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Yu Y, Wang B, Pan L, Ge N, Gu X, Fang Y, Zhang H, Zhang J, Ma Y, Duan H. Associations between air pollutants and emergency ambulance dispatches for all-cause and nervous system disease in China Qingdao: a time-stratified case-crossover study. ENVIRONMENTAL MONITORING AND ASSESSMENT 2025; 197:528. [PMID: 40202545 DOI: 10.1007/s10661-025-13955-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/26/2025] [Indexed: 04/10/2025]
Abstract
The health hazards of air pollution have been recognized worldwide, and emergency ambulance dispatches (EADs) data have excellent research value in the field of environmental health and wellness. This study evaluated EADs data from January 1, 2016 to December 31, 2019, in Qingdao to assess the impact of air pollution on all-cause as well as nervous system emergency ambulance dispatches (NS-EADs). This study adopted a time-stratified case-crossover design to construct a time-series distribution-lagged single-pollutant model to assess the effects of air pollution on all-cause and NS-EADs, stratified by gender, age, and season. Confounding factors that could affect the results were controlled for in the model. Air pollutants were positively associated with all-cause and NS-EADs. The findings of the single-day lag effect demonstrated positive associations between PM2.5 (lag0 and lag1 days), CO (lag0 and lag1 days), PM10 (lag0 and lag1 days), SO2 (lag1 days), and NO2 (lag1 days) with an increased risk of all-cause EADs. Additionally, O3 (lag0 days), CO (lag0 days), PM10 (lag0 days), and NO2 (lag0 days) exhibited positive correlations with an elevated risk of NS-EADs. To be specific, with every 10 μg/m3 increase in the concentrations of O3, CO, PM10, and NO2 at lag 0, there was a corresponding increase in NS-EADs risk of 0.67% (95% confidence interval, 0.05%, 1.30%); 0.05% (0.01%, 0.10%); 0.50% (0.13%, 0.87%); and 1.52% (0.24%, 2.82%), respectively. Stratified analysis revealed a higher risk of NS-EADs associated with air pollution, specifically observed in subgroups including individuals under 65 years old, males, and during the cold season. Air pollution was associated with all-cause EADs and NS-EADs, and males, people under 65 years old were more vulnerable to air pollution. Furthermore, the impact of air pollution is more pronounced during the cold season.
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Affiliation(s)
- Yang Yu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Bingling Wang
- Qingdao Municipal Center for Disease Control and Prevention, Institute of Preventive Medicine, Institute of Environmental Health, Qingdao, 266033, Shandong, China
| | - Lu Pan
- Qingdao Municipal Center for Disease Control and Prevention, Institute of Preventive Medicine, Institute of Environmental Health, Qingdao, 266033, Shandong, China
| | - Nan Ge
- Qingdao Municipal Center for Disease Control and Prevention, Institute of Preventive Medicine, Institute of Environmental Health, Qingdao, 266033, Shandong, China
| | - Xiaocheng Gu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Shinan Center for Disease Control and Prevention of Qingdao, Qingdao, 266072, Shandong, China
| | - Yuan Fang
- Eco-Environmental Monitoring Center of Shandong Province, Qingdao, 266003, Shandong, China
| | - Hua Zhang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, 266033, Shandong, China
| | - Jianjun Zhang
- Network Coordination Department, Qingdao Center for Disease Control and Prevention, Qingdao, 266033, Shandong, China
| | - Yan Ma
- Qingdao Meteorological Bureau (Qingdao Marine Meteorological Bureau), Qingdao, 266003, Shandong, China
| | - Haiping Duan
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, 266033, Shandong, China.
- Qingdao Institute of Preventive Medicine, Qingdao, 266033, Shandong, China.
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Tartakovsky D, Kordova-Biezuner L, Broday DM. PM 2.5 and NOX concentrations decrease as a result of a railway electrification. ENVIRONMENTAL MONITORING AND ASSESSMENT 2025; 197:188. [PMID: 39853614 DOI: 10.1007/s10661-025-13654-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 01/14/2025] [Indexed: 01/26/2025]
Abstract
This work examines the impact of the electrification of the Holon-Bat Yam passenger train line (central Israel) on air pollutant concentrations using data collected from air quality monitoring stations that operated at the train stations across the electrified train line. We present statistically significant reduction in the annual average NO2, NO and NOX concentrations (29-45%, 79-85% and 65-75%, respectively), attributed to the electrification of the passenger train line. The drop in the NO and NOX concentrations was much stronger than in the NO2 concentrations, since NO is the main nitrogen species emitted by diesel locomotives. PM2.5 concentrations also significantly decreased, but only in two (out of the three) train stations situated along the electrified line. Following various analyses, we conclude that electrification of train lines reduces train locomotive emissions and improves the air quality at the stations, as expected, thus protecting the passengers and reducing their exposure to air pollutants. Although this study presents a specific case, the findings are expected to be applicable, at least quantitatively, to other locations, as railway electrification removes emissions associated with fossil-fuel-powered locomotives. This work supports railway electrification policy, which has the potential to substantially lower air pollution levels and diminish the passengers' exposure to harmful air pollutants.
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Affiliation(s)
| | - Levana Kordova-Biezuner
- Air Quality and Asbestos Division, Israeli Air Monitoring Network, Israeli Ministry of Environmental Protection, Tel Aviv, Israel
| | - David M Broday
- Technion - Israel Institute of Technology, Haifa, Israel
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Hu J, Wang F, Shen H. The influence of PM 2.5 exposure duration and concentration on outpatient visits of urban hospital in a typical heavy industrial city. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:115098-115110. [PMID: 37880395 DOI: 10.1007/s11356-023-30544-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
To explain the duration and dose effects of pollutant exposure on public health and provide scientific data for air pollution prevention and control and disease prevention by examining the influence of PM2.5 concentration and exposure duration on daily outpatient visits among patients with cardiovascular, cerebrovascular, and respiratory diseases in a typical heavy industrial city in China. Daily outpatient data on cardiovascular, cerebrovascular, and respiratory diseases and regional PM2.5 exposure duration and concentration were collected from a provincial hospital in Taiyuan, China, from 2016 to 2021. The correlations of numeric variables were analyzed using the Pearson correlation method. A generalized additive model (GAMs) was also established to investigate the effects of PM2.5 concentration and exposure duration on outpatient visits. Correlation analysis showed that the outpatient visits in Taiyuan was significantly correlated with the PM2.5 concentration and exposure duration. The longer the exposure time of PM2.5 pollution, the stronger the correlation of PM2.5 with outpatient visits showed. Cardiovascular outpatient visits were extremely significant related with medium to long-term exposure of PM2.5 (exposure with more than 30 days) (p < 0.001). In addition, outpatient visits of cerebrovascular and respiratory disease were extremely significant correlated with PM2.5 (exposures within 0-360 days) (p < 0.001). The results of GAMs showed the linear or the nonlinear relationships between outpatient visits and exposure of PM2.5. Among the linear relationships, when average concentration of PM2.5 (exposure within less than 15 days) increased by 1 mg/m3, the cardiovascular outpatient visits increased most dramatically (by about 440 people). For nonlinear relationships, when the average PM2.5 concentration (exposure with over 30 days or more) increased by 1 mg/m3, the most dramatic increase occurred in cardiovascular outpatient visits (with a maximum increase of 7000), followed by cerebrovascular outpatient visits (with a maximum increase of 1200), and respiratory outpatient visits (with a maximum increase of 250). The GAMs also revealed a dose effect in the relationship between outpatient visits and PM2.5 exposure. In moderately polluted air (based on air quality standards of China, GB3095-2012), when the average concentration of PM2.5 increased by 1 mg/m3, the cardiovascular outpatient visits increased the most (by 1200 people), followed by cerebrovascular outpatient visits (by 200 people) and respiratory outpatient visits (by 20 people). We concluded that outpatient visits in cardiovascular, cerebrovascular, and respiratory disease are closely correlated with the concentration and exposure duration of air pollution. There is a linear relationship between short-term air pollution exposure (exposure within less than 15 days) and outpatient visits. As PM2.5 concentration increases, cardiovascular outpatient visits increase gradually, with its growth trend exceeding that of cerebrovascular and respiratory disease. There is a nonlinear relationship between medium and long-term air pollution exposure (exposure with more than 30 days) and outpatient visits, with cardiovascular and cerebrovascular outpatient visits showed a nonlinear but overall upward trend when the atmosphere is moderately polluted.
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Affiliation(s)
- Jingran Hu
- School of Physical Education, Shanxi University, Taiyuan, 030006, Shanxi, China
- Shanxi Cardiovascular Hospital, No. 18 Yifen Road, Taiyuan, 030024, Shanxi, China
| | - Fei Wang
- School of Physical Education, Shanxi University, Taiyuan, 030006, Shanxi, China.
- Sports Science Institute, Shanxi University, Taiyuan, 030006, Shanxi, China.
| | - Hao Shen
- School of Physical Education, Shanxi University, Taiyuan, 030006, Shanxi, China
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Qiu T, Zang T, Fang Q, Xu Z, Cao Y, Fan X, Liu J, Zeng X, Li Y, Tu Y, Li G, Bai J, Huang J, Liu Y. Cumulative and lagged effects of varying-sized particulate matter exposure associates with toddlers' gut microbiota. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 336:122389. [PMID: 37595737 DOI: 10.1016/j.envpol.2023.122389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/30/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023]
Abstract
Particulate matter (PM) is an important component of air pollutants and is associated with various health risks. However, the impact of PM on toddlers' gut microbiota is rarely investigated. This study aimed to assess the cumulative and lagged effects of varying-sized PMs on toddlers' gut microbiota. We collected demographic information, stool samples, and exposure to PM from 36 toddlers aged 2-3 years. The toddlers were divided into warm season group and cooler season group according to the collection time of stool samples. The gut microbiota was processed and analyzed using 16S rRNA V3-V4 gene regions. The concentration of PM was calculated using China High Air Pollutants (CHAP) database. To assess the mixed effects of varying-sized PM, multiple-PM models were utilized. There were significant differences between the community composition, α- and β-diversity between two groups. In multiple-PM models, there was a significant effect of weight quantile sum (PM1, PM2.5, and PM10) on α-diversity indices. In weight quantile sum models, after adjusting for a priori confounders, we found a negative effect of weight quantile sum on Enterococcus (β = -0.134, 95% CI -0.263 to -0.006), positive effects of weight quantile sum on unclassified_f__Ruminococcaceae (β = 0.247, 95% CI 0.102 to 0.393), Ruminococcus_1 (β = 0.444, 95% CI 0.238 to 0.650), unclassified_f__Lachnospiraceae (β = 0.278, 95% CI 0.099 to 0.458), and Family_XIII_AD_3011_group (β = 0.254, 95% CI 0.086 to 0.422) in WSG and CSG. In lagged weight quantile sum models, the correlation between lag time PM levels and the gut microbiota showed seasonal trends, and weights of PM changed with lag periods. This is the first study to highlight that cumulative and lagged effects of PMs synergistically affect the diversities (α- and β-diversity) and abundance of the gut microbiota in toddlers. Further research is needed to explore the mediating mechanism of varying-sized PMs exposure on the gut microbiota in toddlers.
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Affiliation(s)
- Tianlai Qiu
- Center for Women's and Children's Health, Wuhan University School of Nursing, Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Tianzi Zang
- Center for Women's and Children's Health, Wuhan University School of Nursing, Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Qingbo Fang
- Center for Women's and Children's Health, Wuhan University School of Nursing, Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Zhihu Xu
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, 100191, China
| | - Yanan Cao
- Center for Women's and Children's Health, Wuhan University School of Nursing, Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Xiaoxiao Fan
- Center for Women's and Children's Health, Wuhan University School of Nursing, Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Jun Liu
- Center for Women's and Children's Health, Wuhan University School of Nursing, Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Xueer Zeng
- Center for Women's and Children's Health, Wuhan University School of Nursing, Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Yanting Li
- Center for Women's and Children's Health, Wuhan University School of Nursing, Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Yiming Tu
- Center for Women's and Children's Health, Wuhan University School of Nursing, Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Guoxing Li
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, 100191, China; Environmental Research Group, Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Jinbing Bai
- Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA, 30322, USA
| | - Jing Huang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, 100191, China
| | - Yanqun Liu
- Center for Women's and Children's Health, Wuhan University School of Nursing, Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
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Jin L, Zhou T, Fang S, Zhou X, Bai Y. Association of air pollutants and hospital admissions for respiratory diseases in Lanzhou, China, 2014-2019. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2023; 45:941-959. [PMID: 35384572 PMCID: PMC8985563 DOI: 10.1007/s10653-022-01256-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/07/2022] [Indexed: 05/10/2023]
Abstract
The aim of this study was to assess the effects of air pollutants on hospital admissions for respiratory disease (RD) by using distributed lag nonlinear model (DLNM) in Lanzhou during 2014-2019. In this study, the dataset of air pollutants, meteorological, and daily hospital admissions for RD in Lanzhou, from January 1st, 2014 to December 31st, 2019, were collected from three national environmental monitoring stations, China meteorological data service center, and three large general hospitals, respectively. A time-series analysis with DLNM was used to estimate the associations between air pollutants and hospital admissions for RD including the stratified analysis of age, gender, and season. The key findings were expressed as the relative risk (RR) with a 95% confidence interval (CI) for single-day and cumulative lag effects (0-7). A total of 90, 942 RD hospitalization cases were identified during the study period. The highest association (RR, 95% CI) of hospital admissions for RD and PM2.5 (1.030, 1.012-1.049), and PM10 (1.009, 1.001-1.015), and NO2 (1.047, 1.024-1.071) were observed at lag 07 for an increase of 10 μg/m3 in the concentrations, and CO at lag07 (1.140, 1.052-1.236) for an increase of 1 mg/m3 in the concentration. We observed that the RR estimates for gaseous pollutants (e.g., CO and NO2) were larger than those of particulate matter (e.g., PM2.5 and PM10). The harmful effects of PM2.5, PM10, NO2, and CO were greater in male, people aged 0-14 group and in the cold season. However, no significant association was observed for SO2, O38h, and total hospital admissions for RD. Therefore, some effective intervention strategies should be taken to strengthen the treatment of the ambient air pollutants, especially gaseous pollutants (e.g., CO and NO2), thereby, reducing the burden of respiratory diseases.
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Affiliation(s)
- Limei Jin
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou, 73000 China
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou, 73000 China
| | - Tian Zhou
- College of Atmospheric Sciences, Lanzhou University, Lanzhou, 73000 China
| | - Shuya Fang
- College of Atmospheric Sciences, Lanzhou University, Lanzhou, 73000 China
| | - Xiaowen Zhou
- College of Atmospheric Sciences, Lanzhou University, Lanzhou, 73000 China
| | - Yana Bai
- School of Public Health, Lanzhou University, Lanzhou, 73000 China
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Li D, He R, Liu P, Jiang H. Differential effects of size-specific particulate matter on the number of visits to outpatient fever clinics: A time-series analysis in Zhuhai, China. Front Public Health 2022; 10:972818. [PMID: 36620254 PMCID: PMC9816473 DOI: 10.3389/fpubh.2022.972818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION While many studies have investigated the adverse effects of particulate matter (PM), few of them distinguished the different effects of PM2.5, PM10, and coarse PM (PMc) on outpatients with fever. Our study aimed to estimate and compare the acute cumulative effects of exposure to three size-specific particles on the number of visits to outpatient fever clinics. METHODS To examine the association between daily PM concentrations and outpatients in fever clinics, a generalized additive Poisson model was applied, stratified by sex, age, and season. RESULTS Our study included 56,144 outpatient visits in Zhuhai, from January 2020 to June 2021. On the current day, each 10 mg/m3 increment of PM10 and PMc were estimated to increase fever clinic visits by 1.74% (95% CI: 0.59%, 2.91%) and 4.42 % (2.30%, 6.58%), respectively. Cumulative effects enhanced from lag01 to lag05 for PM10 and PMc, and PMc had the strongest impact [ER = 8.92% (5.91%, 12.01%) at lag05]. Female outpatients and outpatients aged 14 years and above had an increased PM-related risk. During the cold season, significant effects could be observed for the three-size PM, while only PMc showed the impact during the warm season. DISCUSSION Overall, the three size-specific PM exerted different effects on the fever clinic visits. Strategies to control the concentrations of PM are still necessary, especially against PM10 and PMc.
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Affiliation(s)
- Duo Li
- Department of Operations, Zhuhai People's Hospital, Zhuhai, China
| | - Rui He
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Peixin Liu
- Department of Spine and Bone Disease, Zhuhai People's Hospital, Zhuhai, China
| | - Hong Jiang
- Department of Operations, Zhuhai People's Hospital, Zhuhai, China
- Faculty of Medicine, Macau University of Science and Technology, Macau SAR, China
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He M, Zhong Y, Chen Y, Zhong N, Lai K. Association of short-term exposure to air pollution with emergency visits for respiratory diseases in children. iScience 2022; 25:104879. [PMID: 36065191 PMCID: PMC9440288 DOI: 10.1016/j.isci.2022.104879] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/07/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Ambient air pollutants are health hazards to children. This study comprised 773,504 emergency department visits (EDVs) at 0–14 years of age with respiratory diseases in southern China. All air pollutants were positively associated with EDVs of total respiratory diseases, especially pneumonia. NO2, PM10, and PM2.5 had intraday effects and cumulative effects on asthma EDVs. The effect of SO2, PM10, and PM2.5 on pneumonia EDVs was stronger in girls than in boys. The effect of NO2 on acute upper respiratory tract infection EDVs was greater in children aged 0–5 years old; however, the effect of PM10 on acute upper respiratory tract infection EDVs was greater in the 6–14 years group. In a two-pollutant model, NO2 was associated with bronchitis and pneumonia, and PM10 was associated with acute upper respiratory tract infection. In this time-series study, NO2 and PM10 were risk indicators for respiratory diseases in children. Air pollution associates with children emergency visits for respiratory diseases NO2 and PM10 are risk indicators for respiratory diseases in children Young children are more sensitive to gaseous pollutants School-age children are more sensitive to PM10
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Zhou X, Gao Y, Wang D, Chen W, Zhang X. Association Between Sulfur Dioxide and Daily Inpatient Visits With Respiratory Diseases in Ganzhou, China: A Time Series Study Based on Hospital Data. Front Public Health 2022; 10:854922. [PMID: 35433609 PMCID: PMC9008542 DOI: 10.3389/fpubh.2022.854922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/01/2022] [Indexed: 12/21/2022] Open
Abstract
Background Sulfur dioxide (SO2) has been reported to be related to the mortality of respiratory diseases, but the relationship between SO2 and hospital inpatient visits with respiratory diseases and the potential impact of different seasons on this relationship is still unclear. Methods The daily average concentrations of air pollutants, including SO2 and meteorological data in Ganzhou, China, from 2017 to 2019 were collected. The data on daily hospitalization for respiratory diseases from the biggest hospital in the city were extracted. The generalized additive models (GAM) and the distributed lag non-linear model (DLNM) were employed to evaluate the association between ambient SO2 and daily inpatient visits for respiratory diseases. Stratified analyses by gender, age, and season were performed to find their potential effects on this association. Results There is a positive exposure-response relationship between SO2 concentration and relative risk of respiratory inpatient visits. Every 10 μg/m3 increase in SO2 was related to a 3.2% (95% CI: 0.6–6.7%) exaltation in daily respiratory inpatient visits at lag3. In addition, SO2 had a stronger association with respiratory inpatient visits in women, older adults (≥65 years), and warmer season (May-Oct) subgroups. The relationship between SO2 and inpatient visits for respiratory diseases was robust after adjusting for other air pollutants, including PM10, NO2, O3, and CO. Conclusion This time-series study showed that there is a positive association between short-term SO2 exposure and daily respiratory inpatient visits. These results are important for local administrators to formulate environmental public health policies.
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Affiliation(s)
- Xingye Zhou
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Yanfang Gao
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
| | - Dongming Wang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health, Ministry of Education, Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weihong Chen
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health, Ministry of Education, Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaokang Zhang
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, China
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