Ambient air pollution and cause-specific risk of hospital admission in China: A nationwide time-series study

[...]the lung autonomic nervous system may be provoked by pulmonary exposure, which could then result in autonomic nervous system imbalance [15]; the levels of stress hormones may also be altered [16]. Ninety-five percent of the total Chinese population was covered by social health insurance schemes...

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Published inPLoS medicine Vol. 17; no. 8; p. e1003188
Main Authors Gu, Jiangshao, Shi, Ying, Zhu, Yifang, Chen, Ning, Wang, Haibo, Zhang, Zongjiu, Chen, Ting
Format Journal Article
LanguageEnglish
Published San Francisco Public Library of Science 01.08.2020
Public Library of Science (PLoS)
Subjects
Air pollution
Autonomic nervous system
Biology and Life Sciences
Cities
Codes
Disease
Earth Sciences
Ecology and Environmental Sciences
Health care policy
Hospitals
Humidity
Medicine and Health Sciences
Monitoring systems
Nervous system
Nitrogen dioxide
Outdoor air quality
Oxidative stress
Patient admissions
People and Places
Pollutants
Population
Social Sciences
China
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Abstract [...]the lung autonomic nervous system may be provoked by pulmonary exposure, which could then result in autonomic nervous system imbalance [15]; the levels of stress hormones may also be altered [16]. Ninety-five percent of the total Chinese population was covered by social health insurance schemes by the end of 2017 [21]. [...]hospital admission records can provide reliable and timely information on the health status of a geographically defined population in China. Since January 1, 2013, class 3 hospitals in China have been mandated to automatically submit inpatient discharge records to the HQMS on a daily basis, in a nationally standardized format. All data used were anonymized and de-identified prior to analysis, under the supervision of Bureau of Medical Administration, National Health Commission of the People’s Republic of China. Because the data were analyzed at the aggregate level with no individual identifiers involved, institutional review board approval and participant written consent were not required for this study.
AbstractList [...]the lung autonomic nervous system may be provoked by pulmonary exposure, which could then result in autonomic nervous system imbalance [15]; the levels of stress hormones may also be altered [16]. Ninety-five percent of the total Chinese population was covered by social health insurance schemes by the end of 2017 [21]. [...]hospital admission records can provide reliable and timely information on the health status of a geographically defined population in China. Since January 1, 2013, class 3 hospitals in China have been mandated to automatically submit inpatient discharge records to the HQMS on a daily basis, in a nationally standardized format. All data used were anonymized and de-identified prior to analysis, under the supervision of Bureau of Medical Administration, National Health Commission of the People’s Republic of China. Because the data were analyzed at the aggregate level with no individual identifiers involved, institutional review board approval and participant written consent were not required for this study.
Jiangshao Gu reveal the increased risk of hospital admission from exposure to PM2.5 in a multi city analysis.
[...]the lung autonomic nervous system may be provoked by pulmonary exposure, which could then result in autonomic nervous system imbalance [15]; the levels of stress hormones may also be altered [16]. Ninety-five percent of the total Chinese population was covered by social health insurance schemes by the end of 2017 [21]. [...]hospital admission records can provide reliable and timely information on the health status of a geographically defined population in China. Since January 1, 2013, class 3 hospitals in China have been mandated to automatically submit inpatient discharge records to the HQMS on a daily basis, in a nationally standardized format. All data used were anonymized and de-identified prior to analysis, under the supervision of Bureau of Medical Administration, National Health Commission of the People’s Republic of China. Because the data were analyzed at the aggregate level with no individual identifiers involved, institutional review board approval and participant written consent were not required for this study.
The impacts of air pollution on circulatory and respiratory systems have been extensively studied. However, the associations between air pollution exposure and the risk of noncommunicable diseases of other organ systems, including diseases of the digestive, musculoskeletal, and genitourinary systems, remain unclear or inconclusive. We aimed to systematically assess the associations between short-term exposure to main air pollutants (fine particulate matter [PM2.5] and ozone) and cause-specific risk of hospital admission in China over a wide spectrum of human diseases.BACKGROUNDThe impacts of air pollution on circulatory and respiratory systems have been extensively studied. However, the associations between air pollution exposure and the risk of noncommunicable diseases of other organ systems, including diseases of the digestive, musculoskeletal, and genitourinary systems, remain unclear or inconclusive. We aimed to systematically assess the associations between short-term exposure to main air pollutants (fine particulate matter [PM2.5] and ozone) and cause-specific risk of hospital admission in China over a wide spectrum of human diseases.Daily data on hospital admissions for primary diagnosis of 14 major and 188 minor disease categories in 252 Chinese cities (107 cities in North China and 145 cities in South China) from January 1, 2013, to December 31, 2017, were obtained from the Hospital Quality Monitoring System of China (covering 387 hospitals in North China and 614 hospitals in South China). We applied a 2-stage analytic approach to assess the associations between air pollution and daily hospital admissions. City-specific associations were estimated with quasi-Poisson regression models and then pooled by random-effects meta-analyses. Each disease category was analyzed separately, and the P values were adjusted for multiple comparisons. A total of 117,338,867 hospital admissions were recorded in the study period. Overall, 51.7% of the hospitalized cases were male, and 71.3% were aged <65 years. Robust positive associations were found between short-term PM2.5 exposure and hospital admissions for 7 major disease categories: (1) endocrine, nutritional, and metabolic diseases; (2) nervous diseases; (3) circulatory diseases; (4) respiratory diseases; (5) digestive diseases; (6) musculoskeletal and connective tissue diseases; and (7) genitourinary diseases. For example, a 10-μg/m3 increase in PM2.5 was associated with a 0.21% (95% CI 0.15% to 0.27%; adjusted P < 0.001) increase in hospital admissions for diseases of the digestive system on the same day in 2-pollutant models (adjusting for ozone). There were 35 minor disease categories significantly positively associated with same-day PM2.5 in both single- and 2-pollutant models, including diabetes mellitus, anemia, intestinal infection, liver diseases, gastrointestinal hemorrhage, renal failure, urinary tract calculus, chronic ulcer of skin, and back problems. The association between short-term ozone exposure and respiratory diseases was robust. No safety threshold in the exposure-response relationships between PM2.5 and hospital admissions was observed. The main limitations of the present study included the unavailability of data on personal air pollution exposures.METHODS AND FINDINGSDaily data on hospital admissions for primary diagnosis of 14 major and 188 minor disease categories in 252 Chinese cities (107 cities in North China and 145 cities in South China) from January 1, 2013, to December 31, 2017, were obtained from the Hospital Quality Monitoring System of China (covering 387 hospitals in North China and 614 hospitals in South China). We applied a 2-stage analytic approach to assess the associations between air pollution and daily hospital admissions. City-specific associations were estimated with quasi-Poisson regression models and then pooled by random-effects meta-analyses. Each disease category was analyzed separately, and the P values were adjusted for multiple comparisons. A total of 117,338,867 hospital admissions were recorded in the study period. Overall, 51.7% of the hospitalized cases were male, and 71.3% were aged <65 years. Robust positive associations were found between short-term PM2.5 exposure and hospital admissions for 7 major disease categories: (1) endocrine, nutritional, and metabolic diseases; (2) nervous diseases; (3) circulatory diseases; (4) respiratory diseases; (5) digestive diseases; (6) musculoskeletal and connective tissue diseases; and (7) genitourinary diseases. For example, a 10-μg/m3 increase in PM2.5 was associated with a 0.21% (95% CI 0.15% to 0.27%; adjusted P < 0.001) increase in hospital admissions for diseases of the digestive system on the same day in 2-pollutant models (adjusting for ozone). There were 35 minor disease categories significantly positively associated with same-day PM2.5 in both single- and 2-pollutant models, including diabetes mellitus, anemia, intestinal infection, liver diseases, gastrointestinal hemorrhage, renal failure, urinary tract calculus, chronic ulcer of skin, and back problems. The association between short-term ozone exposure and respiratory diseases was robust. No safety threshold in the exposure-response relationships between PM2.5 and hospital admissions was observed. The main limitations of the present study included the unavailability of data on personal air pollution exposures.In the Chinese population during 2013-2017, short-term exposure to air pollution, especially PM2.5, was associated with increased risk of hospitalization for diseases of multiple organ systems, including certain diseases of the digestive, musculoskeletal, and genitourinary systems; many of these associations are important but still not fully recognized. The effect estimates and exposure-response relationships can inform policy making aimed at protecting public health from air pollution in China.CONCLUSIONSIn the Chinese population during 2013-2017, short-term exposure to air pollution, especially PM2.5, was associated with increased risk of hospitalization for diseases of multiple organ systems, including certain diseases of the digestive, musculoskeletal, and genitourinary systems; many of these associations are important but still not fully recognized. The effect estimates and exposure-response relationships can inform policy making aimed at protecting public health from air pollution in China.
BackgroundThe impacts of air pollution on circulatory and respiratory systems have been extensively studied. However, the associations between air pollution exposure and the risk of noncommunicable diseases of other organ systems, including diseases of the digestive, musculoskeletal, and genitourinary systems, remain unclear or inconclusive. We aimed to systematically assess the associations between short-term exposure to main air pollutants (fine particulate matter [PM2.5] and ozone) and cause-specific risk of hospital admission in China over a wide spectrum of human diseases.Methods and findingsDaily data on hospital admissions for primary diagnosis of 14 major and 188 minor disease categories in 252 Chinese cities (107 cities in North China and 145 cities in South China) from January 1, 2013, to December 31, 2017, were obtained from the Hospital Quality Monitoring System of China (covering 387 hospitals in North China and 614 hospitals in South China). We applied a 2-stage analytic approach to assess the associations between air pollution and daily hospital admissions. City-specific associations were estimated with quasi-Poisson regression models and then pooled by random-effects meta-analyses. Each disease category was analyzed separately, and the P values were adjusted for multiple comparisons. A total of 117,338,867 hospital admissions were recorded in the study period. Overall, 51.7% of the hospitalized cases were male, and 71.3% were aged <65 years. Robust positive associations were found between short-term PM2.5 exposure and hospital admissions for 7 major disease categories: (1) endocrine, nutritional, and metabolic diseases; (2) nervous diseases; (3) circulatory diseases; (4) respiratory diseases; (5) digestive diseases; (6) musculoskeletal and connective tissue diseases; and (7) genitourinary diseases. For example, a 10-μg/m3 increase in PM2.5 was associated with a 0.21% (95% CI 0.15% to 0.27%; adjusted P < 0.001) increase in hospital admissions for diseases of the digestive system on the same day in 2-pollutant models (adjusting for ozone). There were 35 minor disease categories significantly positively associated with same-day PM2.5 in both single- and 2-pollutant models, including diabetes mellitus, anemia, intestinal infection, liver diseases, gastrointestinal hemorrhage, renal failure, urinary tract calculus, chronic ulcer of skin, and back problems. The association between short-term ozone exposure and respiratory diseases was robust. No safety threshold in the exposure-response relationships between PM2.5 and hospital admissions was observed. The main limitations of the present study included the unavailability of data on personal air pollution exposures.ConclusionsIn the Chinese population during 2013-2017, short-term exposure to air pollution, especially PM2.5, was associated with increased risk of hospitalization for diseases of multiple organ systems, including certain diseases of the digestive, musculoskeletal, and genitourinary systems; many of these associations are important but still not fully recognized. The effect estimates and exposure-response relationships can inform policy making aimed at protecting public health from air pollution in China.
Author Chen, Ning
Gu, Jiangshao
Wang, Haibo
Chen, Ting
Zhu, Yifang
Shi, Ying
Zhang, Zongjiu
AuthorAffiliation 6 Institute of the Environment and Sustainability, University of California at Los Angeles, Los Angeles, California, United States of America
8 Bureau of Medical Administration, National Health Commission of the People’s Republic of China, Beijing, China
2 Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing, China
4 China Standard Medical Information Research Center, Shenzhen, China
5 Department of Environmental Health Science, University of California at Los Angeles, Los Angeles, California, United States of America
Monash University, AUSTRALIA
1 Center for Big Data Research in Health and Medicine, Institute for Data Sciences, Tsinghua University, Beijing, China
7 Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
3 Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Department of Computer Science and Technology, Tsi
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– name: 2 Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing, China
– name: 4 China Standard Medical Information Research Center, Shenzhen, China
– name: 5 Department of Environmental Health Science, University of California at Los Angeles, Los Angeles, California, United States of America
– name: 3 Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Department of Computer Science and Technology, Tsinghua University, Beijing, China
– name: 6 Institute of the Environment and Sustainability, University of California at Los Angeles, Los Angeles, California, United States of America
– name: Monash University, AUSTRALIA
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2020 Gu et al 2020 Gu et al
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Snippet [...]the lung autonomic nervous system may be provoked by pulmonary exposure, which could then result in autonomic nervous system imbalance [15]; the levels of...
The impacts of air pollution on circulatory and respiratory systems have been extensively studied. However, the associations between air pollution exposure and...
Jiangshao Gu reveal the increased risk of hospital admission from exposure to PM2.5 in a multi city analysis.
BackgroundThe impacts of air pollution on circulatory and respiratory systems have been extensively studied. However, the associations between air pollution...
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SubjectTerms Air pollution
Autonomic nervous system
Biology and Life Sciences
Cities
Codes
Disease
Earth Sciences
Ecology and Environmental Sciences
Health care policy
Hospitals
Humidity
Medicine and Health Sciences
Monitoring systems
Nervous system
Nitrogen dioxide
Outdoor air quality
Oxidative stress
Patient admissions
People and Places
Pollutants
Population
Social Sciences
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Title Ambient air pollution and cause-specific risk of hospital admission in China: A nationwide time-series study
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https://pubmed.ncbi.nlm.nih.gov/PMC7410211
https://doaj.org/article/dec7b0365e24432a85b6e28413ff53bb
http://dx.doi.org/10.1371/journal.pmed.1003188
Volume 17
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