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01-12-2021 | Septicemia | Research

Sepsis-related hospital admissions and ambient air pollution: a time series analysis in 6 Chinese cities

Authors: Yu Wang, Zhen Liu, Lian Yang, Jiushun Zhou, Jia Li, Hai Lun Liao, Xing Jun Tian

Published in: BMC Public Health | Issue 1/2021

Abstract

Background

Some prevalent but rarely studied causes of hospital admissions, such as sepsis is still unknown whether affected by air pollution.

Methods

We used time-series regression within generalized additive models to estimate the effect of air pollutant level on the sepsis-related hospital admissions, for the years 2017–18, using data from six cities in Sichuan, China. Potential effect modifications by age and sex were also explored. The effects of air pollutant on hospital stays for sepsis were also quantified.

Results

Positive associations between short-term exposure to NO₂ and O₃ and risk of sepsis-related hospital admissions and stays were found. Each 10 μg/m³ increase in short-term NO₂ at lag 03 and O₃ at lag 4 was associated with an increase of 2.76% (95% CI: 0.67, 4.84%) and 0.64% (95% CI: 0.14, 1.14%) hospital admissions, respectively. An increase of 0.72% (95% CI: 0.05, 1.40%) hospital stay was associated with 10 μg/m³ increase in O₃ concentration at lag 4. Besides, the adverse effect of exposure to NO₂ was more significant in males and population aged less than 14 years; while more significant in females and population aged 14 ~ 65 and over 65 years for exposure to O₃. These associations remained stable after the adjustment of other air pollutants.8.

Conclusion

Exposure to ambient NO₂ and O₃ may cause substantial sepsis hospitalizations, and hospital stays in Sichuan, China. These associations were different in subgroup by age and sex.

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Kelly FJ, Fussell JC. Air pollution and public health: emerging hazards and improved understanding of risk. Environ Geochem Health. 2015;37(4):631–49. https://doi.org/10.1007/s10653-015-9720-1.CrossRefPubMedPubMedCentral

Brunekreef B, Holgate ST. Air pollution and health. Lancet. 2002;360(9341):1233–42. https://doi.org/10.1016/S0140-6736(02)11274-8.CrossRefPubMed

Chen F, Liu Q, Huang B, Huang F, Li Y, Peng Y, et al. Association of fine particulate matter exposure with acute noncardiovascular critical illnesses and in-hospital outcomes in patients receiving intensive cardiac care. BMC Public Health. 2020;20(1):610. https://doi.org/10.1186/s12889-020-08758-7.CrossRefPubMedPubMedCentral

Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165–228. https://doi.org/10.1007/s00134-012-2769-8.CrossRefPubMedPubMedCentral

Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the global burden of disease study. Lancet. 2020;395(10219):200–11. https://doi.org/10.1016/S0140-6736(19)32989-7.CrossRefPubMedPubMedCentral

Groves CP, Butland BK, Atkinson RW, Delaney AP, Pilcher DV. Intensive care admissions and outcomes associated with short-term exposure to ambient air pollution: a time series analysis. Intensive Care Med. 2020;46(6):1213–21. https://doi.org/10.1007/s00134-020-06052-z.CrossRefPubMed

Rush B, Wiskar K, Fruhstorfer C, Celi LA, Walley KR. The impact of chronic ozone and particulate air pollution on mortality in patients with Sepsis across the United States. J Intensive Care Med. 2020;35(10):1002-7.

Sarmiento EJ, Moore JX, McClure LA, Griffin R, Al-Hamdan MZ, Wang HE. Fine particulate matter pollution and risk of community-acquired sepsis. Int J Environ Res Public Health. 2018;15(4):818.

Zhang Q, Streets DG, Carmichael GR, He K, Huo H, Kannari A, et al. Asian emissions in 2006 for the NASA INTEX-B mission. Atmos Chem Phys Discuss. 2009;9(14):5131–53. https://doi.org/10.5194/acp-9-5131-2009.CrossRef

10.

Zhang X, Wang Y, Niu T, Zhang X, Gong S, Zhang Y, et al. Atmospheric aerosol compositions in China: spatial/temporal variability, chemical signature, regional haze distribution and comparisons with global aerosols. Atmos Chem Phys Discuss. 2011;11:26571–615.

11.

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for Sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–10. https://doi.org/10.1001/jama.2016.0287.CrossRefPubMedPubMedCentral

12.

Iwashyna TJ, Odden A, Rohde J, Bonham C, Kuhn L, Malani P, et al. Identifying patients with severe sepsis using administrative claims: patient-level validation of the angus implementation of the international consensus conference definition of severe sepsis. Med Care. 2014;52(6):e39–43. https://doi.org/10.1097/MLR.0b013e318268ac86.CrossRefPubMedPubMedCentral

13.

Wang Y, Yao C, Xu C, Zeng X, Zhou M, Lin Y, et al. Carbon monoxide and risk of outpatient visits due to cause-specific diseases: a time-series study in Yichang, China. Environ Health. 2019;18(1):36. https://doi.org/10.1186/s12940-019-0477-3.CrossRefPubMedPubMedCentral

14.

Cai J, Zhao A, Zhao J, Chen R, Wang W, Ha S, et al. Acute effects of air pollution on asthma hospitalization in Shanghai, China. Environ Pollut. 2014;191:139–44. https://doi.org/10.1016/j.envpol.2014.04.028.CrossRefPubMed

15.

Yao C, Wang Y, Williams C, Xu C, Kartsonaki C, Lin Y, et al. 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. 2020;27(5):5240-50.

16.

Tian Y, Liu H, Liang T, Xiang X, Li M, Juan J, et al. Ambient air pollution and daily hospital admissions: a nationwide study in 218 Chinese cities. Environ Pollut. 2018;242(Pt B):1042–9.CrossRefPubMed

17.

Yin P, He G, Fan M, Chiu KY, Fan M, Liu C, et al. Particulate air pollution and mortality in 38 of China's largest cities: time series analysis. BMJ. 2017;356:j667.CrossRefPubMedPubMedCentral

18.

Cheng J, Xu Z, Zhang X, Zhao H, Hu W. Estimating cardiovascular hospitalizations and associated expenses attributable to ambient carbon monoxide in Lanzhou, China: scientific evidence for policy making. Sci Total Environ. 2019;682:514–22. https://doi.org/10.1016/j.scitotenv.2019.05.110.CrossRefPubMed

19.

Bhaskaran K, Gasparrini A, Hajat S, Smeeth L, Armstrong B. Time series regression studies in environmental epidemiology. Int J Epidemiol. 2013;42(4):1187–95. https://doi.org/10.1093/ije/dyt092.CrossRefPubMedPubMedCentral

20.

Barnett AG, Stephen D, Huang C, Wolkewitz M. Time series models of environmental exposures: good predictions or good understanding. Environ Res. 2017;154:222–5. https://doi.org/10.1016/j.envres.2017.01.007.CrossRefPubMed

21.

Liu C, Chen R, Sera F, Vicedo-Cabrera AM, Guo Y, Tong S, et al. Ambient particulate air pollution and daily mortality in 652 cities. N Engl J Med. 2019;381(8):705–15. https://doi.org/10.1056/NEJMoa1817364.CrossRefPubMedPubMedCentral

22.

Li Z, Mao X, Liu Q, Song H, Ji Y, Xu D, et al. Long-term effect of exposure to ambient air pollution on the risk of active tuberculosis. Int J Infect Dis. 2019;87:177–84. https://doi.org/10.1016/j.ijid.2019.07.027.CrossRefPubMed

23.

Nhung N, Amini H, Schindler C, Kutlar JM, Dien TM, Probst-Hensch N, et al. Short-term association between ambient air pollution and pneumonia in children: a systematic review and meta-analysis of time-series and case-crossover studies. Environ Pollut. 2017;230:1000–8. https://doi.org/10.1016/j.envpol.2017.07.063.CrossRefPubMed

24.

Tian Y, Liu H, Wu Y, Si Y, Li M, Wu Y, et al. Ambient particulate matter pollution and adult hospital admissions for pneumonia in urban China: a national time series analysis for 2014 through 2017. PLoS Med. 2019;16(12):e1003010. https://doi.org/10.1371/journal.pmed.1003010.CrossRefPubMedPubMedCentral

25.

Nhung N, Schindler C, Dien TM, Probst-Hensch N, Perez L, Kunzli N. Acute effects of ambient air pollution on lower respiratory infections in Hanoi children: an eight-year time series study. Environ Int. 2018;110:139–48. https://doi.org/10.1016/j.envint.2017.10.024.CrossRefPubMed

26.

Li A, Fan L, Xie L, Ren Y, Li L. Associations between air pollution, climate factors and outpatient visits for eczema in West China hospital, Chengdu, South-Western China: a time series analysis. J Eur Acad Dermatol Venereol. 2018;32(3):486–94. https://doi.org/10.1111/jdv.14730.CrossRefPubMed

27.

Wei Y, Wang Y, Di Q, Choirat C, Wang Y, Koutrakis P, et al. Short term exposure to fine particulate matter and hospital admission risks and costs in the Medicare population: time stratified, case crossover study. BMJ. 2019;367:l6258.CrossRefPubMedPubMedCentral

28.

Scapellato ML, Lotti M. Short-term effects of particulate matter: an inflammatory mechanism? Crit Rev Toxicol. 2007;37(6):461–87. https://doi.org/10.1080/10408440701385622.CrossRefPubMed

29.

Khafaie MA, Salvi SS, Ojha A, Khafaie B, Gore SS, Yajnik CS. Systemic inflammation (C-reactive protein) in type 2 diabetic patients is associated with ambient air pollution in Pune City, India. Diabetes Care. 2013;36(3):625–30. https://doi.org/10.2337/dc12-0388.CrossRefPubMedPubMedCentral

Title: Sepsis-related hospital admissions and ambient air pollution: a time series analysis in 6 Chinese cities
Authors: Yu Wang
Zhen Liu
Lian Yang
Jiushun Zhou
Jia Li
Hai Lun Liao
Xing Jun Tian
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Septicemia
Septicemia
Air Pollutants
Published in: BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-021-11220-x

At a glance: The STEP trials

Springer Medicine

Sepsis-related hospital admissions and ambient air pollution: a time series analysis in 6 Chinese cities

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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