Individual exposure to ambient PM2.5 and hospital admissions for COPD in 110 hospitals: a case-crossover study in Guangzhou, China

Abstract

Few studies have evaluated the short-term association between hospital admissions and individual exposure to ambient particulate matter (PM2.5). Particularly, no studies focused on hospital admissions for chronic obstructive pulmonary disease (COPD) at the individual level. We assessed the short-term effects of PM2.5 on hospitalization admissions for COPD in Guangzhou, China, during 2014–2015, based on satellite-derived estimates of ambient PM2.5 concentrations at a 1-km resolution near the residential address as individual-level exposure for each patient. Around 40,002 patients with COPD admitted to 110 hospitals were included in this study. A time-stratified case-crossover design with conditional logistic regression models was applied to assess the effects of PM2.5 based on a 1-km grid data of aerosol optical depth provided by the National Aeronautics and Space Administration on hospital admissions for COPD. Further, we performed stratified analyses by individual demographic characteristics and season of hospital admission. Around 10 μg/m3 increase in individual-level PM2.5 was associated with an increase of 1.6% (95% confidence interval [CI]: 0.6%, 2.7%) in hospitalization for COPD at a lag of 0–5 days. The impact of PM2.5 on hospitalization for COPD was greater significantly in males and patients admitted in summer. Our study strengthened the evidence for the adverse effect of PM2.5 based on satellite-based individual-level exposure data.

Air pollution and long-term risk of hospital admission due to chronic obstructive pulmonary disease exacerbations in Poland: a time-stratified, case-crossover study

“…In a study from Kermanshah, Iran, COPD admissions were increased one day after exposure to PM10, NO2, and SO2 [25]. Lin et al reported that acute COPD exacerbations were more likely over 7 days since exposure to PM10, NO2, and SO2 in Taiwan [26]. In a study from Shijiazhuang, China, the risk of hospital admission due to an exacerbation of COPD was increased over 7 days since exposure to PM2.5 (RR per 10 μg/m3 [95% CI] 1.011 [1.003, 1.018], PM10 (1.004 [0.999, 1.01]), SO2…”

“…In a study from Guangzhou, China, the risk of hospitalization due to a COPD exacerbation was greatest immediately after and then around 15 days after exposure to NO2 [35]. In another study from Guangzhou, which gathered data from 110 hospitals, the risk of hospitalization due to COPD was associated with exposure to PM10, but only the short-term risk was assessed (RR of 1.015 over 6 days) [26]. These observations were confirmed in other studies from China (Shenyang, Beijing, Jinhua) [36][37][38].…”

High levels of indoor fine particulate matter during the cold season in Almaty prompt urgent public health action

“…First and foremost, burning coal and wood for heating and cooking in the suburbs of Almaty poses colossal burden on healthcare. Other studies in large populations have clearly demonstrated that pollution with fine PM is associated with a very wide range of health effects, including emergency room visits and hospitalizations for cerebrovascular disease, even more in vulnerable groups, such as the elderly [ 16 – 18 ], premature mortality due to cardiovascular disease and ischemic heart disease [ 19 – 21 ], COPD incidence and hospitalization with it [ 22 , 23 ] and even depression [ 24 ] and suicides [ 25 ]. Given that low- and middle-income countries like Kazakhstan endure the greatest burden of PM 2.5 -related diseases, such as COPD [ 26 ], deposition of PM 2.5 is very high [ 27 ] and a very large fraction of ambient fine PM pollution during the cold season is found indoors, we call for urgent mitigation and control action.…”

Association between PM2.5 Exposure and Cardiovascular and Respiratory Hospital Admissions Using Spatial GIS Analysis

“…Therefore, the findings should not be generalized for the whole population. Second, limited by the ecological design of the study, we were unable to adjust the model for the potential confounders related to individual characteristics (e.g., age, gender, smoking) [31,32] and time activity patterns (e.g., occupation, commuting, indoor air pollution) [33]. Third, we conducted only a one-pollutant model to examine the association between PM 2.5 and hospital admissions; collinearity between pollutants could, however, occur.…”