Top

BMC Public Health

Published in:

Open Access 01-12-2022 | Pulmonary Emergencies | Research

Association and interaction of O₃ and NO₂ with emergency room visits for respiratory diseases in Beijing, China: a time-series study

Authors: Yuanwei Fu, Wenlou Zhang, Yan Li, Hongyu Li, Furong Deng, Qingbian Ma

Published in: BMC Public Health | Issue 1/2022

Abstract

Background

Ozone (O₃) and nitrogen dioxide (NO₂) are the two main gaseous pollutants in the atmosphere that act as oxidants. Their short-term effects and interaction on emergency room visits (ERVs) for respiratory diseases remain unclear.

Methods

We conducted a time-series study based on 144,326 ERVs for respiratory diseases of Peking University Third Hospital from 2014 to 2019 in Beijing, China. Generalized additive models with quasi-Poisson regression were performed to analyze the association of O₃, NO₂ and their composite indicators (O_x and O_x^wt) with ERVs for respiratory diseases. An interaction model was further performed to evaluate the interaction between O₃ and NO₂.

Results

Exposure to O₃, NO₂, O_x and O_x^wt was positively associated with ERVs for total respiratory diseases and acute upper respiratory infection (AURI). For instance, a 10 μg/m³ increase in O₃ and NO₂ were associated with 0.93% (95%CI: 0.05%, 1.81%) and 5.87% (95%CI: 3.92%, 7.85%) increase in AURI at lag0-5 days, respectively. Significant linear exposure–response relationships were observed in O_x and O_x^wt over the entire concentration range. In stratification analysis, stronger associations were observed in the group aged < 18 years for both O₃ and NO₂, in the warm season for O₃, but in the cold season for NO₂. In interaction analysis, the effect of O₃ on total respiratory emergency room visits and AURI visits was the strongest at high levels (> 75% quantile) of NO₂ in the < 18 years group.

Conclusions

Short-term exposure to O₃ and NO₂ was positively associated with ERVs for respiratory diseases, particularly in younger people (< 18 years). This study for the first time demonstrated the synergistic effect of O₃ and NO₂ on respiratory ERVs, and O_x and O_x^wt may be potential proxies.

Available only for authorised users

Huang W, Wang T, He Y, et al. Trends and characteristics in pre-hospital emergency care in Beijing from 2008 to 2017. Chin Med J. 2020;133:1268–75. https://doi.org/10.1097/CM9.0000000000000770.CrossRefPubMedPubMedCentral

Taj T, Malmqvist E, Stroh E, et al. Short-Term Associations between Air Pollution Concentrations and Respiratory Health-Comparing Primary Health Care Visits, Hospital Admissions, and Emergency Department Visits in a Multi-Municipality Study. Int J Environ Res Public Health. 2017;14:587. https://doi.org/10.3390/ijerph14060587.CrossRefPubMedPubMedCentral

Liu P, Wang X, Fan J, et al. 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;13:341. https://doi.org/10.3390/ijerph13030341.CrossRefPubMedPubMedCentral

Rodopoulou S, Chalbot M, Samoli E, et al. Air pollution and hospital emergency room and admissions for cardiovascular and respiratory diseases in Doña Ana County. New Mexico Environ Res. 2014;129:39–46. https://doi.org/10.1016/j.envres.2013.12.006.CrossRefPubMed

Szyszkowicz M, Kousha T, Castner J, et al. Air pollution and emergency department visits for respiratory diseases: A multi-city case crossover study. Environ Res. 2018;163:263–9. https://doi.org/10.1016/j.envres.2018.01.043.CrossRefPubMed

Chen R, Yin P, Meng X, et al. Associations between Coarse Particulate Matter Air Pollution and Cause-Specific Mortality: A Nationwide Analysis in 272 Chinese Cities. Environ Health Perspect. 2019;127:17008. https://doi.org/10.1289/EHP2711.CrossRefPubMed

Xue L, Wang T, Louie PK, et al. Increasing external effects negate local efforts to control ozone air pollution: a case study of Hong Kong and implications for other Chinese cities. Environ Sci Technol. 2014;48:10769–75. https://doi.org/10.1021/es503278g.CrossRefPubMed

Guo H. Comparisons of combined oxidant capacity and redox-weighted oxidant capacity in their association with increasing levels of FeNO. Chemosphere. 2018;211:584–90. https://doi.org/10.1016/j.chemosphere.2018.07.191.CrossRefPubMed

Zhu Y, Wang Y, Xu H, et al. Joint effect of multiple air pollutants on daily emergency department visits in Chengdu, China. Environ Pollut. 2020;257:113548. https://doi.org/10.1016/j.envpol.2019.113548.

10.

Dong J, Liu Y, Bao H. Revalue associations of short-term exposure to air pollution with respiratory hospital admissions in Lanzhou, China after the control and treatment of current pollution. Int J Hyg Environ Health. 2021;231:113658. https://doi.org/10.1016/j.ijheh.2020.113658.

11.

Yuan Z, Chen P, Yang L, et al. Combined oxidant capacity, redox-weighted oxidant capacity and elevated blood pressure: A panel study. Ecotoxicol Environ Saf. 2022;234: 113364. https://doi.org/10.1016/j.ecoenv.2022.113364.CrossRefPubMed

12.

Weichenthal S, Lavigne E, Evans G, et al. Ambient PM2.5 and risk of emergency room visits for myocardial infarction: impact of regional PM2.5 oxidative potential: a case-crossover study. Environ Healt. 2016;15:46. https://doi.org/10.1186/s12940-016-0129-9.CrossRef

13.

Jiang Y, Wang C, Lin Z, et al. Alleviated systemic oxidative stress effects of combined atmospheric oxidant capacity by fish oil supplementation: A randomized, double-blinded, placebo-controlled trial. Ecotoxicol Environ Saf. 2019;184:109598. https://doi.org/10.1016/j.ecoenv.2019.109598.CrossRefPubMed

14.

Korsiak J, Perepeluk KL, Peterson NG, et al. Air pollution and retinal vessel diameter and blood pressure in school-aged children in a region impacted by residential biomass burning. Sci Rep. 2021;11(1):12790. https://doi.org/10.1038/s41598-021-92269-x.CrossRefPubMedPubMedCentral

15.

Williams ML, Atkinson RW, Anderson HR. Associations between daily mortality in London and combined oxidant capacity, ozone and nitrogen dioxide. Air Qual Atmos Health. 2014;7:407–14. https://doi.org/10.1007/s11869-014-0249-8.CrossRefPubMedPubMedCentral

16.

Elten M, Donelle J, Lima I, et al. Ambient air pollution and incidence of early-onset paediatric type 1 diabetes: A retrospective population-based cohort study. Environ Res. 2020;184:109291. https://doi.org/10.1016/j.envres.2020.109291.

17.

Gu Y, Lin H, Liu T, et al. The Interaction between Ambient PM10 and NO₂ on Mortality in Guangzhou, China. Int J Environ Res Public Health. 2017;14:1381. https://doi.org/10.3390/ijerph14111381.CrossRefPubMedPubMedCentral

18.

Huang J, Song Y, Chu M, et al. Cardiorespiratory responses to low-level ozone exposure: The inDoor Ozone Study in childrEn (DOSE). Environ Int. 2019;131:105021. https://doi.org/10.1016/j.envint.2019.105021.CrossRefPubMed

19.

Shi W, Sun Q, Du P, et al. Modification Effects of Temperature on the Ozone-Mortality Relationship: A Nationwide Multicounty Study in China. Environ Sci Technol. 2020;54:2859–68. https://doi.org/10.1021/acs.est.9b05978.CrossRefPubMed

20.

Qiu H, Yu H, Wang L, et al. The burden of overall and cause-specific respiratory morbidity due to ambient air pollution in Sichuan Basin, China: A multi-city time-series analysis. Environ Res. 2018;167:428–36. https://doi.org/10.1016/j.envres.2018.08.011.CrossRefPubMed

21.

Tian Y, Liu H, Si Y, et al. Association between temperature variability and daily hospital admissions for cause-specific cardiovascular disease in urban China: A national time-series study. PLoS Med. 2019;16(1):e1002738.https://doi.org/10.1371/journal.pmed.1002738

22.

Tian Y, Wu Y, Liu H, et al. The impact of ambient ozone pollution on pneumonia: A nationwide time-series analysis. Environ Int. 2020;136:105498.https://doi.org/ 10.1016 /j.envint.2020.105498

23.

Phosri A, Ueda K, Phung V, et al. Effects of ambient air pollution on daily hospital admissions for respiratory and cardiovascular diseases in Bangkok, Thailand. Sci Total Environ. 2019;651:1144–53. https://doi.org/10.1016/j.scitotenv.2018.09.183.CrossRefPubMed

24.

Wang W, Zhang W, Zhao J, et al. Short-Term Exposure to Ambient Air Pollution and Increased Emergency Room Visits for Skin Diseases in Beijing, China. Toxics. 2021;9:108. https://doi.org/10.3390/toxics9050108.CrossRefPubMed

25.

Liang L, Cai Y, Barratt B, et al. Associations between daily air quality and hospitalisations for acute exacerbation of chronic obstructive pulmonary disease in Beijing, 2013–17: an ecological analysis. Lancet Planet Health. 2019;3:e270–9. https://doi.org/10.1016/S2542-5196(19)30085-3.CrossRefPubMedPubMedCentral

26.

Liang Z, Xu C, Cao Y, et al. The association between short-term ambient air pollution and daily outpatient visits for schizophrenia: A hospital-based study. Environ Pollut. 2019;244:102–8. https://doi.org/10.1016/j.envpol.2018.09.142.CrossRefPubMed

27.

Chen K, Zhou L, Chen X, Bi J, et al. Acute effect of ozone exposure on daily mortality in seven cities of Jiangsu Province, China: No clear evidence for threshold. Environ Res. 2017;155:235–41. https://doi.org/10.1016/j.envres.2017.02.009.CrossRefPubMedPubMedCentral

28.

Liu S, Zhang K. Fine particulate matter components and mortality in Greater Houston: Did the risk reduce from 2000 to 2011? Sci Total Environ. 2015;538:162–8. https://doi.org/10.1016/j.scitotenv.2015.08.037.CrossRefPubMed

29.

Tian Y, Liu H, Zhao Z, et al. Association between ambient air pollution and daily hospital admissions for ischemic stroke: A nationwide time-series analysis. PLoS Med. 2018;15(10): e1002668. https://doi.org/10.1371/journal.pmed.1002668.CrossRefPubMedPubMedCentral

30.

Huang K, Ding K, Yang XJ, et al. Association between short-term exposure to ambient air pollutants and the risk of tuberculosis outpatient visits: a time-series study in Hefei, China. Environ Res. 2020;184:109343. https://doi.org/10.1016/j.envres.2020.109343.CrossRefPubMed

31.

Torres P, Ferreira J, Monteiro A, et al. Air pollution: A public health approach for Portugal. Sci Total Environ. 2018;643:1041–53. https://doi.org/10.1016/j.scitotenv.2018.06.281.CrossRefPubMed

32.

Zhang Y, Wang SG, Xia M, et al. Association between Ambient Air Pollution and Hospital Emergency Admissions for Respiratory and Cardiovascular Diseases in Beijing:a Time Series Study. Biomed Environ Sci. 2015;28:352–63. https://doi.org/10.3967/bes2015.049.CrossRefPubMed

33.

Rodriguez-Villamizar LA, Rojas-Roa NY, Blanco-Becerra LC, et al. Short-Term Effects of Air Pollution on Respiratory and Circulatory Morbidity in Colombia 2011–2014: A Multi-City, Time-Series Analysis. Int J Environ Res Public Health. 2018;15:1610. https://doi.org/10.3390/ijerph15081610.CrossRefPubMedPubMedCentral

34.

Kim H, Eckel SP, Kim JH, et al. Exhaled NO: Determinants and Clinical Application in Children With Allergic Airway Disease. Allergy Asthma Immunol Res. 2016;8:12. https://doi.org/10.4168/aair.2016.8.1.12.CrossRefPubMed

35.

Guarnieri M, Balmes JR. Outdoor air pollution and asthma. Lancet. 2014;383:1581–92. https://doi.org/10.1016/S0140-6736(14)60617-6.CrossRefPubMedPubMedCentral

36.

Arjomandi M, Balmes JR, Frampton MW, et al. Respiratory Responses to Ozone Exposure. MOSES (The Multicenter Ozone Study in Older Subjects). Am J Respir Crit Care Med. 2018; 197:1319–1327. https://doi.org/10.1164/rccm.201708-1613OC.

37.

Huang W, Wang GF, Lu SE, et al. Inflammatory and oxidative stress responses of healthy young adults to changes in air quality during the beijing olympics. Am J Resp Crit Care. 2012;186:1150–9. https://doi.org/10.1164/rccm.201205-0850OC.CrossRef

38.

Kim KH, Jahan SA, Kabir E. A review on human health perspective of air pollution with respect to allergies and asthma. Environ Int. 2013;59:41–52. https://doi.org/10.1016/j.envint.2013.05.007.CrossRefPubMed

39.

Yang C, Li H, Chen R, Xu W, Wang C, Tse LA, et al. Combined atmospheric oxidant capacity and increased levels of exhaled nitric oxide. Environ Res Lett. 2016;11:074014. https://doi.org/10.1088/1748-9326/11/7/074014.CrossRef

40.

Yee J, Cho YA, Yoo HJ, et al. Short-term exposure to air pollution and hospital admission for pneumonia: a systematic review and meta-analysis. Environ Health. 2021;20:6. https://doi.org/10.1186/s12940-020-00687-7.CrossRefPubMedPubMedCentral

41.

Tasci SS, Kavalci C, Kayipmaz AE, et al. Relationship of Meteorological and Air Pollution Parameters with Pneumonia in Elderly Patients. Emerg Med Int. 2018;2018:1–9. https://doi.org/10.1155/2018/4183203.CrossRef

42.

Tao Y, Mi S, Zhou S, et al. Air pollution and hospital admissions for respiratory diseases in Lanzhou, China. Environ Pollut. 2014;185:196–201. https://doi.org/10.1016/j.envpol.2013.10.035.CrossRefPubMed

43.

Luo L, Zhang Y, Jiang J, et al. Short-Term Effects of Ambient Air Pollution on Hospitalization for Respiratory Disease in Taiyuan, China: A Time-Series Analysis. Int J Environ Res Public Health. 2018;15:2160. https://doi.org/10.3390/ijerph15102160.CrossRefPubMedPubMedCentral

44.

Xu Q, Li X, Wang S, et al. Fine Particulate Air Pollution and Hospital Emergency Room Visits for Respiratory Disease in Urban Areas in Beijing, China, in 2013. PLoS ONE. 2016;11:e153099. https://doi.org/10.1371/journal.pone.0153099.CrossRef

45.

Harms CA. Does gender affect pulmonary function and exercise capacity? Respir Physiol Neurobiol. 2006;151:124–31. https://doi.org/10.1016/j.resp.2005.10.010.CrossRefPubMed

46.

Oiamo T, Luginaah I. Extricating Sex and Gender in Air Pollution Research: A Community-Based Study on Cardinal Symptoms of Exposure. Int J Environ Res Public Health. 2013;10:3801–17. https://doi.org/10.3390/ijerph10093801.CrossRefPubMedPubMedCentral

47.

Chai F, Gao J, Chen Z, et al. Spatial and temporal variation of particulate matter and gaseous pollutants in 26 cities in China. J Environ Sci (China). 2014;26:75–82. https://doi.org/10.1016/s1001-0742(13)60383-6.CrossRefPubMed

48.

Eccles R. An explanation for the seasonality of acute upper respiratory tract viral infections. Acta Otolaryngol. 2002;122:183–91. https://doi.org/10.1080/00016480252814207.CrossRefPubMed

49.

Mauderly JL, Samet JM. Is there evidence for synergy among air pollutants in causing health effects? Environ Health Perspect. 2009;117:1–6. https://doi.org/10.1289/ehp.11654.CrossRefPubMed

50.

Yang Y, Liu X, Zheng J, et al. Characteristics of one-year observation of VOCs, NOx, and O3 at an urban site in Wuhan. China J Environ Sci. 2019;79:297–310. https://doi.org/10.1016/j.jes.2018.12.002.CrossRef

51.

Petit PC, Fine DH, Vásquez GB, et al. The Pathophysiology of Nitrogen Dioxide During Inhaled Nitric Oxide Therapy. ASAIO J. 2017;63:7–13. https://doi.org/10.1097/MAT.0000000000000425.CrossRefPubMed

52.

Gamon LF, Wille U. Oxidative Damage of Biomolecules by the Environmental Pollutants NO₂• and NO₃•. Acc Chem Res.2016;49:2136–2145 https://doi.org/10.1021/acs.accounts.6b00219

Title: Association and interaction of O3 and NO2 with emergency room visits for respiratory diseases in Beijing, China: a time-series study
Authors: Yuanwei Fu
Wenlou Zhang
Yan Li
Hongyu Li
Furong Deng
Qingbian Ma
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Pulmonary Emergencies
Air Pollutants
Published in: BMC Public Health / Issue 1/2022
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-022-14473-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Association and interaction of O₃ and NO₂ with emergency room visits for respiratory diseases in Beijing, China: a time-series study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2022

A state-wide education program on opioid use disorder: influential community members’ knowledge, beliefs, and opportunities for coalition development

Behavioral activation / inhibition systems and lifestyle as predictors of mental disorders in adolescent athletes during Covid19 pandemic

Dual mediating effects of changes in daily life and anxiety on the relationship between occupation and depression in Korea during the COVID-19 pandemic

Development, validation, and implementation of a Short Breast Health Perception Questionnaire

Correction: Acceptability and usability of oral fluid-based HIV self-testing among female sex workers and men who have sex with men in Morocco

The burden of risk factors for non-communicable disease in rural Bihar, India: a comparative study with national health surveys