Abstract
Due to the rapid economic development and acceleration of industrialization, most cities in China are experiencing severe air pollution. Exposure to fine particulate matter (PM2.5) has been associated with acute lower respiratory tract infection (ALRI). To estimate associations between short-term exposure to PM2.5 and ALRI hospitalization in Yancheng City, China. This was a 6-year time-series study from 2014 to 2019. Data on hospitalization were collected from four high-ranked general hospitals, including for community-acquired pneumonia (CAP), acute exacerbation of chronic bronchitis (AECB), acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and acute exacerbation of bronchiectasis (AEB), and the sum was termed total ALRIs. We obtained pollutant exposure data from five fixed monitoring stations. The association between PM2.5 and ALRI hospitalization was estimated using the generalized linear model with quasi-Poisson regression. Two-pollutant models were applied to test the robustness of the observed correlations. Subgroup analyses included sex, age, and season. During the study period, a total of 43,283 cases of total ALRIs were recorded. The average annual mean PM2.5 concentration was 45.4 ± 32.3 μg/m3. A 10-μg/m3 increase in PM2.5 concentration (lag 0) was significantly associated with increases in hospitalizations for total ALRIs (at 0.73%; 95% CI: 0.40%, 1.06%), in CAP (at 0.80%; 95% CI: 0.02%, 1.57%), in for AECOPD (1.08%; 95% CI: 0.38%, 1.78%), and AECB (0.67%; 95% CI: 0.23%, 1.11%). The estimated effects for total ALRIs and AECB were relatively robust with adjustment for other air pollutants. Associations between PM2.5 and total ALRIs were stronger in females, in the elderly, and in the cold season. PM2.5 exposure was significantly associated with ALRI morbidity, and females and older people were more susceptible to PM2.5 air pollution, especially in the cold season.
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References
Behbod B, Urch B, Speck M, Scott JA, Liu L, Poon R, Coull B, Schwartz J, Koutrakis P, Silverman F, Gold DR (2013) Endotoxin in concentrated coarse and fine ambient particles induces acute systemic inflammation in controlled human exposures. Occup Environ Med 70:761–767. https://doi.org/10.1136/oemed-2013-101498
Belleudi V, Faustini A, Stafoggia M, Cattani G, Marconi A, Perucci CA, Forastiere F (2010) Impact of fine and ultrafine particles on emergency hospital admissions for cardiac and respiratory diseases. Epidemiology 21:414–423. https://doi.org/10.1097/EDE.0b013e3181d5c021
Billas A (1990) Lower respiratory tract infections. Prim Care 17:811–824. https://doi.org/10.5005/jp/books/11182_11
Brown JS, Gordon T, Price O, Asgharian B (2013) Thoracic and respirable particle definitions for human health risk assessment. Part Fibre Toxicol 10:1–12. https://doi.org/10.1186/1743-8977-10-12
Cadelis G, Tourres R, Molinie J (2014) Short-term effects of the particulate pollutants contained in Saharan dust on the visits of children to the emergency department due to asthmatic conditions in Guadeloupe (French archipelago of the Caribbean). PLoS One 9. https://doi.org/10.1371/journal.pone.0091136
Chen R, Huang W, Wong CM, Wang Z, Thach TQ, Chen B, Kan H, CAPES Collaborative Group (2012) Short-term exposure to sulfur dioxide and daily mortality in 17 Chinese cities: the China air pollution and health effects study (CAPES). Environ Res 118:101–106. https://doi.org/10.1016/j.envres.2012.07.003
Chen X, Wang N, Chen Y, Xiao T, Fu C, Xu B (2016) Costs of chronic obstructive pulmonary disease in urban areas of China: a cross-sectional study in four cities. Int J Chron Obstruct Pulmon Dis 11:2625–2632. https://doi.org/10.2147/copd.S118523
Chen R, Yin P, Meng X, Liu C, Wang L, Xu X, Ross JA, Tse LA, Zhao Z, Kan H, Zhou M (2017) Fine Particulate Air Pollution and Daily Mortality. A Nationwide Analysis in 272 Chinese Cities. Am J Respir Crit Care Med 196:73–81. https://doi.org/10.1164/rccm.201609-1862OC
Chen R, Yin P, Meng X, Wang L, Liu C, Niu Y, Liu Y, Liu J, Qi J, You J, Kan H, Zhou M (2019) Associations between coarse particulate matter air pollution and cause-specific mortality: a nationwide analysis in 272 Chinese Cities. Environ Health Perspect 127:17008. https://doi.org/10.1289/ehp2711
CNEMC (2021) CNEMC, China National Environmental Monitoring Centre. Available from: http://www.cnemc.cn/en/
GBD Rist Factors Collaborators (2020) Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396:1223–1249. https://doi.org/10.1016/s0140-6736(20)30752-2
Glencross DA, Ho TR, Camiña N, Hawrylowicz CM, Pfeffer PE (2020) Air pollution and its effects on the immune system. Free Radic Biol Med 151:56–68. https://doi.org/10.1016/j.freeradbiomed.2020.01.179
Host S, Larrieu S, Pascal L, Blanchard M, Declercq C, Fabre P, Jusot JF, Chardon B, le Tertre A, Wagner V, Prouvost H, Lefranc A (2008) Short-term associations between fine and coarse particles and hospital admissions for cardiorespiratory diseases in six French cities. Occup Environ Med 65:544–551. https://doi.org/10.1136/oem.2007.036194
Kan H, London SJ, Chen G, Zhang Y, Song G, Zhao N, Jiang L, Chen B (2007) Differentiating the effects of fine and coarse particles on daily mortality in Shanghai, China. Environ Int 33:376–384. https://doi.org/10.1016/j.envint.2006.12.001
Kan H, London SJ, Chen G, Zhang Y, Song G, Zhao N, Jiang L, Chen B (2008) Season, sex, age, and education as modifiers of the effects of outdoor air pollution on daily mortality in Shanghai, China: The Public Health and Air Pollution in Asia (PAPA) Study. Environ Health Perspect 116:1183–1188. https://doi.org/10.1289/ehp.10851
Kim KH, Kabir E, Kabir S (2015) A review on the human health impact of airborne particulate matter. Environ Int 74:136–143. https://doi.org/10.1016/j.envint.2014.10.005
Kloog I, Nordio F, Zanobetti A, Coull BA, Koutrakis P, Schwartz JD (2014) Short term effects of particle exposure on hospital admissions in the mid-Atlantic states: a population estimate. PLoS One 9:1–7. https://doi.org/10.1371/journal.pone.0088578
Liu C, Chen R, Sera F, Vicedo-Cabrera AM, Guo Y, Tong S, Coelho MSZS, Saldiva PHN, Lavigne E, Matus P, Valdes Ortega N, Osorio Garcia S, Pascal M, Stafoggia M, Scortichini M, Hashizume M, Honda Y, Hurtado-Díaz M, Cruz J, Nunes B, Teixeira JP, Kim H, Tobias A, Íñiguez C, Forsberg B, Åström C, Ragettli MS, Guo YL, Chen BY, Bell ML, Wright CY, Scovronick N, Garland RM, Milojevic A, Kyselý J, Urban A, Orru H, Indermitte E, Jaakkola JJK, Ryti NRI, Katsouyanni K, Analitis A, Zanobetti A, Schwartz J, Chen J, Wu T, Cohen A, Gasparrini A, Kan H (2019) Ambient particulate air pollution and daily mortality in 652 cities. N Engl J Med 381:705–715. https://doi.org/10.1056/NEJMoa1817364
Malagon-Rojas J, Pinzón-Silva DC, Parra EL, Lagos L, Toloza-Perez YG, Hernández Florez LJ, Morales R, Romero Díaz SA, Ríos Cabra AP, Sarmiento OL (2020) Assessment of personal exposure to particulate air pollution in different microenvironments and traveling by several modes of transportation in Bogotá, Colombia: protocol for a mixed-methods study. JMIR Res Protoc. https://doi.org/10.2196/25690
Mariani J, Favero C, Spinazzè A, Cavallo DM, Carugno M, Motta V, Bonzini M, Cattaneo A, Pesatori AC, Bollati V (2018) Short-term particulate matter exposure influences nasal microbiota in a population of healthy subjects. Environ Res 162:119–126. https://doi.org/10.1016/j.envres.2017.12.016
Qin T, Zhang F, Zhou H, Ren H, du Y, Liang S, Wang F, Cheng L, Xie X, Jin A, Wu Y, Zhao J, Xu J (2019) High-level PM2.5/PM10 exposure is associated with alterations in the human pharyngeal microbiota composition. Front Microbiol 10:54. https://doi.org/10.3389/fmicb.2019.00054
Rahman MS, Azad MAK, Hasanuzzaman M, Salam R, Islam ARMT, Rahman MM, Hoque MMM (2021) How air quality and COVID-19 transmission change under different lockdown scenarios? A case from Dhaka city, Bangladesh. Sci Total Environ 762:143161. https://doi.org/10.1016/j.scitotenv.2020.143161
Ravindra K, Rattan P, Mor S, Aggarwal AN (2019a) Generalized additive models: building evidence of air pollution, climate change and human health. Environ Int 132:104987. https://doi.org/10.1016/j.envint.2019.104987
Ravindra K, Singh T, Mor S, Singh V, Mandal TK, Bhatti MS, Gahlawat SK, Dhankhar R, Mor S, Beig G (2019b) Real-time monitoring of air pollutants in seven cities of North India during crop residue burning and their relationship with meteorology and transboundary movement of air. Sci Total Environ 690:717–729. https://doi.org/10.1016/j.scitotenv.2019.06.216
Schwartz J, Spix C, Touloumi G, Bacharova L, Barumamdzadeh T, le Tertre A, Piekarksi T, Ponce de Leon A, Ponka A, Rossi G, Saez M, Schouten JP (1996) Methodological issues in studies of air pollution and daily counts of deaths or hospital admissions. J Epidemiol Community Health 50:S3–S11. https://doi.org/10.1136/jech.50.suppl_1.s3
Song YZ, Yang HL, Peng JH, Song YR, Sun Q, Li Y (2015) Estimating PM2.5 concentrations in Xi’an City using a generalized additive model with multi-source monitoring data. PLoS One 10. https://doi.org/10.1371/journal.pone.0142149
Stafoggia M, Samoli E, Alessandrini E, Cadum E, Ostro B, Berti G, Faustini A, Jacquemin B, Linares C, Pascal M, Randi G, Ranzi A, Stivanello E, Forastiere F, the MED-PARTICLES Study Group (2013) Short-term associations between fine and coarse particulate matter and hospitalizations in Southern Europe: results from the MED-PARTICLES project. Environ Health Perspect 121:1026–1033. https://doi.org/10.1289/ehp.1206151
Sun Q, Liu C, Chen R, Wang C, Li J, Sun J, Kan H, Cao J, Bai H (2019) Association of fine particulate matter on acute exacerbation of chronic obstructive pulmonary disease in Yancheng, China. Sci Total Environ 650:1665–1670. https://doi.org/10.1016/j.scitotenv.2018.09.278
Sunyer J, Schwartz J, Tobías A et al (2000) Patients with chronic obstructive pulmonary disease are at increased risk of death associated with urban particle air pollution: a case-crossover analysis. Am J Epidemiol 151:50–56. https://doi.org/10.1093/oxfordjournals.aje.a010121
Tian Y, Xiang X, Juan J, Song J, Cao Y, Huang C, Li M, Hu Y (2018) Short-term effects of ambient fine particulate matter pollution on hospital visits for chronic obstructive pulmonary disease in Beijing, China. Environ Health 17:21. https://doi.org/10.1186/s12940-018-0369-y
Tian Y, Liu H, Wu Y, Si Y, Li M, Wu Y, Wang X, Wang M, Chen L, Wei C, Wu T, Gao P, Hu Y (2019a) Ambient particulate matter pollution and adult hospital admissions for pneumonia in urban China: a national time series analysis for 2014 through 2017. PLoS Med 16:e1003010. https://doi.org/10.1371/journal.pmed.1003010
Tian Y, Liu H, Wu Y, Si Y, Li M, Wu Y, Wang X, Wang M, Chen L, Wei C, Wu T, Gao P, Hu Y (2019b) Ambient particulate matter pollution and adult hospital admissions for pneumonia in urban China: a national time series analysis for 2014 through 2017. PLoS Med 16:1–18. https://doi.org/10.1371/journal.pmed.1003010
Tsai SS, Chiu HF, Liou SH, Yang CY (2014) Short-term effects of fine particulate air pollution on hospital admissions for respiratory diseases: a case-crossover study in a tropical city. J Toxicol Environ Health A 77:1091–1101. https://doi.org/10.1080/15287394.2014.922388
WHO (2016) WHO The top 10 causes of death Available from: http://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
Xie W, Li G, Zhao D, Xie X, Wei Z, Wang W, Wang M, Li G, Liu W, Sun J, Jia Z, Zhang Q, Liu J (2015) Relationship between fine particulate air pollution and ischaemic heart disease morbidity and mortality. Heart 101:257–263. https://doi.org/10.1136/heartjnl-2014-306165
Xu Q, Li X, Wang S, Wang C, Huang F, Gao Q, Wu L, Tao L, Guo J, Wang W, Guo X (2016) Fine particulate air pollution and hospital emergency room visits for respiratory disease in urban areas in Beijing, China, in 2013. PLoS One 11:e0153099. https://doi.org/10.1371/journal.pone.0153099
Yao C, Wang Y, Williams C, Xu C, Kartsonaki C, Lin Y, Zhang P, Yin P, Lam KBH (2020) The association between high particulate matter pollution and daily cause-specific hospital admissions: a time-series study in Yichang, China. Environ Sci Pollut Res Int 27:5240–5250. https://doi.org/10.1007/s11356-019-06734-2
Yee J, Cho YA, Yoo HJ, Yun H, Gwak HS (2021) Short-term exposure to air pollution and hospital admission for pneumonia: a systematic review and meta-analysis. Environ Heal A Glob Access Sci Source 20:6. https://doi.org/10.1186/s12940-020-00687-7
Zhao Y, Wang S, Lang L, Huang C, Ma W, Lin H (2017) Ambient fine and coarse particulate matter pollution and respiratory morbidity in Dongguan, China. Environ Pollut 222:126–131. https://doi.org/10.1016/j.envpol.2016.12.070
Zuo B, Liu C, Chen R, Kan H, Sun J, Zhao J, Wang C, Sun Q, Bai H (2019) Associations between short-term exposure to fine particulate matter and acute exacerbation of asthma in Yancheng, China. Chemosphere 237:124497. https://doi.org/10.1016/j.chemosphere.2019.124497
Acknowledgments
We acknowledge the data support from the 4 high-ranked general hospitals (the First People’s Hospital of Yancheng, the Third People’s Hospital of Yancheng, Yancheng Hospital of Traditional Chinese Medicine, and Tinghu District People’s Hospital of Yancheng), China National Environmental Monitoring Center, and Yancheng Meteorological Bureau.
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Study concept and design: JZ, QS, and HjB. Acquisition of the data: JZ, QS, and JS. Analysis and interpretation of the data, drafting of the manuscript, and statistical analysis: JZ, QS, TZ, JjL, and YjC. Critical revision of the manuscript for important intellectual content: JZ and QS. Study supervision: HyZ. All authors read and approved the final version.
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Zhuang, J., Bai, H., Sun, J. et al. The association between fine particulate matter and acute lower respiratory infections in Yancheng City, China. Environ Sci Pollut Res 28, 61723–61731 (2021). https://doi.org/10.1007/s11356-021-15102-y
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DOI: https://doi.org/10.1007/s11356-021-15102-y