Air pollution and hospitalization of patients with idiopathic pulmonary fibrosis in Beijing: a time-series study

Abstract

Background A small number of studies suggested that air pollution was associated with idiopathic pulmonary fibrosis (IPF) exacerbation, incidence and mortality. However, no studies to date were conducted in regions where air pollution is substantial. We aimed to investigate whether there are associations between acute increases in air pollution and hospitalization of patients with a confirmed primary diagnosis of IPF in Beijing. Methods Daily count of IPF hospitalizations (International Classification of Disease-10th Revision, J84.1) was obtained from an administrative database for 2013–2017 while daily city-wide average concentrations of PM10, PM2.5, NO2, Ozone, SO2 were obtained from 35 municipal monitoring stations for the same period. The association between daily IPF hospitalization and average concentration of each pollutant was analyzed with a generalized additive model estimating Poisson distribution. Results Daily 24-h mean PM2.5 concentration during 2013–2017 was 76.7 μg/m3. The relative risk (RR) of IPF hospitalization per interquartile range (IQR) higher (72 μg/m3) in PM2.5 was 1.049 (95% CI 1.024–1.074) and 1.031 (95% CI 1.007–1.056) for lag0 and moving averages 0–1 days respectively. No significant associations were observed for other lags. Statistically significant positive associations were also observed at lag0 with SO2, Ozone and NO2 (in men only). Positive associations were seen at moving averages 0–30 days for PM10 (RR per 86 μg/m3: 1.021, 95% CI 0.994–1.049), NO2 (RR per 30 μg/m3: 1.029, 95% CI 0.999–1.060), and SO2 (RR per 15 μg/m3: 1.060 (95% CI 1.025–1.097), but not with PM2.5 or Ozone. Conclusions Despite improvement in air quality since the implementation of clean air policy in 2013, acute exposure to higher levels of air pollution is significantly associated with IPF hospitalization in Beijing. Air quality policy should be continuously enforced to protect vulnerable IPF populations as well as the general public.

The impact of air pollution on interstitial lung disease: a systematic review and meta-analysis

“…Three studies were conducted each in Spain ( 53 , 54 , 63 ) and South Korea ( 43 , 57 , 64 ). Two studies each came from France ( 47 , 65 ) and mainland China ( 59 , 60 ). The remaining studies were conducted in Italy ( 45 ), Chile ( 51 ), Taiwan ( 52 ), Japan ( 55 ), Greece ( 56 ), the United Kingdom ( 61 ), and Australia ( 66 ).…”

“…Among the 24 studies incorporated in the analysis, seven studies scrutinized the link between short-term exposure to air pollution and its impact on health outcomes ( 43 , 46 , 49 , 51 , 55 , 59 , 60 ). Fourteen studies delved into the connection between long-term exposure to air pollution and health outcomes ( 44 , 45 , 48 , 50 , 52 , 54 , 56–58 , 62 , 64–66 ).…”

“…The limitations identified in the remaining six studies involved data sources, accuracy of diagnoses, measurement of exposure, and potential confounding factors. Most studies had limitations of potential underestimation or misclassification of cases due to data sources or diagnostic coding ( 45 , 51 , 54 , 59 ). Additionally, there was a lack of adjustment for individual-level factors ( 45 , 51 , 59 , 60 ), and limited data on certain pollutants ( 54 , 59 ) or occupational history ( 45 , 59 ).…”

Impact of Short-Term Exposure to Nitrogen Dioxide (NO2) and Ozone (O3) on Hospital Admissions for Non-ST-Segment Elevation Acute Coronary Syndrome

“…Additionally, pollutants like O 3 and SO 2 , surpassing predefined thresholds on a limited number of days (0.52% for O 3 and 0.37% for SO 2 ), were included for a more accurate evaluation of atmospheric pollutants’ influence on hospitalization rates for acute coronary events. Subsequently, we conducted an analysis for each increment of ≥10 μg/m 3 in environmental pollutants at various time lags (e.g., lags 03, 05, and 07) concerning NSTE-ACS incidents [ 28 , 29 ]. Including a time lag is essential, as it allows for the observation of the impact of pollutant exposure not only on the day of exposure but also over subsequent days.…”

Effects of indoor air pollution on clinical outcomes in patients with interstitial lung disease: protocol of a multicentre prospective observational study

“…It has a poor prognosis, with a median survival of 3–5 years without treatment 1–3. Several studies have demonstrated the harmful effects of air pollution on IPF prognosis, including incidence,4 5 acute exacerbation (AE),6 7 hospitalisation,8 9 changes in lung function10–12 and mortality 13 14. Particulate matter (PM) refers to the mixture of solid particles and liquid droplets found in the air.…”