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Air pollution and hospital admissions for critical illness in emergency department: a tertiary-center research in Changsha, China, 2016–2020

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Abstract

We aimed to comprehensively investigate the associations of air pollutants with hospital admissions for critical illness in ED. Patients with critical illness including level 1 and level 2 of the Emergency Severity Index admitted in ED of Changsha Central Hospital from January 2016 to December 2020 were enrolled. Meteorological and air pollutants data source were collected from the National Meteorological Science Data Center. A Poisson generalized linear regression combined with a polynomial distributed lag model (PDLM) was utilized to explore the effect of air pollution on hospital admissions for critical illness in ED. Benchmarks as references (25th) were conducted for comparisons with high levels of pollutant concentrations (75th). At first, lagged effects of all different air pollutants were analyzed. Then, based on the most significant factor, analyses in subgroups were performed by gender (male and female), age (< 45, 45–65, and > 65), disorders (cardiovascular, neurological, respiratory), and seasons (spring, summer, autumn, and winter). A total of 47,290 patients with critical illness admitted in ED were included. The effects of air pollutants (PM2.5, PM10, SO2, NO2, O3 and CO) on critical illness ED visits were statistically significant. Strong collinearity between PM2.5 and PM10 (r = 0.862) was found. Both single-day lag and cumulative-day lag day models showed that PM2.5 had the strongest effects (lag 0, RR = 1.025, 95% CI 1.008–1.043, and lag 0–14, RR = 1.067, 95% CI 1.017–1.120, respectively). In both PM2.5 and PM10, the risks of critical illness in male, > 65 ages, respiratory diseases, and winter increased the most significant. Air pollutants, especially PM2.5 and PM10 exposure, could increase the risk of critical illness admission.

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Data availability

The datasets used and/or analyzed during the present study are available from the corresponding author on reasonable request.

Abbreviations

PM2.5 :

Particulate matter with an aerodynamic diameter ≤ 2.5 μm

PM10 :

Particulate matter with an aerodynamic diameter ≤ 10 μm

SO2 :

Sulfur dioxide

NO2 :

Nitrogen dioxide

CO:

Carbon monoxide

O3 :

Ozone

T:

Temperature

SD:

Standard deviation

ESI:

Emergency Severity Index

ED:

Emergency department

PDLM:

Polynomial distributed lag model

AQI:

Air quality index

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Funding

Changsha Central Hospital, University of South China (YNKY202115); Natural Science Foundation of Changsha (kq2004172).

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Author notes

  1. Hang Lin and Yong Long contributed equally to this work.

Authors and Affiliations

  1. Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO. 161 Shaoshan South Road, Changsha, Hunan, 410004, China

    Hang Lin, Yong Long, Yingjie Su, Kun Song, Changluo Li & Ning Ding

Authors
  1. Hang Lin
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  2. Yong Long
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  3. Yingjie Su
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  4. Kun Song
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  5. Changluo Li
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  6. Ning Ding
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Contributions

Conception and design: Hang Lin, Ning Ding

Administrative support: Ning Ding

Provision of study materials or patients: Changluo Li, Yong Long, Kun Song, Yingjie Su

Collection and assembly of data: Yingjie Su, Ning Ding

Data analysis and interpretation: Hang Lin, Ning Ding

Final approval of manuscript: All authors

Corresponding author

Correspondence to Ning Ding.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the Ethics Committees of Changsha Central Hospital of University of South China (Changsha, China). All research was performed in accordance with the relevant guidelines and regulations. Due to the retrospective characteristics of the study, informed consent was waived, which was also approved by the Ethics Committee of Changsha Central Hospital of University of South China (Changsha, China).

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Not applicable.

Conflict of interest

The authors declare no competing interests.

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Lin, H., Long, Y., Su, Y. et al. Air pollution and hospital admissions for critical illness in emergency department: a tertiary-center research in Changsha, China, 2016–2020. Environ Sci Pollut Res 29, 21440–21450 (2022). https://doi.org/10.1007/s11356-021-17295-8

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  • DOI: https://doi.org/10.1007/s11356-021-17295-8

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