Association of short-term exposure to air pollution with emergency visits for respiratory diseases in children

He, Miao; Zhong, Yaping; Chen, Yuehan; Zhong, Nanshan; Lai, Kefang

doi:10.1016/j.isci.2022.104879

Cited by 12 publications

(8 citation statements)

References 34 publications

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“…Additionally, our study provided a comparative insight into short-term associations of PM 1 and PM 2.5 exposure in raising the risk of childhood illnesses within a day ( Figure 1 ), which coincided with a daily time-series study on EDVs for all ages’ coverage of 26 cities across China [ 11 ]. Highly consistent effect patterns between PM 1 and PM 2.5 were also reported in previous children’s studies on the consequences of daily hospital admission and hospitalizations for cardiovascular [ 7 , 17 ] and respiratory diseases [ 2 , 6 ], along with EDVs [ 24 , 25 ]. When developing strategies to protect children’s health, local authorities should thus consider the adverse effects of sub-daily scale air pollutants to help children avoid exposure to high-risk time windows.…”

Section: Discussionsupporting

confidence: 82%

Emergency Department Visits in Children Associated with Exposure to Ambient PM1 within Several Hours

Zhu

Wang

et al. 2023

IJERPH

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Background: Emerging evidence has integrated short-term exposure to PM1 with children’s morbidity and mortality. Nevertheless, most available studies have been conducted on a daily scale, ignoring the exposure variations over the span of a day. Objective: The main intention of this study was to examine the association between pediatric emergency department visits (PEDVs) and intra-day exposures to PM1 and PM2.5. We also aimed to investigate whether a high PM1/PM2.5 ratio elevated the risk of PEDVs independent from PM2.5 exposure within several hours. Methods: We collected hourly data on aerial PM1 and PM2.5 concentrations, all-cause PEDVs, and meteorological factors from two megacities (i.e., Guangzhou and Shenzhen) in southern China during 2015–2016. Time-stratified case-crossover design and conditional logistic regression analysis were used to assess the associations of PEDVs with exposures to PM1 and PM2.5 at different lag hours. The contribution of PM1 to PM2.5-associated risk was quantified by introducing PM1/PM2.5 ratio as an additional exposure indicator in the analysis adjusting for PM2.5. Subgroup analyses were performed stratified by sex, age, and season. Results: During this study period, 97,508 and 101,639 children were included from Guangzhou and Shenzhen, respectively. PM1 and PM2.5 exposures within several hours were both remarkably related to an increased risk of PEDVs. Risks for PEDVs increased by 3.9% (95% confidence interval [CI]: 2.7–5.0%) in Guangzhou and 3.2% (95% CI: 1.9–4.4%) in Shenzhen for each interquartile range (Guangzhou: 21.4 μg/m3, Shenzhen: 15.9 μg/m3) increase in PM1 at lag 0–3 h, respectively. A high PM1/PM2.5 ratio was substantially correlated with increased PEDVs, with an excess risk of 2.6% (95% CI: 1.2–4.0%) at lag 73–96 h in Guangzhou and 1.2% (95% CI: 0.4–2.0%) at lag 0–3 h in Shenzhen. Stratified analysis showed a clear seasonal pattern in PM-PEDVs relationships, with notably stronger risks in cold months (October to March of the following year) than in warm months (April to September). Conclusions: Exposures to ambient PM1 and PM2.5 within several hours were related to increased PEDVs. A high PM1/PM2.5 ratio may contribute an additional risk independent from the short-term impacts of PM2.5. These findings highlighted the significance of reducing PM1 in minimizing health risks due to PM2.5 exposure in children.

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Section: Discussionsupporting

confidence: 82%

Emergency Department Visits in Children Associated with Exposure to Ambient PM1 within Several Hours

Zhu

Wang

et al. 2023

IJERPH

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“…Recent studies conducted in Jinan found significant increase in pediatric pneumonia hospitalization rate with elevated PM 2.5 concentrations [ 24 ]. While other heavily polluted cities such as Shanghai, Guangzhou and Shenzhen, also demonstrated increased risk for respiratory diseases [ 25 , 26 ]. Thus, the findings in our study are not only relevant for Jinan but may serve as benchmarks for other heavily polluted cities.…”

Section: Discussionmentioning

confidence: 99%

“…In association with emergency department visits for asthma, PM 2.5 showed no delay (lag 0-day) [ 25 ]; a 3–4 day lag for the maximum effects of PM 2.5 on the risk of pneumonia [ 20 ]; a 2-day delay for ambient air pollution on hospitalization for respiratory diseases [ 33 ]. Similarly, the cumulative effect over 7 days that we observed in this study is also consistent with the cumulative effects of O 3 on lower respiratory diseases in children over 6 days [ 34 ], and the cumulative-day lag effect of PM 2.5 on asthma [ 25 ]. In our data, PM 2.5 posed the most significant risk for VAP when pre-exposure occurred 2 days prior to VAP diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Short-term exposure to ambient fine particulate pollution aggravates ventilator-associated pneumonia in pediatric intensive care patients undergoing cardiovascular surgeries

Cui

et al. 2023

Environ Health

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Background Ambient air pollutants can be hazardous to human health, especially for vulnerable children. The impact of ambient air pollutant exposure before and during intensive care unit (ICU) stays on the development of ventilator-associated pneumonia (VAP) in critically ill children has not been established. We aimed to determine the correlations between short-term exposures to ambient fine particulate matter (PM2.5) and VAP in pediatric cardiac surgery patients in the ICU, and explore the effect of delayed exposure. Methods The medical record of 1755 child patients requiring artificial ventilation in the ICU between December 2013 to December 2020, were analyzed. The daily average concentrations of particulate matters (PM2.5 and PM10), sulfur dioxide (SO2), and ozone (O3) were calculated from public data. Interactions between these pollutants and VAP were simulated with the distributed lag non-linear model. Results Three hundred forty-eight cases (19.829%) of VAP were identified in this study, while the average concentrations of PM2.5, PM10, O3 and SO2 were 58, 118, 98 and 26 μg/m3, respectively. Exposure to increased levels of PM2.5 two days prior (lag 2-day) to VAP diagnosis is significantly correlated with an enhanced risk for VAP development. Even a slight increase of 10 μg/m3 in PM2.5 can translate to a 5.4% increase in VAP incidence (95% CI: 1.4%-9.5%) while the VAP incidence increased to 11.1% (95%CI: 4.5–19.5%) when PM2.5 concentration is well below the National Ambient Air Quality standard (NAAQS) of 50 μg/m3. The association was more pronounced in those aged below 3-months, with low body mass index or suffered from pulmonary arterial hypertension. Conclusion Short-term PM2.5 exposure is a significant risk for development of VAP in pediatric patients. This risk is present even with PM2.5 levels below the NAAQS. Ambient PM2.5 may represent a previously unrecognized risk factor for pneumonia and the current environmental pollution standards need to be reevaluated to consider susceptible populations. Trial registration The trial was registered with the National Clinical Trial Center: The correlation between ambient air pollution and the complications in ICU underwent cardiac surgery. Trial registration number: ChiCTR2000030507. Date of registration: March 5, 2020. URL of trial registry record: http://www.chictr.org.cn/index.aspx.

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“…Short-term exposure to increased PM was associated with increased susceptibility to respiratory infections including influenza 24 , 52 and influenza-like illness, 53–55 RSV bronchiolitis, 25 , 26 , 56 and acute lower respiratory tract infections (LTRI) 22 including pneumonia. 23 , 24 , 57 Chen et al observed that across 47 Chinese cities, a 10 μg/m 3 increase in PM 2 , 5 was associated with an increased risk of influenza (RR 1.020, 95% CI 1.006, 1.034) at lag days 2–3, after controlling for seasonality and weather conditions. 52 Croft et al examined data from 500,000 ED visits and hospitalizations from New York state and found that IQR increases in PM 2.5 during the prior week were significantly associated with higher rates of ED visits for influenza (3.9%, 95% CI 2.105.6%; at 7 days) and culture-negative pneumonia (2.5%, 95% CI 1.4–3.6%; at 6 days).…”

Section: Air Pollution and Respiratory Infection: Epidemiologic Evidencementioning

confidence: 99%

Risk Factors for Respiratory Viral Infections: A Spotlight on Climate Change and Air Pollution

Burbank¹

2023

JAA

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Climate change has both direct and indirect effects on human health, and some populations are more vulnerable to these effects than others. Viral respiratory infections are most common illnesses in humans, with estimated 17 billion incident infections globally in 2019. Anthropogenic drivers of climate change, chiefly the emission of greenhouse gases and toxic pollutants from burning of fossil fuels, and the consequential changes in temperature, precipitation, and frequency of extreme weather events have been linked with increased susceptibility to viral respiratory infections. Air pollutants like nitrogen dioxide, particulate matter, diesel exhaust particles, and ozone have been shown to impact susceptibility and immune responses to viral infections through various mechanisms, including exaggerated or impaired innate and adaptive immune responses, disruption of the airway epithelial barrier, altered cell surface receptor expression, and impaired cytotoxic function. An estimated 90% of the world’s population is exposed to air pollution, making this a topic with high relevance to human health. This review summarizes the available epidemiologic and experimental evidence for an association between climate change, air pollution, and viral respiratory infection.

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Association of short-term exposure to air pollution with emergency visits for respiratory diseases in children

Cited by 12 publications

References 34 publications

Emergency Department Visits in Children Associated with Exposure to Ambient PM1 within Several Hours

Emergency Department Visits in Children Associated with Exposure to Ambient PM1 within Several Hours

Short-term exposure to ambient fine particulate pollution aggravates ventilator-associated pneumonia in pediatric intensive care patients undergoing cardiovascular surgeries

Risk Factors for Respiratory Viral Infections: A Spotlight on Climate Change and Air Pollution

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