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

  • Chang SuEmail author
  • Susanne Breitner
  • Alexandra Schneider
  • Liqun Liu
  • Ulrich Franck
  • Annette Peters
  • Xiaochuan Pan
Original Article



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.


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.


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.


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.


Emergency room visits Fine particulate matter Cardiovascular diseases Time-series study Polynomial distributed model 



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).

Compliance with ethical standards

Conflict of interest

There exists no conflict of any competing financial interest regarding the submitted article.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Chang Su
    • 1
    • 2
    Email author
  • Susanne Breitner
    • 1
  • Alexandra Schneider
    • 1
  • Liqun Liu
    • 2
  • Ulrich Franck
    • 3
  • Annette Peters
    • 1
  • Xiaochuan Pan
    • 2
  1. 1.Institute of Epidemiology IIHelmholtz Zentrum München - German Research Center for Environmental HealthNeuherbergGermany
  2. 2.School of Public HealthPeking University Health Science CenterBeijingChina
  3. 3.Core Facility StudiesHelmholtz Centre for Environmental Research – UFZLeipzigGermany

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