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Published in: Respiratory Research 1/2018

Open Access 01-12-2018 | Research

The impact of outdoor air pollutants on outpatient visits for respiratory diseases during 2012–2016 in Jinan, China

Authors: Shanshan Wang, Yifan Li, Aimin Niu, Yao Liu, Lili Su, Wanmei Song, Jinyue Liu, Yunxia Liu, Huaichen Li

Published in: Respiratory Research | Issue 1/2018

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Abstract

Background

Few studies have investigated the associations between outdoor air pollution and outpatient visits for respiratory diseases (RDs) in general population.

Methods

We collected daily outpatient data of primary RDs from five hospitals in Jinan during January 2012 and December 2016, as well as daily measurements of air pollutants from the Jinan Environmental Monitoring Center and daily meteorological variables from the China Meteorological Data Sharing Service System. A generalized additive model (GAM) with quasi-Poisson regression was constructed to estimate the associations between daily average concentrations of outdoor air pollutants (PM2.5,PM10, SO2, NO2, CO and O3) and daily outpatient visits of RDs after adjusting for long-time trends, seasonality, the “day of the week” effect, and weather conditions. Subgroup analysis stratified by gender, age group and the type of RDs was conducted.

Results

A total of 1,373,658 outpatient visits for RDs were identified. Increases of 10 μg/m3 in PM2.5, PM10, NO2, CO and O3 were associated with0.168% (95% CI, 0.072–0.265%), 0.149% (95% CI, 0.082–0.215%), 0.527% (95% CI, 0.211–0.843%), 0.013% (95% CI, 0.003–0.023%), and 0.189% (95% CI, 0.032–0.347%) increases in daily outpatient visits for RDs, respectively. PM2.5 and PM10 showed instant and continuous effects, while NO2, CO and O3 showed delayed effects on outpatient visits for RDs. In stratification analysis, PM2.5 and PM10 were associated with acute RDs only.

Conclusions

Exposure to outdoor air pollutants including PM2.5, PM10, NO2, CO and O3 associated with increased risk of outpatient visits for RDs.
Appendix
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Literature
1.
go back to reference Yang BY, Qian ZM, Li S, Chen G, Bloom MS, Elliott M, et al. Ambient air pollution in relation to diabetes and glucose-homoeostasis markers in China: a cross-sectional study with findings from the 33 communities Chinese health study. Lancet Planet Health. 2018;2(2):e64–73.CrossRef Yang BY, Qian ZM, Li S, Chen G, Bloom MS, Elliott M, et al. Ambient air pollution in relation to diabetes and glucose-homoeostasis markers in China: a cross-sectional study with findings from the 33 communities Chinese health study. Lancet Planet Health. 2018;2(2):e64–73.CrossRef
2.
go back to reference Chen G, Li S, Zhang Y, Zhang W, Li D, Wei X, et al. Effects of ambient PM1 air pollution on daily emergency hospital visits in China: an epidemiological study. Lancet Planet Health. 2017;1(6):e221–9.CrossRef Chen G, Li S, Zhang Y, Zhang W, Li D, Wei X, et al. Effects of ambient PM1 air pollution on daily emergency hospital visits in China: an epidemiological study. Lancet Planet Health. 2017;1(6):e221–9.CrossRef
3.
go back to reference Qiu H, Pun VC, Tian L. Short-term effects of fine and coarse particles on deaths in Hong Kong elderly population: An analysis of mortality displacement. Environ Pollut. 2018;241:148–54.CrossRef Qiu H, Pun VC, Tian L. Short-term effects of fine and coarse particles on deaths in Hong Kong elderly population: An analysis of mortality displacement. Environ Pollut. 2018;241:148–54.CrossRef
4.
go back to reference He Y, Gao Z, Guo T, Qu F, Liang D, Li D, et al. Fine particulate matter associated mortality burden of lung cancer in Hebei Province, China. Thorac Cancer. 2018;9(7):820–6.CrossRef He Y, Gao Z, Guo T, Qu F, Liang D, Li D, et al. Fine particulate matter associated mortality burden of lung cancer in Hebei Province, China. Thorac Cancer. 2018;9(7):820–6.CrossRef
5.
go back to reference Wang Y, Zu Y, Huang L, Zhang H, Wang C, Hu J. Associations between daily outpatient visits for respiratory diseases and ambient fine particulate matter and ozone levels in Shanghai, China. Environ Pollut. 2018;240:754–63.CrossRef Wang Y, Zu Y, Huang L, Zhang H, Wang C, Hu J. Associations between daily outpatient visits for respiratory diseases and ambient fine particulate matter and ozone levels in Shanghai, China. Environ Pollut. 2018;240:754–63.CrossRef
6.
go back to reference Guo H, Chen M. Short-term effect of air pollution on asthma patient visits in Shanghai area and assessment of economic costs. Ecotoxicol Environ Saf. 2018;161:184–9.CrossRef Guo H, Chen M. Short-term effect of air pollution on asthma patient visits in Shanghai area and assessment of economic costs. Ecotoxicol Environ Saf. 2018;161:184–9.CrossRef
7.
go back to reference An Z, Jin Y, Li J, Li W, Wu W. Impact of particulate air pollution on cardiovascular health. Curr Allergy Asthma Rep. 2018;18(3):15.CrossRef An Z, Jin Y, Li J, Li W, Wu W. Impact of particulate air pollution on cardiovascular health. Curr Allergy Asthma Rep. 2018;18(3):15.CrossRef
8.
go back to reference Guo P, Wang Y, Feng W, Wu J, Fu C, Deng H, et al. Ambient air pollution and risk for ischemic stroke: a short-term exposure assessment in South China. Int J Environ Res Public Health. 2017;14(9):E1091.CrossRef Guo P, Wang Y, Feng W, Wu J, Fu C, Deng H, et al. Ambient air pollution and risk for ischemic stroke: a short-term exposure assessment in South China. Int J Environ Res Public Health. 2017;14(9):E1091.CrossRef
9.
go back to reference He J, Gong S, Yu Y, Yu L, Wu L, Mao H, et al. Air pollution characteristics and their relation to meteorological conditions during 2014-2015 in major Chinese cities. Environ Pollut. 2017;223:484–96.CrossRef He J, Gong S, Yu Y, Yu L, Wu L, Mao H, et al. Air pollution characteristics and their relation to meteorological conditions during 2014-2015 in major Chinese cities. Environ Pollut. 2017;223:484–96.CrossRef
10.
go back to reference Liu Y, He K, Li S, Wang Z, Christiani DC, Koutrakis P. A statistical model to evaluate the effectiveness of PM2.5 emissions control during the Beijing 2008 Olympic games. Environ Int. 2012;44:100–5.CrossRef Liu Y, He K, Li S, Wang Z, Christiani DC, Koutrakis P. A statistical model to evaluate the effectiveness of PM2.5 emissions control during the Beijing 2008 Olympic games. Environ Int. 2012;44:100–5.CrossRef
11.
go back to reference Schwartz J, Bellinger D, Glass T. Exploring potential sources of differential vulnerability and susceptibility in risk from environmental hazards to expand the scope of risk assessment. Am J Public Health. 2011;101 Suppl:S94–101.CrossRef Schwartz J, Bellinger D, Glass T. Exploring potential sources of differential vulnerability and susceptibility in risk from environmental hazards to expand the scope of risk assessment. Am J Public Health. 2011;101 Suppl:S94–101.CrossRef
12.
go back to reference Zhang J, Liu Y, Cui LL, Liu SQ, Yin XX, Li HC. Ambient air pollution, smog episodes and mortality in Jinan, China. Sci Rep. 2017;7(1):11209.CrossRef Zhang J, Liu Y, Cui LL, Liu SQ, Yin XX, Li HC. Ambient air pollution, smog episodes and mortality in Jinan, China. Sci Rep. 2017;7(1):11209.CrossRef
13.
go back to reference Liu P, Wang X, Fan J, Xiao W, Wang Y. Effects of air pollution on hospital emergency room visits for respiratory diseases: urban-suburban differences in eastern China. Int J Environ Res Public Health. 2016;13(3):341.CrossRef Liu P, Wang X, Fan J, Xiao W, Wang Y. Effects of air pollution on hospital emergency room visits for respiratory diseases: urban-suburban differences in eastern China. Int J Environ Res Public Health. 2016;13(3):341.CrossRef
14.
go back to reference Wang W, Ying Y, Wu Q, Zhang H, Ma D, Xiao WA. GIS-based spatial correlation analysis for ambient air pollution and AECOPD hospitalizations in Jinan, China. Respir Med. 2015;109(3):372–8.CrossRef Wang W, Ying Y, Wu Q, Zhang H, Ma D, Xiao WA. GIS-based spatial correlation analysis for ambient air pollution and AECOPD hospitalizations in Jinan, China. Respir Med. 2015;109(3):372–8.CrossRef
15.
go back to reference Hastie T, Tibshirani R. Generalized additive models for medical research. Stat Methods Med Res. 1995;4(3):187–96.CrossRef Hastie T, Tibshirani R. Generalized additive models for medical research. Stat Methods Med Res. 1995;4(3):187–96.CrossRef
16.
go back to reference Dominici F, McDermott A, Zeger SL, Samet JM. On the use of generalized additive models in time-series studies of air pollution and health. Am J Epidemiol. 2002;156(3):193–203.CrossRef Dominici F, McDermott A, Zeger SL, Samet JM. On the use of generalized additive models in time-series studies of air pollution and health. Am J Epidemiol. 2002;156(3):193–203.CrossRef
17.
go back to reference Xu Q, Wang S, Guo Y, Wang C, Huang F, Li X, et al. Acute exposure to fine particulate matter and cardiovascular hospital emergency room visits in Beijing, China. Environ Pollut. 2017;220:317–27.CrossRef Xu Q, Wang S, Guo Y, Wang C, Huang F, Li X, et al. Acute exposure to fine particulate matter and cardiovascular hospital emergency room visits in Beijing, China. Environ Pollut. 2017;220:317–27.CrossRef
18.
go back to reference Zhang H, Niu Y, Yao Y, Chen R, Zhou X, Kan H. The impact of ambient air pollution on daily hospital visits for various respiratory diseases and the relevant medical expenditures in Shanghai, China. Int J Environ Res Public Health. 2018;15(3):E425.CrossRef Zhang H, Niu Y, Yao Y, Chen R, Zhou X, Kan H. The impact of ambient air pollution on daily hospital visits for various respiratory diseases and the relevant medical expenditures in Shanghai, China. Int J Environ Res Public Health. 2018;15(3):E425.CrossRef
19.
go back to reference Wood S. Generalized Additive Models: An introduction with R. Boca Raton: CRC Press; 2006.CrossRef Wood S. Generalized Additive Models: An introduction with R. Boca Raton: CRC Press; 2006.CrossRef
20.
go back to reference Li Q, Wang HJ, Song Y, Ma J, Song JY, Guo Y. Association between children’s forced vital capacity and long-term exposure to local ambient temperature in China: a national cross-sectional survey. Sci Total Environ. 2016;557–558:880–7.CrossRef Li Q, Wang HJ, Song Y, Ma J, Song JY, Guo Y. Association between children’s forced vital capacity and long-term exposure to local ambient temperature in China: a national cross-sectional survey. Sci Total Environ. 2016;557–558:880–7.CrossRef
21.
go back to reference Chen R, Chu C, Tan J, Cao J, Song W, Xu X, et al. Ambient air pollution and hospital admission in Shanghai, China. J Hazard Mater. 2010;181(1–3):234–40.CrossRef Chen R, Chu C, Tan J, Cao J, Song W, Xu X, et al. Ambient air pollution and hospital admission in Shanghai, China. J Hazard Mater. 2010;181(1–3):234–40.CrossRef
22.
go back to reference Lin M, Stieb DM, Chen Y. Coarse particulate matter and hospitalization for respiratory infections in children younger than 15 years in Toronto: a case-crossover analysis. Pediatrics. 2005;116(2):e235–40.CrossRef Lin M, Stieb DM, Chen Y. Coarse particulate matter and hospitalization for respiratory infections in children younger than 15 years in Toronto: a case-crossover analysis. Pediatrics. 2005;116(2):e235–40.CrossRef
23.
go back to reference Wong TW, Tam W, Tak Sun YI, Wun YT, Wong AH, Wong CM. Association between air pollution and general practitioner visits for respiratory diseases in Hong Kong. Thorax. 2006;61(7):585–91.CrossRef Wong TW, Tam W, Tak Sun YI, Wun YT, Wong AH, Wong CM. Association between air pollution and general practitioner visits for respiratory diseases in Hong Kong. Thorax. 2006;61(7):585–91.CrossRef
24.
go back to reference Li R, Jiang N, Liu Q, Huang J, Guo X, Liu F, et al. Impact of air pollutants on outpatient visits for acute respiratory outcomes. Int J Environ Res Public Health. 2017;14(1):47.CrossRef Li R, Jiang N, Liu Q, Huang J, Guo X, Liu F, et al. Impact of air pollutants on outpatient visits for acute respiratory outcomes. Int J Environ Res Public Health. 2017;14(1):47.CrossRef
25.
go back to reference Liu Y, Xie S, Yu Q, Huo X, Ming X, Wang J, et al. Short-term effects of ambient air pollution on pediatric outpatient visits for respiratory diseases in Yichang city, China. Environ Pollut. 2017;227:116–24.CrossRef Liu Y, Xie S, Yu Q, Huo X, Ming X, Wang J, et al. Short-term effects of ambient air pollution on pediatric outpatient visits for respiratory diseases in Yichang city, China. Environ Pollut. 2017;227:116–24.CrossRef
26.
go back to reference Li G, Lan H, Liu Z, Rui T, Lu J, Bian L, et al. The association between short-term exposure to fine particulate matter and outpatient visit in Beijing, China. Iran J Public Health. 2017;46(11):1486–94.PubMedPubMedCentral Li G, Lan H, Liu Z, Rui T, Lu J, Bian L, et al. The association between short-term exposure to fine particulate matter and outpatient visit in Beijing, China. Iran J Public Health. 2017;46(11):1486–94.PubMedPubMedCentral
27.
go back to reference Sinclair AH, Edgerton ES, Wyzga R, Tolsma DA. Two-time-period comparison of the effects of ambient air pollution on outpatient visits for acute respiratory illnesses. J Air Waste Manag Assoc. 2010;60(2):163–75.CrossRef Sinclair AH, Edgerton ES, Wyzga R, Tolsma DA. Two-time-period comparison of the effects of ambient air pollution on outpatient visits for acute respiratory illnesses. J Air Waste Manag Assoc. 2010;60(2):163–75.CrossRef
28.
go back to reference Bai L, Su X, Zhao D, Zhang Y, Cheng Q, Zhang H, et al. Exposure to traffic-related air pollution and acute bronchitis in children: season and age as modifiers. J Epidemiol Community Health. 2018;72(5):426–33.CrossRef Bai L, Su X, Zhao D, Zhang Y, Cheng Q, Zhang H, et al. Exposure to traffic-related air pollution and acute bronchitis in children: season and age as modifiers. J Epidemiol Community Health. 2018;72(5):426–33.CrossRef
29.
go back to reference Wu W, Jin Y, Carlsten C. Inflammatory health effects of indoor and outdoor particulate matter. J Allergy Clin Immunol. 2018;141(3):833–44.CrossRef Wu W, Jin Y, Carlsten C. Inflammatory health effects of indoor and outdoor particulate matter. J Allergy Clin Immunol. 2018;141(3):833–44.CrossRef
30.
go back to reference Gong J, Zhu T, Kipen H, Wang G, Hu M, Guo Q, et al. Comparisons of ultrafine and fine particles in their associations with biomarkers reflecting physiological pathways. Environ Sci Technol. 2014;48(9):5264–73.CrossRef Gong J, Zhu T, Kipen H, Wang G, Hu M, Guo Q, et al. Comparisons of ultrafine and fine particles in their associations with biomarkers reflecting physiological pathways. Environ Sci Technol. 2014;48(9):5264–73.CrossRef
31.
go back to reference Han Y, Zhu T, Guan T, Zhu Y, Liu J, Ji Y, et al. Association between size-segregated particles in ambient air and acute respiratory inflammation. Sci Total Environ. 2016;565:412–9.CrossRef Han Y, Zhu T, Guan T, Zhu Y, Liu J, Ji Y, et al. Association between size-segregated particles in ambient air and acute respiratory inflammation. Sci Total Environ. 2016;565:412–9.CrossRef
32.
go back to reference Chen BY, Chan CC, Lee CT, Cheng TJ, Huang WC, Jhou JC, et al. The association of ambient air pollution with airway inflammation in school children. Am J Epidemiol. 2012;175(8):764–74.CrossRef Chen BY, Chan CC, Lee CT, Cheng TJ, Huang WC, Jhou JC, et al. The association of ambient air pollution with airway inflammation in school children. Am J Epidemiol. 2012;175(8):764–74.CrossRef
33.
go back to reference Ohtoshi T, Takizawa H, Okazaki H, Kawasaki S, Takeuchi N, Ohta K, et al. Diesel exhaust particles stimulate human airway epithelial cells to produce cytokines relevant to airway inflammation in vitro. J Allergy Clin Immunol. 1998;101(6):778–85.CrossRef Ohtoshi T, Takizawa H, Okazaki H, Kawasaki S, Takeuchi N, Ohta K, et al. Diesel exhaust particles stimulate human airway epithelial cells to produce cytokines relevant to airway inflammation in vitro. J Allergy Clin Immunol. 1998;101(6):778–85.CrossRef
34.
go back to reference Li Y, Rittenhouse-Olson K, Scheider WL, Mu L. Effect of particulate matter air pollution on C-reactive protein: a review of epidemiologic studies. Rev Environ Health. 2012;27(2–3):133–49.PubMedPubMedCentral Li Y, Rittenhouse-Olson K, Scheider WL, Mu L. Effect of particulate matter air pollution on C-reactive protein: a review of epidemiologic studies. Rev Environ Health. 2012;27(2–3):133–49.PubMedPubMedCentral
35.
go back to reference Mo Z, Fu Q, Zhang L, Lyu D, Mao G, Wu L, et al. Acute effects of air pollution on respiratory disease mortalities and outpatients in southeastern China. Sci Rep. 2018;8(1):3461.CrossRef Mo Z, Fu Q, Zhang L, Lyu D, Mao G, Wu L, et al. Acute effects of air pollution on respiratory disease mortalities and outpatients in southeastern China. Sci Rep. 2018;8(1):3461.CrossRef
36.
go back to reference Lee SL, Wong WHS, Lau YL. Association between air pollution and asthma admission among children in Hong Kong. Clin Exp Allergy. 2006;36(9):1138–46.CrossRef Lee SL, Wong WHS, Lau YL. Association between air pollution and asthma admission among children in Hong Kong. Clin Exp Allergy. 2006;36(9):1138–46.CrossRef
37.
go back to reference Ge E, Fan M, Qiu H, Hu H, Tian L, Wang X, et al. Ambient sulfur dioxide levels associated with reduced risk of initial outpatient visits for tuberculosis: a population based time series analysis. Environ Pollut. 2017;228:408–15.CrossRef Ge E, Fan M, Qiu H, Hu H, Tian L, Wang X, et al. Ambient sulfur dioxide levels associated with reduced risk of initial outpatient visits for tuberculosis: a population based time series analysis. Environ Pollut. 2017;228:408–15.CrossRef
38.
go back to reference Becklake MR, Kauffmann F. Gender differences in airway behaviour over the human life span. Thorax. 1999;54(12):1119–38.CrossRef Becklake MR, Kauffmann F. Gender differences in airway behaviour over the human life span. Thorax. 1999;54(12):1119–38.CrossRef
39.
go back to reference Dong GH, Chen T, Liu MM, Wang D, Ma YN, Ren WH, et al. Gender differences and effect of air pollution on asthma in children with and without allergic predisposition: northeast Chinese children health study. PLoS One. 2011;6(7):e22470.CrossRef Dong GH, Chen T, Liu MM, Wang D, Ma YN, Ren WH, et al. Gender differences and effect of air pollution on asthma in children with and without allergic predisposition: northeast Chinese children health study. PLoS One. 2011;6(7):e22470.CrossRef
40.
go back to reference DeVries R, Kriebel D, Sama S. Outdoor air pollution and COPD-related emergency department visits, hospital admissions, and mortality: a meta-analysis. COPD. 2017;14(1):113–21.CrossRef DeVries R, Kriebel D, Sama S. Outdoor air pollution and COPD-related emergency department visits, hospital admissions, and mortality: a meta-analysis. COPD. 2017;14(1):113–21.CrossRef
Metadata
Title
The impact of outdoor air pollutants on outpatient visits for respiratory diseases during 2012–2016 in Jinan, China
Authors
Shanshan Wang
Yifan Li
Aimin Niu
Yao Liu
Lili Su
Wanmei Song
Jinyue Liu
Yunxia Liu
Huaichen Li
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Respiratory Research / Issue 1/2018
Electronic ISSN: 1465-993X
DOI
https://doi.org/10.1186/s12931-018-0958-x

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