Associations between daily air quality and hospitalisations for acute exacerbation of chronic obstructive pulmonary disease in Beijing, 2013–17: an ecological analysis

Abstract

Summary Background Air pollution in Beijing has been improving through implementation of the Air Pollution Prevention and Control Action Plan (2013–17), but its implications for respiratory morbidity have not been directly investigated. We aimed to assess the potential effects of air-quality improvements on respiratory health by investigating the number of cases of acute exacerbations of chronic obstructive pulmonary disease (COPD) advanced by air pollution each year. Methods Daily city-wide concentrations of PM 10 , PM 2·5 , PM coarse (particulate matter >2·5–10 μm diameter), nitrogen dioxide (NO 2 ), sulphur dioxide (SO 2 ), carbon monoxide (CO), and ozone (O 3 ) in 2013–17 were averaged from 35 monitoring stations across Beijing. A generalised additive Poisson time-series model was applied to estimate the relative risks (RRs) and 95% CIs for hospitalisation for acute exacerbation of COPD associated with pollutant concentrations. Findings From Jan 18, 2013, to Dec 31, 2017, 161 613 hospitalisations for acute exacerbation of COPD were recorded. Mean ambient concentrations of SO 2 decreased by 68% and PM 2·5 decreased by 33% over this 5-year period. For each IQR increase in pollutant concentration, RRs for same-day hospitalisation for acute exacerbation of COPD were 1·029 (95% CI 1·023–1·035) for PM 10 , 1·028 (1·021–1·034) for PM 2·5 , 1·018 (1·013–1·022) for PM coarse , 1·036 (1·028–1·044) for NO 2 , 1·019 (1·013–1·024) for SO 2 , 1·024 (1·018–1·029) for CO, and 1·027 (1·010–1·044) for O 3 in the warm season (May to October). Women and patients aged 65 years or older were more susceptible to the effects of these pollutants on hospitalisation risk than were men and patients younger than 65 years. In 2013, there were 12 679 acute exacerbations of COPD cases that were advanced by PM 2·5 pollution above the expected number of cases if daily PM 2·5 concentrations had not exceeded the WHO target (25 μg/m 3 ), whereas the respective figure in 2017 was 7377 cases. Interpretation Despite improvement in overall air quality, increased acute air pollution episodes were significantly associated with increased hospitalisations for acute exacerbations of COPD in Beijing. Stringent air pollution control policies are important and effective for reducing COPD morbidity, and long-term multidimensional policies to safeguard public health are indicated. Funding UK Medical Research Council.

Associations between ambient air pollution and daily incidence of pediatric hand, foot and mouth disease in Ningbo, 2014–2016: a distributed lag nonlinear model

“…Possible explanations for this discrepancy include that the O 3 concentration in Ningbo City may be different from that in other regions, or that other air pollutants may interact with O 3 . Liang L et al analysed the association between dairy SO 2 , NO 2 , O 3 , CO, PM 10 and PM 2.5 and hospitalisations for acute exacerbation of COPD in Beijing from 2013 to 2017 and the results indicated that exposure-response association of NO 2 with COPD cases was linear, while the SO 2 , CO, PM 10 and PM 2.5 were nonlinear, no significance was found in O 3 with COPD incidence [43]. Liu C et al investigated the air pollution and daily mortality in 652 cities, the results demonstrated that exposure-response association of PM 2.5 with mortality was non-linear [26].…”

A Systematic Review and Meta-Analysis of Short-Term Ambient Ozone Exposure and COPD Hospitalizations

“…and disagreements were settled by consensus. The characteristics of the included studies [17][18][19][20] are shown in Tables S1, S2, and S3.…”

“…So far, four analyses have been conducted to quantify the association between short-term ambient ozone exposure and COPD hospitalizations [13][14][15][16] (Table S1): one was focused solely on East Asia [13], one was based on publications before 2008 [14], and the other two, conducted in 2015 [15] and 2016 [16], simply reported pooled risk estimates. Since then, several original investigations have been published [17][18][19][20]. In addition, a major issue has been raised regarding exposure to other air pollutants simultaneously, which may confound ozone-related effect estimates [21].…”

MicroRNA‐497 functions as an inflammatory suppressor via targeting DDX3Y and modulating toll‐like receptor 4/NF‐κB in cigarette smoke extract‐stimulated human bronchial epithelial cells

“…1,2 The incidence and mortality of COPD are increasing progressively year by year. 1,2 The incidence and mortality of COPD are increasing progressively year by year.…”

“…Chronic obstructive pulmonary disease (COPD), featured by chronic and progressive dyspnea, is the leading cause of global disease burden. 1,2 The incidence and mortality of COPD are increasing progressively year by year. 3 According to report by the World Health Organization in 2017, COPD is anticipated to be the third largest death causes by 2030.…”