Attributable Risk and Economic Cost of Cardiovascular Hospital Admissions Due to Ambient Particulate Matter in Wuhan, China

The Short-Term Effects and Burden of Ambient Air Pollution on Hospitalization for Type 2 Diabetes: Time-Stratified Case-Crossover Evidence From Sichuan, China

Type 2 diabetes mellitus (T2DM), a complicated metabolic disease, might be developed or exacerbated by air pollution, resulting in economic and health burden to patients. So far, limited studies have estimated associations between short-term exposure to air pollution and disease burden of T2DM in China. Hence, we aimed to estimate the associations and burden of ambient air pollutants (NO2, PM10, PM2.5, SO2, and CO) on hospital admissions (HAs) for T2DM using a time-stratified case-crossover design. Data on HAs for T2DM during 2017-2019 were collected from hospital electronic health records in nine cities in Sichuan Province using conditional poisson regression. Totally, 92,381 T2DM hospitalizations were recorded. There were significant short-term effects of NO2, PM10, PM2.5, SO2 and CO on HAs for T2DM. A 10 μg/m3 increment of NO2, PM10, PM2.5, SO2 and CO as linked with a 3.39% (95% CI: 2.26%, 4.54%), 0.33% (95% CI: 0.04%, 0.62%), 0.76% (95% CI: 0.35%, 1.16%), 12.68% (95% CI: 8.14%, 17.42%) and 79.00% (95% CI: 39.81%, 129.18%) increase in HAs for T2DM at lag 6. Stratified analyses modified by age, sex, and season showed old (≥65 years) and female patients linked with higher impacts. Using WHO's air quality guidelines of NO2, PM10, PM2.5, and CO as the reference, the attributable number of T2DM HAs exceeding these pollutants exposures were 786, 323, 793, and 2,127 during 2017-2019. Besides, the total medical costs of 25.83, 10.54, 30.74, and 67.78 million China Yuan were attributed to NO2, PM10, PM2.5, and CO. In conclusion, short-term exposures to air pollutants were associated with higher risks of HAs for T2DM.

Long-term effects of particulate matter on incident cardiovascular diseases in middle-aged and elder adults: The CHARLS cohort study

BACKGROUND

Although there is evidence of long-term effects of particulate matter (PM) on cardiovascular diseases (CVD), researches about long-term effects of PM₁ on CVD are limited. We aimed to examine the long-term effects and magnitude of PM, especially PM₁, on incident CVD in China.

METHODS

We included 6016 participants aged ≥ 45 years without CVD at baseline in 2011 from the China Health and Retirement Longitudinal Study. Personal PM (PM₁, PM_2.5, and PM₁₀) concentrations were estimated using geocoded residential address. Generalized linear mixed models and SHapley Additive exPlanation were utilized to calculate the impacts and contributions of PM on CVD. Sensitivity analyses were used to check the robustness.

RESULTS

After a follow up of 4-year, 481 (7.99 %) participants developed CVD. Per 10 μg/m³ uptick in 1-year average concentrations of PM₁, PM_2.5 and PM₁₀ was associated with a 1.20 [95 % confidence interval (CI): 1.05-1.37], 1.13 (95 % CI: 1.11-1.15), and 1.10 (95 % CI: 1.06-1.13) fold risk of incident CVD, respectively. The 2-year average concentrations of PM₁, PM_2.5 and PM₁₀ were associated with incident CVD, corresponding to a 1.03 (95 % CI: 0.96-1.10), 1.11 (95 % CI: 1.02-1.21), and 1.09 (95 % CI: 1.03-1.15) fold risk, respectively. The SHapley Additive exPlanation values of PM₁, PM_2.5, and PM₁₀ were 0.170, 0.153, and 0.053, respectively, corresponding to the first, second, and fifth among all air pollutants. Effects of PM₁, PM_2.5 and PM₁₀ on CVD remained statistically significant in two-pollutant models. The elderly, males, smokers and alcohol drinkers tended to have slightly higher effects, while the differences were not statistically significant (all P-values > 0.05) between subgroups.

CONCLUSION

Long-term exposure to PM₁, PM_2.5, and PM₁₀ was associated with an increased incidence of CVD. The smaller the particle size, the more important it was for incident CVD indicating that emphasis should be placed on small size of PM.

Short-term exposure to ambient fine particulate pollution aggravates ventilator-associated pneumonia in pediatric intensive care patients undergoing cardiovascular surgeries

BACKGROUND

Ambient air pollutants can be hazardous to human health, especially for vulnerable children. The impact of ambient air pollutant exposure before and during intensive care unit (ICU) stays on the development of ventilator-associated pneumonia (VAP) in critically ill children has not been established. We aimed to determine the correlations between short-term exposures to ambient fine particulate matter (PM_2.5) and VAP in pediatric cardiac surgery patients in the ICU, and explore the effect of delayed exposure.

METHODS

The medical record of 1755 child patients requiring artificial ventilation in the ICU between December 2013 to December 2020, were analyzed. The daily average concentrations of particulate matters (PM_2.5 and PM₁₀), sulfur dioxide (SO₂), and ozone (O₃) were calculated from public data. Interactions between these pollutants and VAP were simulated with the distributed lag non-linear model.

RESULTS

Three hundred forty-eight cases (19.829%) of VAP were identified in this study, while the average concentrations of PM_2.5, PM₁₀, O₃ and SO₂ were 58, 118, 98 and 26 μg/m³, respectively. Exposure to increased levels of PM_2.5 two days prior (lag 2-day) to VAP diagnosis is significantly correlated with an enhanced risk for VAP development. Even a slight increase of 10 μg/m³ in PM_2.5 can translate to a 5.4% increase in VAP incidence (95% CI: 1.4%-9.5%) while the VAP incidence increased to 11.1% (95%CI: 4.5-19.5%) when PM_2.5 concentration is well below the National Ambient Air Quality standard (NAAQS) of 50 μg/m³. The association was more pronounced in those aged below 3-months, with low body mass index or suffered from pulmonary arterial hypertension.

CONCLUSION

Short-term PM_2.5 exposure is a significant risk for development of VAP in pediatric patients. This risk is present even with PM_2.5 levels below the NAAQS. Ambient PM_2.5 may represent a previously unrecognized risk factor for pneumonia and the current environmental pollution standards need to be reevaluated to consider susceptible populations.

TRIAL REGISTRATION

The trial was registered with the National Clinical Trial Center: The correlation between ambient air pollution and the complications in ICU underwent cardiac surgery.

TRIAL REGISTRATION NUMBER

ChiCTR2000030507. Date of registration: March 5, 2020. URL of trial registry record: http://www.chictr.org.cn/index.aspx .

Health and economic impacts of ambient air pollution on hospital admissions for overall and specific cardiovascular diseases in Panzhihua, Southwestern China

Background

The associations of ambient air pollution with hospital admissions (HAs) for overall and specific causes of cardiovascular diseases (CVDs), as well as related morbidity and economic burdens remain understudied, especially in low-pollution areas of low- and middle-income countries (LMICs). We evaluated the short-term effects of exposure to PM_2.5 (particles with an aerodynamic diameter ≤2.5 μm), PM₁₀ (particles with an aerodynamic diameter ≤10 μm), and SO₂ (sulfur dioxide) on HAs for CVDs in Panzhihua, China, during 2016-2020, and calculated corresponding attributable risks and economic burden.

Methods

We used a generalized additive model (GAM) while controlling for time trends, meteorological conditions, holidays, and days of the week to estimate the associations. The cost of illness (COI) method was adopted to further assess corresponding hospitalization costs and productivity losses.

Results

A total of 27 660 HAs for CVDs were included in this study. PM₁₀ and SO₂ were significantly associated with elevated risks of CVDs hospitalizations. Each 10 μg/m³ increase in PM₁₀ and SO₂ at lag06 corresponded to an increase of 2.48% (95% confidence interval (CI) = 0.92%-4.06%), and 5.50% (95% CI = 3.09%-7.97%) in risk of HAs for CVDs, respectively. The risk estimates of PM₁₀ and SO₂ on CVD hospitalizations were generally robust after adjustment for other pollutants in two-pollutant models. We found stronger associations between air pollution (PM₁₀ and SO₂) and CVDs in cool seasons than in warm seasons. For specific causes of CVDs, significant associations of PM₁₀ and SO₂ exposure with cerebrovascular disease and ischaemic heart disease were observed. Using 0 μg/m³ as the reference concentrations, 11.91% (95%CI = 4.64%-18.56%) and 15.71% (95%CI = 9.30%-21.60%) of HAs for CVDs could be attributable to PM₁₀ and SO₂, respectively. During the study period, PM₁₀ and SO₂ brought 144.34 million Yuan economic losses for overall CVDs, accounting for 0.028% of local GDP.

Conclusions

Our results suggest that PM₁₀ and SO₂ exposure might be an important trigger of HAs for CVDs and accounted for substantial morbidity and economic burden.

The short-term effects and burden of particle air pollution on hospitalization for coronary heart disease: a time-stratified case-crossover study in Sichuan, China

BACKGROUND

Coronary heart disease (CHD), the leading cause of death globally, might be developed or exacerbated by air pollution, resulting high burden to patients. To date, limited studies have estimated the relations between short-term exposure to air pollution and CHD disease burden in China, with inconsistent results. Hence, we aimed to estimate the short-term impact and burden of ambient PM pollutants on hospitalizations of CHD and specific CHD.

METHODS

PM10 and PM2.5 were measured at 82 monitoring stations in 9 cities in Sichuan Province, China during 2017-2018. Based on the time-stratified case-crossover design, the effects of short-term exposure to particle matter (PM) pollution on coronary heart disease (CHD) hospital admissions were estimated. Meanwhile, the linked burden of CHD owing to ambient PM pollution were estimated.

RESULTS

A total of 104,779 CHD records were derived from 153 hospitals from these 9 cities. There were significant effects of PM pollution on hospital admissions (HAs) for CHD and specific CHD in Sichuan Province. A 10 μg/m3 increase of PM10 and PM2.5 was linked with a 0.46% (95% CI: 0.08, 0.84%), and 0.57% (95% CI: 0.05, 1.09%) increments in HAs for CHD at lag7, respectively. The health effects of air pollutants were comparable modified by age, season and gender, showing old (≥ 65 years) and in cold season being more vulnerable to the effects of ambient air pollution, while gender-specific effects is positive but not conclusive. Involving the WHO's air quality guidelines as the reference, 1784 and 2847 total cases of HAs for CHD could be attributable to PM10 and PM2.5, separately. The total medical cost that could be attributable to exceeding PM10 and PM2.5 were 42.04 and 67.25 million CNY from 2017 to 2018, respectively.

CONCLUSIONS

This study suggested that the short-term exposure to air pollutants were associated with increased HAs for CHD in Sichuan Province, which could be implications for local environment improvement and policy reference.

Effects of particulate matter on hospital admissions for respiratory diseases: an ecological study based on 12.5 years of time series data in Shanghai

BACKGROUND

Previous epidemiological studies on the association between short-term exposure to particulate matter (PM) with hospital admission in major cities in China were limited to shorter study periods or a single hospital. The aim of this ecological study based on a 12.5-year time series was to investigate the association of short-term exposure to PM with aerodynamic diameter ≤ 2.5 μm (PM_2.5) and aerodynamic diameter ≤ 10 μm (PM₁₀) with hospital admissions for respiratory diseases.

METHODS

Daily hospital admissions data were from the Shanghai Medical Insurance System for the period January 1, 2008 to July 31, 2020. We estimated the percentage change with its 95% confidence interval (CI) for each 10 μg/m³ increase in the level of PM_2.5 and PM₁₀ after adjustment for calendar time, day of the week, public holidays, and meteorological factors applying a generalized additive model with a quasi-Poisson distribution.

RESULTS

There were 1,960,361 hospital admissions for respiratory diseases in Shanghai during the study period. A 10 μg/m³ increase in the level of each class of PM was associated with increased total respiratory diseases when the lag time was 0 day (PM_2.5: 0.755%; 95% CI: 0.422, 1.089%; PM₁₀: 0.250%; 95% CI: 0.042, 0.459%). The PM_2.5 and PM₁₀ levels also had positive associations with admissions for COPD, asthma, and pneumonia. Stratified analyses demonstrated stronger effects in patients more than 45 years old and during the cold season. Total respiratory diseases increased linearly with PM concentration from 0 to 100 μg/m³, and increased more slowly at higher PM concentrations.

CONCLUSIONS

This time-series study suggests that short-term exposure to PM increased the risk for hospital admission for respiratory diseases, even at low concentrations. These findings suggest that reducing atmospheric PM concentrations may reduce hospital admissions for respiratory diseases.

PM2.5-associated risk for cardiovascular hospital admission and related economic burdens in Beijing, China

BACKGROUND

The study of ambient air particulate matter (PM_2.5)-associated health and economic burdens of cardiovascular disease are crucial for air pollution control and disease prevention strategies. Quantified evidence remains inadequate.

OBJECTIVES

This study aimed to estimate the PM_2.5 associated risk in cardiovascular hospital admission as well as attributable health burdens and economic costs.

METHODS

A total of 2,202,244 hospital admission records of cardiovascular disease and six common clinical subtypes in Beijing were included. A time-stratified case-crossover design was applied to estimate the associations and the concentration-response curve. Then, the annual average additional hospital admissions, days of hospital stay, and hospital expenditures were evaluated from 2013 to 2017 and compared between 2017 and 2013.

RESULTS

The results showed that each 10 μg/m³ increase in previous-day PM_2.5 concentration was associated with a risk increase of 0.44% (95%CI: 0.40%, 0.47%) for cardiovascular disease, 0.66% (95%CI: 0.58%, 0.73%) for angina pectoris, 0.53% (95%CI: 0.39%, 0.66%) for chronic ischemic heart disease, 0.48% (95%CI: 0.34%, 0.63%) for myocardial infarction, 0.44% (95%CI: 0.29%, 0.60%) for hypertensive heart disease and 0.40% (95%CI: 0.27%, 0.52%) for ischemic stroke. There were 1938 PM_2.5 attributed additional hospital admissions, resulting in 21,668 additional days in hospital, along with 5527.12 and 1947.04 ten-thousand of additional total hospital cost and self-afforded cost, respectively. Compared with 2013, the above-mentioned four burdens decreased by 18.17%, 28.80%, 18.90% and 13.72% in 2017, respectively.

CONCLUSION

PM_2.5 exposure was significantly associated with substantial burdens of cardiovascular hospital admission and economic expenditures. The results highlight the necessity of continuous PM_2.5 control from the perspective of healthy and sustainable city development in urban China.

Short-Term Associations of Ambient Fine Particulate Matter (PM2.5) with All-Cause Hospital Admissions and Total Charges in 12 Japanese Cities

The short-term association between ambient particulate matter ≤2.5 microns in diameter (PM_2.5) and hospital admissions is not fully understood. Studies of this association with hospital admission costs are also scarce, especially in entire hospitalized populations. We examined the association between ambient PM_2.5 and all-cause hospital admissions, the corresponding total charges, and the total charges per patient by analyzing the hospital admission data of 2 years from 628 hospitals in 12 cities in Japan. We used generalized additive models with quasi-Poisson regression for hospital admissions and generalized additive models with log-linear regression for total charges and total charges per patient. We first estimated city-specific results and the combined results by random-effect models. A total of 2,017,750 hospital admissions were identified. A 10 µg/m³ increase in the 2 day moving average was associated with a 0.56% (95% CI: 0.14–0.99%) increase in all-cause hospital admissions and a 1.17% (95% CI: 0.44–1.90%) increase in total charges, and a 10 µg/m³ increase in the prior 2 days was associated with a 0.75% (95% CI: 0.34–1.16%) increase in total charges per patient. Short-term exposure to ambient PM_2.5 was associated with increased all-cause hospital admissions, total charges, and total charges per patient.