Impact of Air Pollution and Trans-Boundary Haze on Nation-Wide Emergency Department Visits and Hospital Admissions in Singapore

Abstract

Introduction: Air pollution is associated with adverse health outcomes. However, its impact on emergency health services is less well understood. We investigated the impact of air pollution on nation-wide emergency department (ED) visits and hospital admissions to public hospitals in Singapore. Materials and Methods: Anonymised administrative and clinical data of all ED visits to public hospitals in Singapore from January 2010 to December 2015 were retrieved and analysed. Primary and secondary outcomes were defined as ED visits and hospital admissions, respectively. Conditional Poisson regression was used to model the effect of Pollutant Standards Index (PSI) on each outcome. Both outcomes were stratified according to subgroups defined a priori based on age, diagnosis, gender, patient acuity and time of day. Results: There were 5,791,945 ED visits, of which 1,552,187 resulted in hospital admissions. No significant association between PSI and total ED visits (Relative risk [RR], 1.002; 99.2% confidence interval [CI], 0.995–1.008; P = 0.509) or hospital admissions (RR, 1.005; 99.2% CI, 0.996–1.014; P = 0.112) was found. However, for every 30-unit increase in PSI, significant increases in ED visits (RR, 1.023; 99.2% CI, 1.011–1.036; P = 1.24 × 10˗6) and hospital admissions (RR, 1.027; 99.2% CI, 1.010–1.043; P = 2.02 × 10˗5) for respiratory conditions were found. Conclusion: Increased PSI was not associated with increase in total ED visits and hospital admissions, but was associated with increased ED visits and hospital admissions for respiratory conditions in Singapore. Key words: Epidemiology, Healthcare utilisation, PSI, Public health, Time series

The Annals: Welcoming the future of Medicine

“…16 The Annals has published outcomes from the Growing Up in Singapore Towards healthy Outcomes (GUSTO), 17 the Singapore Mental Health Study, [18][19][20] and several other cohort studies providing vital epidemiological insights into disease dynamics in Singapore. Other notable articles covered the cost of managing chronic diseases, 16 drug utilisation and long-term outcomes of stroke patients, 21,22 prehospital care among patients with cardiac arrests, 23,24 risk factors for obstetric emergencies such as uterine rupture, 25 Southeast Asia's annual affair with trans-boundary haze, 26,27 and the adoption of newer laparoscopic and robot-assisted surgical techniques. 28 To contextualise these reports, we encourage authors to provide bullet-point summaries to explain their key findings and their clinical implications.…”