Guangzhou is a metropolitan in south China with unique pollutants and geographic location. Unlike those in western countries and the rest of China, the appearance of haze in Guangzhou is often (about 278 days per year on average of 4 years). Little is known about the influence of these hazes on health. In this study, we investigated whether short-term exposures to haze and air pollution are associated with hospital admissions in Guangzhou. The relationships between haze, air pollution, and daily hospital admissions during 2008–2011 were assessed using generalized additive model. Studies were categorized by gender, age, season, lag, and disease category. In haze episodes, an increase in air pollutant emissions corresponded to 3.46 (95 % CI, 1.67, 5.27) increase in excessive risk (ER) of total hospital admissions at lag 1, 11.42 (95 % CI, 4.32, 18.99) and 11.57 (95 % CI, 4.38, 19.26) increases in ERs of cardiovascular illnesses at lags 2 and 4 days, respectively. As to total hospital admissions, an increase in NO2 was associated with a 0.73 (95 % CI, 0.11, 1.35) and a 0.28 (95 % CI, 0.11, 0.46) increases in ERs at lag 5 and lag 05, respectively. For respiratory illnesses, increases in NO2 was associated with a 1.94 (95 % CI, 0.50, 3.40) increase in ER at lag 0, especially among chronic obstructive pulmonary disease. Haze (at lag1) and air pollution (for NO2 at lag 5 and for SO2 at lag3) both presented more drastic effects on the 19 to 64 years old and in the females. Together, we demonstrated that haze pollution was associated with total and cardiovascular illnesses. NO2 was the sole pollutant with the largest risk of hospital admissions for total and respiratory diseases in both single- and multi-pollutant models.
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Chronic obstructive pulmonary disease
Upper respiratory infection
Ischemic heart disease
- PM10 :
A diameter measuring less than 10 μm
- SO2 :
- NO2 :
Generalized additive model
The International Classification of Disease 10th Revision
Ackermann-Liebrich U et al (1997) Lung function and long term exposure to air pollutants in Switzerland. Study on Air Pollution and Lung Diseases in Adults (SAPALDIA) Team. Am J Respir Crit Care Med 155:122–129
Brunekreef B (2002) Particulate matter and lung function growth in children: a 3-yr follow-up study in Austrian schoolchildren. Eur Respir J 20:1354–1355
Chen B, Kan H, Chen R, Jiang S, Hong C (2011) Air pollution and health studies in China—Policy implications. J. Air & Waste Manage. Assoc., 61:1292-1299
Clougherty JE (2010) A growing role for gender analysis in air pollution epidemiology. Environ Health Perspect 118: 167–176
Daniels MJ, Dominici F, Zeger S (2004) Underestimation of standard errors in multi-site time series studies. Epidemiology 15:57–62
Dominici F, McDermott A, Zeger SL, Samet JM (2002) On the use of generalized additive models in time-series studies of air pollution and health. Am J Epidemiol 156:193–203
Franco Suglia S, Gryparis A, Schwartz J, Wright RJ (2008) Association between traffic-related black carbon exposure and lung function among urban women. Environ Health Perspect 116:1333–1337
Gotschi T, Sunyer J, Chinn S, de Marco R, Forsberg B, Gauderman JW, Garcia-Esteban R, Heinrich J, Jacquemin B, Jarvis D, Ponzio M, Villani S, Kunzli N (2008) Air pollution and lung function in the European Community Respiratory Health Survey. Int J Epidemiol 37:1349–1358
Guo Y, Jia Y, Pan X, Liu L, Wichmann HE (2009) The association between fine particulate air pollution and hospital emergency room visits for cardiovascular diseases in Beijing, China. Sci Total Environ 407:4826–4830
Horvath H (1995) Estimation of the average visibility in central Europe. Atmos Environ 29:6
Kan H, Chen B (2003a) Air pollution and daily mortality in Shanghai: a time-series study. Arch Environ Health 58:360–367
Kan H, Chen B (2003b) A case-crossover analysis of air pollution and daily mortality in Shanghai. J Occup Health 45:119–124
Lin JS (1995): Climatic characteristics of visibility in Guangzhou. GuangDong Meteorology 1, 3
Mannino DM (2002) COPD: epidemiology, prevalence, morbidity and mortality, and disease heterogeneity. Chest 121:121S–126S
Marshall JD, Brauer M, Frank LD (2009) Healthy neighborhoods: walkability and air pollution. Environ Health Perspect 117:1752–1759
Menon S, Hansen J, Nazarenko L, Luo Y (2002) Climate effects of black carbon aerosols in China and India. Science 297:2250–2253
Mitsakou C, Housiadas C, Eleftheriadis K, Vratolis S, Helmis C, Asimakopoulos D (2007) Lung deposition of fine and ultrafine particles outdoors and indoors during a cooking event and a no activity period. Indoor Air 17:143–152
Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS (2001) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 163:1256–1276
Ponce de Leon A, Anderson HR, Bland JM, Strachan DP, Bower J (1996) Effects of air pollution on daily hospital admissions for respiratory disease in London between 1987–88 and 1991–92. J Epidemiol Community Health 50(Suppl 1):s63–s70
Qian Z, He Q, Lin HM, Kong L, Liao D, Dan J, Bentley CM, Wang B (2007) Association of daily cause-specific mortality with ambient particle air pollution in Wuhan, China. Environ Res 105:380–389
Rundell KW, Caviston R, Hollenbach AM, Murphy K (2006) Vehicular air pollution, playgrounds, and youth athletic fields. Inhal Toxicol 18:541–547
Santus P, Russo A, Madonini E, Allegra L, Blasi F, Centanni S, Miadonna A, Schiraldi G, Amaducci S (2012) How air pollution influences clinical management of respiratory diseases. A case-crossover study in Milan. Respir Res 13: 95
Schikowski T, Sugiri D, Ranft U, Gehring U, Heinrich J, Wichmann HE, Kramer U (2005) Long-term air pollution exposure and living close to busy roads are associated with COPD in women. Respir Res 6:152
Senaratne I, Shooter D (2004) Elemental composition in source identification of brown haze in Auckland, New Zealand. Atmos. Environ 38:3049–3059
Shao M, Zhang Y, Zeng L, Tang X, Zhang J, Zhong L, Wang B (2009) Ground-level ozone in the Pearl River Delta and the roles of VOC and NO(x) in its production. J Environ Manag 90:512–518
So KL, Wang T (2003) On the local and regional influence on ground-level ozone concentrations in Hong Kong. Environ Pollut 123:307–317
Speizer FE, Ferris B Jr, Bishop YM, Spengler J (1980) Respiratory disease rates and pulmonary function in children associated with NO2 exposure. Am Rev Respir Dis 121:3–10
Strak M, Boogaard H, Meliefste K, Oldenwening M, Zuurbier M, Brunekreef B, Hoek G (2010) Respiratory health effects of ultrafine and fine particle exposure in cyclists. Occup Environ Med 67: 118–24
Streets DG, Yu C, Wu Y, Chin M, Zhao ZC, Hayasaka T, Shi GY (2008) Aerosol trends over China, 1980–2000. Atmos Res 88:9
Sun Y, Zhuang G, Tang AA, Wang Y, An Z (2006) Chemical characteristics of PM2.5 and PM10 in haze-fog episodes in Beijing. Environ Sci Technol 40:3148–3155
Teksam O, Gumus P, Bayrakci B, Erdogan I, Kale G (2010) Acute cardiac effects of carbon monoxide poisoning in children. Eur J Emerg Med 17: 192–6
van der Zee SC, Hoek G, Boezen MH, Schouten JP, van Wijnen JH, Brunekreef B (2000) Acute effects of air pollution on respiratory health of 50–70 yr old adults. Eur Respir J 15:700–709
Xu X, Gao J, Dockery DW, Chen Y (1994) Air pollution and daily mortality in residential areas of Beijing, China. Arch Environ Health 49:216–222
Xu Z, Yu D, Jing L, Xu X (2000) Air pollution and daily mortality in Shenyang, China. Arch Environ Health 55:115–120
Yadav AK, Kumar K, Awg Makarimi Hj Awg Kasim, Singh MP, Parida SK, Sharan M (2003) Visibility and incidence of respiratory diseases during the 1998 haze episode in Brunei Darussalam. Pure appl Geophys 160:265–277
Zheng CL, de Sa VR, Gribskov M, Nair TM (2003) On selecting features from splice junctions: an analysis using information theoretic and machine learning approaches. Genome Inform 14:73–83
This work was supported by the National Natural Science Foundation of China (81070043, 81071917, 81173112, 81170052, 81220108001), the Chinese Central Government Key Research Projects of the 973 grants (2009CB522107), a Changjiang Scholars and Innovative Research Team in University grant (IRT0961), a Guangdong Natural Science Foundation team grant (1035101200300000), the Guangdong Department of Science and Technology of China (2009B050700041, 2010B031600301), the Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme (2008) China, a Guangdong Department of Education research grant (cxzd1025), and Guangzhou Department of Education Yangcheng Scholarships (10A058S, 12A001S). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Conflicts of interest
The authors have declared that no competing interests exist.
Zili Zhang and Jian Wang contributed equally to this article.
Responsible editor: Constantini Samara
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Zhang, Z., Wang, J., Chen, L. et al. Impact of haze and air pollution-related hazards on hospital admissions in Guangzhou, China. Environ Sci Pollut Res 21, 4236–4244 (2014). https://doi.org/10.1007/s11356-013-2374-6
- Air pollutants
- Hospital admissions
- Respiratory and cardiovascular diseases