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Associations between acute exposure to ambient air pollution and length of stay for inpatients with ischemic heart disease: a multi-city analysis in central China

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Abstract

Ambient air pollution (AAP) has been widely associated with increased morbidity of ischemic heart disease (IHD). However, no prior studies have investigated the effects of AAP exposure on the length of stay (LOS) due to IHD. Hospital data during 2015–2017 were obtained from hospital information system in five cities of Hubei province, China. We collected daily mean concentrations of air pollutants, including PM2.5, PM10, SO2, NO2, O3, and CO, and meteorological data during the same time period. Poisson regression was applied to estimate the acute impacts of AAP on the LOS of IHD inpatients. A total of 42,114 inpatients with primary diagnosis of IHD were included, 50.63% of which were chronic IHD inpatients. Annual average concentrations of PM2.5, PM10, SO2, NO2, O3, and CO were 61.93 μg/m3, 95.47 μg/m3, 18.59 μg/m3, 35.87 μg/m3, 100.30 μg/m3, and 1.117 mg/m3, respectively. After adjusting for temperature, relative humidity, gender, age group, payment method, number of hospital beds, location of hospital, and surgery or not, exposures to PM2.5, PM10, SO2, O3, and CO were associated with increased LOS for all IHD patients in both single- and multi-pollutant models, and stronger associations were observed among chronic IHD patients. In addition, subgroup analyses demonstrated that males and the group aged 65+ years were more vulnerable to air pollution, and the adverse effects were also promoted by low temperature in cold season. This study provides the first investigation of the adverse effects of AAP on the LOS for IHD patients. In order to shorten the LOS of IHD, measures should be taken to strengthen the AAP management and protect the high-risk population.

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Acknowledgments

We acknowledge the Hubei National Environmental Monitoring Center for providing air pollution data and the China Meteorological Data Network for providing meteorological data. We greatly thank the hospitals of Wuhan, Yichang, Shiyan, Jingmen, and Huanggang in Hubei province for providing the hospitalization data and the Health Commission of Hubei Province (the former Health and Family Planning Commission of Hubei Province) for undertaking the organization and communication works.

Funding

This work was supported by the National Natural Science Foundation of China (Grant No. 81773552), the National Key Research and Development Program of China (Grant Nos. 2018YFC1315302, 2017YFC1200502), and Key Research Center for Humanities and Social Sciences in Hubei Province (Hubei University of Medicine) (Grant Nos. 2020ZD001, 2016YB008).

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  1. Xuyan Wang and Yong Yu are co-first authors who contributed equally to this work.

Authors and Affiliations

  1. Department of Epidemiology and Health Statistics, School of Health Sciences, Wuhan University, Wuhan, 430071, China

    Xuyan Wang, Chuanhua Yu & Fang Shi

  2. Center of Health Administration and Development Studies, Hubei University of Medicine, Shiyan, 442000, China

    Yong Yu

  3. Global Health Institute, Wuhan University, Wuhan, 430071, China

    Chuanhua Yu

  4. Department of Epidemiology and Biostatistics, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, 430065, China

    Yunquan Zhang

  5. Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, 430065, China

    Yunquan Zhang

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  1. Xuyan Wang
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Wang, X., Yu, Y., Yu, C. et al. Associations between acute exposure to ambient air pollution and length of stay for inpatients with ischemic heart disease: a multi-city analysis in central China. Environ Sci Pollut Res 27, 43743–43754 (2020). https://doi.org/10.1007/s11356-020-10256-7

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