Abstract
Exposure to air pollutants has been linked to the exacerbation of the respiratory disease. The air quality index and air quality health index (AQHI) were used to evaluate the number of asthma hospitalization attributed to air quality using time-series regression analysis with a distributed lag model. This study was performed from March 2014 to February 2019 in Hamadan, Iran. A generalized linear model (GLM) and distributed lag model (DLM) with the family of Poisson distribution were used to investigate the asthma hospitalization associated with air pollution. The seasonal effect of air pollution was considered in data analysis. Results showed that during the study period, 671 people were hospitalized. The mean (SD) values for AQI, AQHI, and PM2.5 levels were 70.66 (37.77), 3.58 (2.22), and 38.59 (17.43), respectively. The highest adverse effects on asthma hospitalization were observed for AQHI at lag 1 (RR = 1.052, 95% CI 0.998–1.109) and for AQI at lag 1 (RR = 1.002, 95% CI 0.997–1.007), for 1-unit increase of the indexes, and were observed for PM2.5 at lag 0 (RR = 1.005, 95% CI 1.001–1.009) and lag 7 (RR = 1.005, 95% CI 1.001–1.009) for 10 µg/m3 increase in PM2.5 levels. Seasonal analysis results showed that hospitalization in the warm season was significantly higher than that of the cold season for AQI and PM2.5 levels, while RR obtained for AQHI was higher in the cold season. The results confirm the association between air pollutants and an increase in a load of adult asthma hospitalization. To confirm the effects of seasonal variation of PM level and other possible factors (such as meteorological factors) on hospitalization due to asthma, more research will be needed. Our findings provide valuable data to increasing policymakers’ awareness and developing a strategy to improve air quality.
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Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Not applicable for that section.
Change history
29 December 2021
A Correction to this paper has been published: https://doi.org/10.1007/s11869-021-01137-0
References
Abelsohn A, Stieb DM (2011) Health effects of outdoor air pollution: approach to counseling patients using the Air Quality Health Index. Can Fam Physician 57:881–887
Alizadeh, M., Hashtroodi, L. G., Chavoshzadeh, Z. & Rezaei, N. 2016. Effect of air pollution in frequency of hospitalizations in asthmatic children. Acta Medica Iranica, 542–546.
Amarloei, A., Fazlzadeh, M., Jafari, A. J., Zarei, A. & Mazloomi, S. 2020. Particulate matters and bioaerosols during Middle East dust storms events in Ilam, Iran. Microchemical Journal, 152, 104280.
Amini H, Nhung NTT, Schindler C, Yunesian M, Hosseini V, Shamsipour M, Hassanvand MS, Mohammadi Y, Farzadfar F, Vicedo-Cabrera AM (2019) Short-term associations between daily mortality and ambient particulate matter nitrogen dioxide and the air quality index in a Middle Eastern megacity. Environmental Pollution 254:113121
Arnedo-Pena A, García-Marcos L, Bercedo-Sanz A, Aguinaga-Ontoso I, González-Díaz C, García-Merino Á, Busquets-Monge R, Suárez-Varela MM, Batlles-Garrido J, Blanco-Quirós AA (2013) Prevalence of asthma symptoms in schoolchildren, and climate in west European countries: an ecologic study. Int J Biometeorol 57:775–784
Asl FB, Leili M, Vaziri Y, Arian SS, Cristaldi A, Conti GO, Ferrante M (2018) Health impacts quantification of ambient air pollutants using AirQ model approach in Hamadan. Iran Environ Res 161:114–121
BahramiAsl F, Leili M, Vasiri Y, Arian SS, Cristaldi A, Conti GO, Ferrante M (2018) Health impacts quantification of ambient air pollutants using AirQ model approach in Hamadan. Iran Environ Res 161:114–121
Bateson TF, Schwartz J (2007) Children’s response to air pollutants. J Toxicol Environ Health A 71:238–243
Beelen R, Raaschou-Nielsen O, Stafoggia M, Andersen ZJ, Weinmayr G, Hoffmann B, Wolf K, Samoli E, Fischer P, Nieuwenhuijsen M (2014) Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project. The Lancet 383:785–795
Blaisdell CJ, Weiss SR, Kimes DS, Levine ER, Myers M, Timmins S, Bollinger ME (2002) Using seasonal variations in asthma hospitalizations in children to predict hospitalization frequency. J Asthma : Off J Assoc Care of Asthma 39:567–575
Cai J, Zhao A, Zhao J, Chen R, Wang W, Ha S, Xu X, Kan H (2014) Acute effects of air pollution on asthma hospitalization in Shanghai, China. Environ Pollut 191:139–144
Cakmak S, Kauri L, Shutt R, Liu L, Green MS, Mulholland M, Stieb D, Dales R (2014) The association between ambient air quality and cardiac rate and rhythm in ambulatory subjects. Environ Int 73:365–371
Chen K, Glonek G, Hansen A, Williams S, Tuke J, Salter A, Bi P (2016) The effects of air pollution on asthma hospital admissions in Adelaide, South Australia, 2003–2013: time-series and case–crossover analyses. Clin Exp Allergy 46:1416–1430
Cheng M-H, Chen C-C, Chiu H-F, Yang C-Y (2014) Fine particulate air pollution and hospital admissions for asthma: a case-crossover study in Taipei. J Toxicol Environ Health A 77:1075–1083
Climate-Data. 2016. Climate-Data.Org. Available from: https://en.climatedata.org/location/956725/. [Online]. [Accessed].
Climate-Data. 2019. Climate-Data.Org. Available from: https://en.climate-data.org/asia/iran/hamadan/hamedan-494/ [Online]. [Accessed].
COX Jr LAT (2017) Socioeconomic and air pollution correlates of adult asthma, heart attack, and stroke risks in the United States, 2010–2013. Environ Res 155:92–107
Cyrys, J., Heinrich, J., Richter, K., Wölke, G., Wichmann, H.-E., Group, I.-S. G. I.-S. & For Environment, G.-N. R. C. 2000. Sources and concentrations of indoor nitrogen dioxide in Hamburg (west Germany) and Erfurt (east Germany). Science of the Total Environment, 250, 51-62
DALAL P (2015) Modeling of air quality index. Int J Adv Res Eng App Sci 4:1–11
Delamater PL, Finley AO, Banerjee S (2012) An analysis of asthma hospitalizations, air pollution, and weather conditions in Los Angeles County, California. Sci Total Environ 425:110–118
Ding L, Zhu D, Peng D, Zhao Y (2017) Air pollution and asthma attacks in children: a case–crossover analysis in the city of Chongqing, China. Environ Pollut 220:348–353
Du X, Chen R, Meng X, Liu C, Niu Y, Wang W, Li S, Kan H, Zhou M (2020) The establishment of National Air Quality Health Index in China. Environ Int 138:105594
Elliot AJ, Smith S, Dobney A, Thornes J, Smith GE, Vardoulakis S (2016) Monitoring the effect of air pollution episodes on health care consultations and ambulance call-outs in England during March/April 2014: A retrospective observational analysis. Environ Pollut 214:903–911
Gayer, A., Adamkiewicz, Ł., Mucha, D. & Badyda, A. Air quality health indices-review. MATEC Web of Conferences, 2018. EDP Sciences, 00002.
Gowers AM, Cullinan P, Ayres JG, Anderson HR, Strachan DP, Holgate ST, Mills IC, Maynard RL (2012) Does outdoor air pollution induce new cases of asthma? Biological plausibility and evidence; a review. Respirol 17:887–898
Guarnieri M, Balmes JR (2014) Outdoor air pollution and asthma. The Lancet 383:1581–1592
Hassanvand MS, Naddafi K, Faridi S, Arhami M, Nabizadeh R, Sowlat MH, Pourpak Z, Rastkari N, Momeniha F, Kashani H (2014) Indoor/outdoor relationships of PM10, PM2.5, and PM1 mass concentrations and their water-soluble ions in a retirement home and a school dormitory. Atmos Environ 82:375–382
Hassanvand MS, Naddafi K, Faridi S, Nabizadeh R, Sowlat MH, Momeniha F, Gholampour A, Arhami M, Kashani H, Zare A (2015) Characterization of PAHs and metals in indoor/outdoor PM10/PM2.5/PM1 in a retirement home and a school dormitory. Sci Total Environ 527:100–110
Huang, K., Ding, K., Yang, X.-J., Hu, C.-Y., Jiang, W., Hua, X.-G., Liu, J., Cao, J.-Y., Zhang, T. & Kan, X.-H. 2020. Association between short-term exposure to ambient air pollutants and the risk of tuberculosis outpatient visits: a time-series study in Hefei, China. Environmental Research, 109343.
Kan H, London SJ, Chen G, Zhang Y, Song G, Zhao N, Jiang L, Chen B (2008) Season, sex, age, and education as modifiers of the effects of outdoor air pollution on daily mortality in Shanghai, China: The Public Health and Air Pollution in Asia (PAPA) Study. Environ Health Perspect 116:1183–1188
Karimi B, Samadi S (2019) Mortality and hospitalizations due to cardiovascular and respiratory diseases associated with air pollution in Iran: a systematic review and meta-analysis. Atmos Environ 198:438–447
Khaniabadi YO, Sicard P, Takdastan A, Hopke PK, Taiwo AM, Khaniabadi FO, de Marco A, Daryanoosh M (2019) Mortality and morbidity due to ambient air pollution in Iran. Clin Epidemiol Global Health 7:222–227
Kim H, Kim H, Park Y-H, Lee J-T (2017) Assessment of temporal variation for the risk of particulate matters on asthma hospitalization. Environ Res 156:542–550
Ko FW, Tam W, Wong TW, Lai C, Wong G, Leung TF, Ng S, Hui D (2007) Effects of air pollution on asthma hospitalization rates in different age groups in Hong Kong. Clin Exp Allergy 37:1312–1319
Kwon J-W, Han Y-J, Oh MK, Lee CY, Kim JY, Kim EJ, Kim H, Kim WJ (2016) Emergency department visits for asthma exacerbation due to weather conditions and air pollution in Chuncheon, Korea: a case-crossover analysis. Allergy, Asthma Immunol Res 8:512–521
Lai L-W, Cheng W-L (2017) Difference of performance in response to disease admissions between daily time air quality indices and those derived from average and entropy functions. Environ Sci Pollut Res 24:14924–14933
Lee CC, Sheridan SC, Lin S (2012) Relating weather types to asthma-related hospital admissions in New York State. EcoHealth 9:427–439
Lee S-W, Huang Y-C, Lin C-Y, Huang H-Y, Liu C-W, Hsieh M-T, Lee C-L, Chung W-Y, Chung KF, Wang C-H (2021) Impact of annual exposure to polycyclic aromatic hydrocarbons on acute exacerbation frequency in asthmatic patients. Journal of Asthma and Allergy 14:81
Leili, M., Nadali, A., Karami, M., Bahrami, A. & Afkhami, A. 2021. Short-term effect of multi-pollutant air quality indexes and PM2.5 on cardiovascular hospitalization in Hamadan, Iran: a time-series analysis. Environmental Science and Pollution Research, 1–15.
Li L, Lin G-Z, Liu H-Z, Guo Y, Ou C-Q, Chen P-Y (2015) Can the Air Pollution Index be used to communicate the health risks of air pollution? Environ Pollut 205:153–160
Li X, Xiao J, Lin H, Liu T, Qian Z, Zeng W, Guo L, Ma W (2017) The construction and validity analysis of AQHI based on mortality risk: a case study in Guangzhou, China. Environ Pollut 220:487–494
Lin H, Tao J, Du Y, Liu T, Qian Z, Tian L, Di Q, Rutherford S, Guo L, Zeng W, Xiao J, Li X, He Z, Xu Y, Ma W (2016) Particle size and chemical constituents of ambient particulate pollution associated with cardiovascular mortality in Guangzhou, China. Environ Pollut 208:758–766
Liu L, Liu C, Chen R, Zhou Y, Meng X, Hong J, Cao L, Lu Y, Dong X, Xia M (2020) Associations of short-term exposure to air pollution and emergency department visits for pediatric asthma in Shanghai. China. Chemosphere 263:127856
Lovinsky-Desir S, Acosta LM, Rundle AG, Miller RL, Goldstein IF, Jacobson JS, Chillrud SN, Perzanowski MS (2019) Air pollution, urgent asthma medical visits and the modifying effect of neighborhood asthma prevalence. Pediatr Res 85:36–42
Mannucci PM, Harari S, Franchini M (2019) Novel evidence for a greater burden of ambient air pollution on cardiovascular disease. haematologica 104:2349–2357
Moghtaderi M, Zarei M, Farjadian S, Shamsizadeh S (2016) Prediction of the impact of air pollution on rates of hospitalization for asthma in Shiraz based on air pollution indices in 2007–2012. Open Journal of Air Pollution 5:37–43
Movahedi S, Afzali SM (2013) Analysis of the number of dusty days in the west and south west of Iran. Res J Recent Sci 2:18–21
Nadali, A., Leili, M., Bahrami, A., Karami, M. Afkhami, A. Phase distribution and risk assessment of PAHs in ambient air of Hamadan Iran. Ecotoxicology and Environmental Safety, 209, 111807.
Olstrup H, Johansson C, Forsberg B, Tornevi A, Ekebom A, Meister K (2019) A multi-pollutant air quality health index (AQHI) based on short-term respiratory effects in Stockholm, Sweden. Int J Environ Res Public Health 16:105
Pan R, Wang X, Yi W, Wei Q, Gao J, Xu Z, Duan J, He Y, Tang C, Liu X (2020) Interactions between climate factors and air quality index for improved childhood asthma self-management. Science of The Total Environment 723:137804
Park M, Luo S, Kwon J, Stock TH, Delclos G, Kim H, Yun-Chul H (2013) Effects of air pollution on asthma hospitalization rates in different age groups in metropolitan cities of Korea. Air Qual Atmos Health 6:543–551
Phung D, Hien TT, Linh HN, Luong LM, Morawska L, Chu C, Binh ND, Thai PK (2016) Air pollution and risk of respiratory and cardiovascular hospitalizations in the most populous city in Vietnam. Sci Total Environ 557:322–330
PORTET S (2020) A primer on model selection using the Akaike Information Criterion. Infect Dis Model 5:111–128
Prasauskas T, Martuzevicius D, Krugly E, Ciuzas D, Stasiulaitiene I, Sidaraviciute R, Kauneliene V, Seduikyte L, Jurelionis A, Haverinen-Shaughnessy U (2014) Spatial and temporal variations of particulate matter concentrations in multifamily apartment buildings. BUILD ENVIRON 76:10–17
Raji H, Riahi A, Borsi SH, Masoumi K, Khanjani N, Ahmadiangali K, Goudarzi G, Dastoorpoor M (2020) Acute effects of air pollution on hospital admissions for asthma, COPD, and bronchiectasis in Ahvaz. Iran Int J Chronic Obstruct Pulmonary Dis 15:501
Shahsavani A, Naddafi K, Haghighifard NJ, Mesdaghinia A, Yunesian M, Nabizadeh R, Arahami M, Sowlat M, Yarahmadi M, Saki H (2012) The evaluation of PM10, PM2.5, and PM1 concentrations during the Middle Eastern Dust (MED) events in Ahvaz, Iran, from April through September 2010. J Arid Environ 77:72–83
Sharma AK, Saini S, Chhabra P, Chhabra SK, Ghosh C, Baliyan P (2020) Air pollution and weather as the determinants of acute attacks of asthma: spatiotemporal approach. Indian J Public Health 64:124
Simoni M, Baldacci S, Maio S, Cerrai S, Sarno G, Viegi G (2015) Adverse effects of outdoor pollution in the elderly. J Thorac Dis 7:34
Škrbić B, Marinković V, Spaić S, Milanko V, Branovački S (2018) Profiles of polycyclic aromatic hydrocarbons in smoke from combustion and thermal decomposition of poplar wood pellets and sawdust. Microchem J 139:9–17
Soleimani Z, Boloorani AD, Khalifeh R, Teymouri P, Mesdaghinia A, Griffin DW (2019) Air pollution and respiratory hospital admissions in Shiraz, Iran, 2009 to 2015. Atmos Environ 209:233–239
SZYSZKOWICZ M (2019) The Air Quality Health Index and all emergency department visits. Environ Sci Pollut Res 26:24357–24361
Thalib L, Al-Taiar A (2012) Dust storms and the risk of asthma admissions to hospitals in Kuwait. Sci Total Environ 433:347–351
Tian Y, Liu H, Liang T, Xiang X, Li M, Juan J, Song J, Cao Y, Wang X, Chen L (2019) Fine particulate air pollution and adult hospital admissions in 200 Chinese cities: a time-series analysis. Int J Epidemiol 48:1142–1151
Tian Y, Liu H, Si Y, Cao Y, Song J, Li M, Wu Y, Wang X, Xiang X, Juan J (2019) Association between temperature variability and daily hospital admissions for cause-specific cardiovascular disease in urban China: a national time-series study. PLoS med 16:e1002738
Tian Y, Xiang X, Juan J, Sun K, Song J, Cao Y, Hu Y (2017) Fine particulate air pollution and hospital visits for asthma in Beijing, China. Environ Pollut 230:227–233
To T, Feldman L, Simatovic J, Gershon AS, Dell S, Su J, Foty R, Licskai C (2015) Health risk of air pollution on people living with major chronic diseases: a Canadian population-based study. BMJ Open 5:e009075
To T, Shen S, Atenafu EG, Guan J, McLimont S, Stocks B, Licskai C (2013) The air quality health index and asthma morbidity: a population-based study. Environ Health Perspect 121:46–52
Vanasse A, Talbot D, Chebana F, Belanger D, Blais C, Gamache P, Giroux J-X, Dault R, Gosselin P (2017) Effects of climate and fine particulate matter on hospitalizations and deaths for heart failure in elderly: a population-based cohort study. Environ Int 106:257–266
WEISS KB (1990) Seasonal trends in US asthma hospitalizations and mortality. JAMA 263:2323–2328
WHO 2013. (World Health Organization) Review of evidence on health aspects of air pollution–REVIHAAP project. Technical Report. Copenhagen: WHO Regional Office for Europe. Available
WHO 2018. World Health Organization. Burden of disease from the joint effects of household and ambient air pollution https://www.who.int/airpollution/ data/cities/en/.
Acknowledgements
This manuscript is a part of a funded Ph.D. thesis. The authors are grateful to the Department of the Environment for providing data on hourly air pollutants concentrations, the Hamadan University of Medical Sciences for providing the data on hospital admission, and also Hamadan’s Meteorological Organization for providing the climate data.
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The research was funded by the Vice Chancellery for Research at Hamadan University of Medical Sciences (Ph.D. thesis No. 9705022515).
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Azam Nadali: conceptualization, methodology, validation, formal analysis, resources, writing – original draft, writing – review and editing. Mostafa Leili: conceptualization, methodology, validation, formal analysis, investigation, resources, writing – original draft, writing – review and editing, supervision, funding acquisition, project administration. Manoochehr Karami: conceptualization, methodology, validation, formal analysis, writing – original draft, writing – review and editing. Abdolrahman Bahrami: methodology, validation, formal analysis. Abbas Afkhami: conceptualization, methodology, formal analysis.
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This study was approved by the ethics committee of Hamadan University of Medical Sciences (with the code of ethics: IR.UMSHA.REC.1397.313) and was conducted according to the mentioned guidelines.
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Nadali, A., Leili, M., Karami, M. et al. The short-term association between air pollution and asthma hospitalization: a time-series analysis. Air Qual Atmos Health 15, 1153–1167 (2022). https://doi.org/10.1007/s11869-021-01111-w
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DOI: https://doi.org/10.1007/s11869-021-01111-w