gestational age was reduced by 0.89 days (95% CI: -1.37, -0.40) per 10 μg/m³ increment in PM_2.5 exposure. After the exposure period was separated into two groups, PM_2.5 exposure reduced the gestational age by 0.35 days (95% CI: -0.59, -0.11) in the 12 weeks before pregnancy. With maternal exposure to PM_2.5 early in the first trimester, gestational age was reduced by 0.62 days (95% CI: -1.09, -0.14). After mediation analysis, we found that PROM mediated the association between PM_2.5 and gestational age from preconception to the first trimester. Components analysis indicated that exposure to black carbon, organic matter, and nitrate increased the risk of PROM and decreased gestational age.

CONCLUSION

Exposure to PM_2.5 as well as some components of PM_2.5 before and during early pregnancy was associated with PROM and gestational age. PROM might be a potential mediator in associations between PM_2.5 as well as various components and gestational age.

Is PM1 similar to PM2.5? A new insight into the association of PM1 and PM2.5 with children's lung function

Experimental data suggests that PM₁ is more toxic than PM_2.5 although the epidemiologic evidence suggests that the health associations are similar. However, few objective exposure data are available to compare the associations of PM₁ and PM_2.5 with children lung function. Our objectives are a) to evaluate associations between long-term exposure to PM₁, PM_2.5 and children's lung function, and b) to compare the associations between PM₁ and PM_2.5. From 2012 to 2013, we enrolled 6,740 children (7-14 years), randomly recruited from primary and middle schools located in seven cities in northeast China. We measured lung function including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), and maximal mid-expiratory flow (MMEF) utilizing two portable electronic spirometers. We dichotomized continuous lung function measures according the expected values for gender and age. The spatial resolution at which PM₁ and PM_2.5 estimated were estimated using a machine learning method and the temporal average concentrations were averaged from 2009 to 2012. A multilevel regression model was used to estimate the associations of PM₁, PM_2.5 exposure and lung function measures, adjusted for confounding factors. Associations with lower lung function were consistently larger for PM₁ than for PM_2.5. Adjusted odds ratios (OR) per interquartile range greater PM₁ ranged from 1.53 for MMEF (95% confidence interval [CI]: 1.20-1.96) to 2.14 for FEV1 (95% CI: 1.66-2.76) and ORs for PM_2.5 ranged from 1.36 for MMEF (95%CI: 1.12-1.66) to 1.82 for FEV1 (95%CI: 1.49-2.22), respectively. PM₁ and PM_2.5 had significant associations with FVC and FEV1 in primary school children, and on PEF and MMEF in middle school children. Long-term PM₁ and PM_2.5 exposure can lead to decreased lung function in children, and the associations of PM₁ are stronger than PM_2.5. Therefore, PM₁ may be more hazardous to children's respiratory health than PM_2.5 exposure.

Characterization of PM2.5-Bound Polycyclic Aromatic Hydrocarbons at Two Central China Cities: Seasonal Variation, Sources, and Health Risk Assessment

In this study, ambient PM_2.5 samples were collected from October 2014 to August 2015 in urban area of Luoyang (LY) and Pingdingshan (PDS), two medium-size industrial cities in central China. Sixteen priority polycyclic aromatic hydrocarbons (PAHs) were analyzed to investigate the seasonal variation, potential pollution sources, and health risk of PAHs bound to PM_2.5 (PM_2.5-bound PAHs). The diagnostic ratios analysis and positive matrix fraction (PMF) model were used to identify potential sources of PM_2.5-bound PAHs. The annual average concentrations of PM_2.5 and PM_2.5-bound PAHs were 128 μg m^-3 and 73 ng m^-3 for LY, and 119 μg m^-3 and 182 ng m^-3 for PDS, respectively, both displaying seasonal trends with higher concentrations in winter and autumn than in spring and summer. BaP equivalent concentrations were 14.4 and 16.5 ng m^-3 in LY and PDS, respectively. The predominant PAHs were 4-6 ring PAHs, with contribution of more than 80% at both sampling sites. PMF analysis revealed that coal combustion was the most important source of PM_2.5-bound PAHs in LY and PDS, accounting for 37% and 39%, respectively, followed by traffic emissions (34% and 33% in LY and PDS, respectively). The average inhalation cancer risk (ICR) for a lifetime of 70 years were 12.5 × 10^-4 and 14.3 × 10^-4 in LY and PDS, respectively, which were much higher than US EPA guideline limit of 10^-6. The traffic source and coal combustion source contributed the highest ICR values in LY and PDS, respectively.

Effect of ambient air quality on exacerbation of COPD in patients and its potential mechanism

Background

Chronic obstructive pulmonary disease (COPD) is a disease of continuous progress and environmental factors may affect the progress. COPD patients’ activity tolerance and quality of life are associated with air quality. COPD exacerbation from the perspective of geographical air quality has not been reported.

Objectives

To explore environmental effect of two different geographical places on COPD exacerbation and the effect of cigarette smoke extract and carbon particles on bronchial epithelial cell viability.

Methods

Total 139 COPD patients, who lived in Beijing during summer and temporarily migrated to Sanya city in winter, have been enrolled. Respiratory symptoms and lung function data were collected when they were living in Beijing or Sanya, respectively. Effect of cigarette smoke extract plus ultrafine carbon particles on airway epithelial cells were studied.

Measurements and main results

Air pollution as measured by air quality index (AQI) in Beijing summer (113.1±14.2) was significantly worse than that in Sanya winter (49.4±8.9, p<0.001). The COPD Assessment Test (CAT) score was significantly higher in Beijing (26.4±7.1) than that in Sanya (20.0±8.0, p=0.019). Modified Medical Research Council dyspnea scale was also significantly higher in Beijing (2.9±0.9) than that in Sanya (1.9±0.8, p<0.001). FEV₁ was significantly improved when the patients were in Sanya (48.88±24.78%) compared to that in Beijing (41.79±20.06%, p<0.01). Compared with Beijing and Sanya, the relative risk (RR) of hospitalization and acute exacerbation were 1.64 and 3.36, respectively. In vitro study demonstrated that apoptosis of BEAS2B cells in response to cigarette smoke extract plus ultrafine carbon particles (25.50±2.10%) was significantly higher than that of control culture (2.30±1.05%, p<0.01).

Conclusion

These findings suggested that ambient air pollution cause COPD exacerbation, and that air pollutants particle matters induce apoptosis of airway epithelial cells.

Geostatistical predictive modeling for asthma and chronic obstructive pulmonary disease using socioeconomic and environmental determinants

The spatial distribution of the prevalence of asthma and chronic obstructive pulmonary disease (COPD) remains under the influence of a wide array of environmental, climatic, and socioeconomic determinants. However, a large proportion of these influences remain unexplained. In completion, this study examined the spatial associations between asthma/COPD morbidity and their determinants using ordinary least squares (OLS) and geographically weighted regressions (GWR). Inpatient records collected from the secondary and tertiary care hospitals in Kandy from 2010 to 2014 were considered as the dependent variable. Potential risk factors (explanatory variables) were identified in four distinguished classes: 1) meteorological factors, (2) direct and indirect factors of air pollution, (3) socioeconomic factors, and (4) characteristics of the physical environment. All possible combinations of candidate explanatory variables were evaluated through an exploratory regression. A comparison between the regression models was also explored. The best OLS regression models revealed about 55% of asthma variation and 62% of COPD variation while GWR models yielded 78% and 74% of the variation of asthma and COPD occurrences respectively. Relative humidity, proximity to roads (0-200 m), road density, use of firewood as a source of fuel, and elevation play a vital role in predicting morbidity from asthma and COPD. Both local and global regression models are important in assessing spatial relationships of asthma and COPD. However, the local models exhibit a better prediction capability for assessing non-stationary relationships of asthma and COPD than global models. The geostatistical aspects used in this study may also provide insights for evaluating heterogeneous environmental risk factors in other epidemiological studies across different spatial settings.

DIFFERENT RESPONSE TO EXPOSURE TO AIR POLLUTANTS IN GIRLS AND BOYS

Objective:

Identify the association between exposure to fine particulate matter and hospitalizations due to respiratory diseases in children up to ten years of age in the city of Cuiabá, Mato Grosso, stratifying the analysis by sex and calculating excess costs.

Methods:

Ecological study of time series. The dependent variable was daily hospitalizations according to the 10^th Revision of the International Classification of Diseases (ICD10): J04.0, J12.0 to J18.9, J20.0 to J21.9 and J45.0 to J45.0. The independent variables were the concentration of fine particulate, estimated by a mathematical model, temperature and relative air humidity, controlled by short and long-term trends. Generalized additive model of Poisson regression was used. Relative risks, proportional attributable risk (PAR) and excess hospitalizations and their respective costs by the population attributable fraction (PAF) were calculated.

Results:

1,165 children were hospitalized, 640 males and 525 females. The mean concentration, estimated by the mathematical model, was 15.1±2.9 mcg/m³ for PM_2.5. For boys, there was no significant association; for girls a relative risk of up to 1.04 of daily hospitalizations due to respiratory diseases was observed for exposure to PM 2.5 in lags 1, 2 and 6. Increase of 5 µg/m³ in these concentrations increased the percentage of the risk in 18%; with an excess 95 hospital admissions and with excess expenses in the order of US$ 35 thousand.

Conclusions:

Significant effect in daily hospitalizations due to respiratory diseases related to exposure to fine particulate matter was noted for girls, suggesting the need for stratification by sex in further studies.

Short-Term Effects of Ambient Air Pollution on Hospitalization for Respiratory Disease in Taiyuan, China: A Time-Series Analysis

In this study, we estimated the short-term effects of ambient air pollution on respiratory disease hospitalization in Taiyuan, China. Daily data of respiratory disease hospitalization, daily concentration of ambient air pollutants and meteorological factors from 1 October 2014 to 30 September 2017 in Taiyuan were included in our study. We conducted a time-series study design and applied a generalized additive model to evaluate the association between every 10-μg/m³ increment of air pollutants and percent increase of respiratory disease hospitalization. A total of 127,565 respiratory disease hospitalization cases were included in this study during the present period. In single-pollutant models, the effect values in multi-day lags were greater than those in single-day lags. PM_2.5 at lag02 days, SO₂ at lag03 days, PM₁₀ and NO₂ at lag05 days were observed to be strongly and significantly associated with respiratory disease hospitalization. No significant association was found between O₃ and respiratory disease hospitalization. SO₂ and NO₂ were still significantly associated with hospitalization after adjusting for PM_2.5 or PM₁₀ into two-pollutant models. Females and younger population for respiratory disease were more vulnerable to air pollution than males and older groups. Therefore, some effective measures should be taken to strengthen the management of the ambient air pollutants, especially SO₂ and NO₂, and to enhance the protection of the high-risk population from air pollutants, thereby reducing the burden of respiratory disease caused by ambient air pollution.

Coarse particles and hospital admissions due to respiratory diseases in children. An ecological time series study

BACKGROUND

Exposure to particulate matter (PM) is associated with hospitalizations due to respiratory diseases among children.

DESIGN AND SETTING

An ecological time series study was carried out to identify the role of coarse fractions of particulate matter (PM10-2.5) in hospitalizations among children up to 10 years of age, in Piracicaba (SP) in the year 2015.

METHODS

A generalized additive model of Poisson regression was used to estimate the risk of hospitalization due to acute laryngitis and tracheitis, pneumonia, bronchitis, bronchiolitis and asthma. Lags of 0 to 7 days were considered, and the model was adjusted for the temperature and relative humidity of the air and controlled for short and long-term exposure. Proportional attributable ratios, population-attributable fractions and hospital costs were calculated with increasing concentrations of these pollutants.

RESULTS

638 hospitalizations were evaluated during this period, with a mean of 1.75 cases per day (standard deviation, SD = 1.86). The daily averages were 22.45 µg/m3 (SD = 13.25) for the coarse fraction (PM10-2.5) and 13.32 µg/m3 (SD = 6.38) for the fine fraction. Significant risks of PM10-2.5 exposure were only observed at lag 0, with relative risk (RR) = 1.012, and at lag 6, with RR = 1.011. An increase of 5 µg/m3 in the coarse fraction concentration implied an increase in the relative risk of hospitalizations of up to 4.8%, with an excess of 72 hospitalizations and excess expenditure of US$ 17,000 per year.

CONCLUSIONS

This study showed the impact of coarse-fraction exposure on hospital admissions among children due to respiratory diseases.

A Multicity Analysis of the Short-Term Effects of Air Pollution on the Chronic Obstructive Pulmonary Disease Hospital Admissions in Shandong, China

Although there is growing evidence linking chronic obstructive pulmonary disease (COPD) hospital admissions to the exposure to ambient air pollution, the effect can vary depending on the local geography, pollution type, and pollution level. The number of large-scale multicity studies remains limited in China. This study aims to assess the short-term effects of ambient air pollution (PM_2.5, PM₁₀, SO₂, NO₂) on chronic obstructive pulmonary disease hospital admissions from 2015 to 2016, with a total of 216,159 records collected from 207 hospitals in 17 cities all over the Shandong province, east China. Generalized additive models and penalized splines were applied to study the data whilst controlling for confounding meteorological factors and long-term trends. The air pollution was analyzed with 0–6 day lag effects and the percentage change of hospital admissions was assessed for a 10-μg/m³ increase in the air pollution levels. We also examined the percentage changes for different age groups and gender, respectively. The results showed that air pollution was significantly associated with adverse health outcomes and stronger effects were observed for females. The air pollution health effects were also impacted by geographical factors such that the air pollution had weaker health effects in coastal cities.

Effects of exposure to air pollutants on children's health in Cuiabá, Mato Grosso State, Brazil

Exposure to air pollutants, usually measured by environmental agencies that are not present in all states, may be associated with respiratory admissions in children. An ecological time series study was conducted with data on hospitalizations due to selected respiratory diseases in children under 10 years of age in 2012 in the city of Cuiabá, Mato Grosso State, Brazil. Mean levels of fine particulate matter (PM2.5) were estimated with a mathematical model, data on low temperatures and relative humidity were obtained from the Brazilian National Institute of Meteorology, and the numbers of brush burnings were obtained from the Environmental Information System. The statistical approach used the Poisson regression generalized additive model with lags of 0 to 7 days. The financial costs and increases in hospitalizations due to increments in PM2.5 were estimated. There were 565 hospitalizations (mean 1.54 admissions/day; SD = 1.52), and mean PM2.5 concentration was 15.7µg/m3 (SD = 3.2). Associations were observed between exposure and hospitalizations in the second semester at lags 2 and 3, and at lag 2 when the entire year was analyzed. An increment of 5µg/m3 in PM2.5 was associated with an increase of 89 hospitalizations and costs exceeding BRL 95,000 (≈ USD 38,000) for the Brazilian Unified National Health System. Data estimated by mathematical models can be used in locations where pollutants are not monitored.

Air pollution and hospital visits for acute upper and lower respiratory infections among children in Ningbo, China: A time-series analysis

Acute upper and lower respiratory infections are main causes of mortality and morbidity in children. Air pollution has been recognized as an important contributor to development and exacerbation of respiratory infections. However, few studies are available in China. In this study, we investigated the short-term effect of air pollution on hospital visits for acute upper and lower respiratory infections among children under 15 years in Ningbo, China. Poisson generalized models were used to estimate the associations between air pollution and hospital visits for acute upper and lower respiratory infections adjusted for temporal, seasonal, and meteorological effects. We found that four pollutants (PM_2.5, PM₁₀, NO₂, and SO₂) were significantly associated with hospital visits for acute upper and lower respiratory infections. The effect estimates for acute upper respiratory infections tended to be higher (PM_2.5 ER = 3.46, 95% CI 2.18, 4.76; PM₁₀ ER = 2.81, 95% CI 1.93, 3.69; NO₂ ER = 11.27, 95% CI 8.70, 13.89; SO₂ ER = 15.17, 95% CI 11.29, 19.19). Significant associations for gaseous pollutants (NO₂ and SO₂) were observed after adjustment for particular matter. Stronger associations were observed among older children and in the cold period. Our study suggested that short-term exposure to outdoor air pollution was associated with hospital visits for acute upper and lower respiratory infections in Ningbo.

A quantitative assessment of source contributions to fine particulate matter (PM2.5)-bound polycyclic aromatic hydrocarbons (PAHs) and their nitrated and hydroxylated derivatives in Hong Kong

Atmospheric polycyclic aromatic hydrocarbons (PAHs) and their derivatives are of great concern due to their adverse health effects. However, source identification and apportionment of these compounds, particularly their nitrated and hydroxylated derivatives (i.e., NPAHs and OHPAHs), in fine particulate matter (PM_2.5) in Hong Kong are still lacking. In this study, we conducted a 1-year observation at an urban site in Hong Kong. PM_2.5-bound PAHs and their derivatives were measured, with median concentrations of 4590, 44.4 and 31.6 pg m^-3 for ∑₂₁PAHs, ∑₁₃NPAHs, and ∑₁₂OHPAHs, respectively. Higher levels were observed on regional pollution days than on long regional transport (LRT) or local emission days. Based on positive matrix factorization analysis, four sources were determined: marine vessels, vehicle emissions, biomass burning, and a mixed source of coal combustion and NPAHs secondary formation. Coal combustion and biomass burning were the major sources of PAHs, contributing over 85% of PAHs on regional and LRT days. Biomass burning was the predominant source of OHPAHs throughout the year, while NPAHs mainly originated from secondary formation and fuel combustion. For benzo[a]pyrene (BaP)-based PM_2.5 toxicity, the mixed source of coal combustion and NPAHs secondary formation was the major contributor, followed by biomass burning and vehicle emissions.

Fine Particulate Air Pollution and Hospital Emergency Room Visits for Respiratory Disease in Urban Areas in Beijing, China, in 2013

Background

Heavy fine particulate matter (PM_2.5) air pollution occurs frequently in China. However, epidemiological research on the association between short-term exposure to PM_2.5 pollution and respiratory disease morbidity is still limited. This study aimed to explore the association between PM_2.5 pollution and hospital emergency room visits (ERV) for total and cause-specific respiratory diseases in urban areas in Beijing.

Methods

Daily counts of respiratory ERV from Jan 1 to Dec 31, 2013, were obtained from ten general hospitals located in urban areas in Beijing. Concurrently, data on PM_2.5 were collected from the Beijing Environmental Protection Bureau, including 17 ambient air quality monitoring stations. A generalized-additive model was used to explore the respiratory effects of PM_2.5, after controlling for confounding variables. Subgroup analyses were also conducted by age and gender.

Results

A total of 92,464 respiratory emergency visits were recorded during the study period. The mean daily PM_2.5 concentration was 102.1±73.6 μg/m³. Every 10 μg/m³ increase in PM_2.5 concentration at lag₀ was associated with an increase in ERV, as follows: 0.23% for total respiratory disease (95% confidence interval [CI]: 0.11%-0.34%), 0.19% for upper respiratory tract infection (URTI) (95%CI: 0.04%-0.35%), 0.34% for lower respiratory tract infection (LRTI) (95%CI: 0.14%-0.53%) and 1.46% for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (95%CI: 0.13%-2.79%). The strongest association was identified between AECOPD and PM_2.5 concentration at lag_0-3 (3.15%, 95%CI: 1.39%-4.91%). The estimated effects were robust after adjusting for SO₂, O₃, CO and NO₂. Females and people 60 years of age and older demonstrated a higher risk of respiratory disease after PM_2.5 exposure.

Conclusion

PM_2.5 was significantly associated with respiratory ERV, particularly for URTI, LRTI and AECOPD in Beijing. The susceptibility to PM_2.5 pollution varied by gender and age.