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Short-term effects of fine particulate air pollution on cardiovascular hospital emergency room visits: a time-series study in Beijing, China

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Abstract

Background

The link between particulate matter (PM) and cardiovascular morbidity has been investigated in numerous studies. Less evidence exists, however, about how age, gender and season may modify this relationship. The aim of this study was to evaluate the association between ambient PM2.5 (PM ≤ 2.5 µm) and daily hospital emergency room visits (ERV) for cardiovascular diseases in Beijing, China. Moreover, potential effect modification by age, gender, season, air mass origin and the specific period with 2008 Beijing Olympic were investigated. Finally, the temporal lag structure of PM2.5 has also been explored.

Methods

Daily counts of cardiovascular ERV were obtained from the Peking University Third Hospital from January 2007 to December 2008. Concurrently, data on PM2.5, PM10 (PM ≤ 10 µm), nitrogen dioxide and sulfur dioxide concentrations were obtained from monitoring networks and a fixed monitoring station. Poisson regression models adjusting for confounders were used to estimate immediate, delayed and cumulative air pollution effects. The temporal lag structure was also estimated using polynomial distributed lag (PDL) models. We calculated the relative risk (RR) for overall cardiovascular disease ERV as well as for specific causes of disease; and also investigated the potential modifying effect of age, gender, season, air mass origin and the period with 2008 Beijing Olympics.

Results

We observed adverse effects of PM2.5 on cardiovascular ERV—an IQR increase (68 μg/m3) in PM2.5 was associated with an overall RR of 1.022 (95 % CI 0.990–1.057) obtained from PDL model. Strongest effects of PM2.5 on cardiovascular ERV were found for a lag of 7 days; the respective estimate was 1.012 (95 % CI 1.002–1.022). The effects were more pronounced in females and in spring. Arrhythmia and cerebrovascular diseases showed a stronger association with PM2.5. We also found stronger PM-effects for stagnant and southern air masses and the period of Olympics modified the air pollution effects.

Conclusions

We observed a rather delayed effect of PM2.5 on cardiovascular ERV, which was modified by gender and season. Our findings provide new evidence about effect modifications and may have implications to improve policy making for particulate air pollution standards in Beijing, China.

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Acknowledgments

We would like to thank the Medical Record Department of Peking University Third Hospital, and Yi Li in Beijing Meteorological Bureau for providing the data of emergency room visits and PM2.5. This work was supported by the National Natural Science Foundation of China [20637026] and the German Research Foundation (DFG) [WI 621/16-1]. Parts of this work were funded by a scholarship being awarded to Chang Su (File No. 2011601062) under the State Scholarship Fund by the China Scholarship Council (CSC).

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Authors and Affiliations

  1. Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany

    Chang Su, Susanne Breitner, Alexandra Schneider & Annette Peters

  2. School of Public Health, Peking University Health Science Center, Beijing, China

    Chang Su, Liqun Liu & Xiaochuan Pan

  3. Core Facility Studies, Helmholtz Centre for Environmental Research – UFZ, Leipzig, Germany

    Ulrich Franck

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  1. Chang Su
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  2. Susanne Breitner
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  3. Alexandra Schneider
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Correspondence to Chang Su.

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Appendix

Appendix

See Figs. 6, 7, 8, 9 and Table 7.

Fig. 6
figure 6

Yearly mean concentrations of major air pollutants between 2001 and 2008

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Fig. 7
figure 7

Time-series of PM10, PM2.5, SO2, NO2 as well as daily case of cardiovascular emergency room visits from Jan 1st 2007 to Dec 31st 2008

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Fig. 8
figure 8

Four clusters of air mass origin obtained from back-trajectories. Cluster 1 consists of trajectories mostly coming from northwest of Beijing, but within China and Mongolia. Cluster 2 represents air mass coming from the areas surrounding Beijing with low wind speed. Cluster 3 consists of air masses mainly coming from northwest, but with much higher wind speed than in cluster 1. Cluster 4 represents air mass coming from north to northwest, stretching to north of Mongolia and Central Siberia

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Fig. 9
figure 9

Exposure-response function for daily total cardiovascular disease emergency room visits associated with PM2.5

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Table 7 Correlation coefficients for daily mean values of meteorological variables and air pollution variables
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Su, C., Breitner, S., Schneider, A. et al. Short-term effects of fine particulate air pollution on cardiovascular hospital emergency room visits: a time-series study in Beijing, China. Int Arch Occup Environ Health 89, 641–657 (2016). https://doi.org/10.1007/s00420-015-1102-6

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