Rural-urban differences in associations between air pollution and cardiovascular hospital admissions in Guangxi, southwest China

Zhang, Guangli; Liu, Xiaoxiao; Zhai, Shiyan; Song, Genxin; Song, Hongquan; Liang, Liyang; Kong, Yali; Ma, Rui; He, Xuhua

doi:10.1007/s11356-021-18196-6

Cited by 18 publications

(8 citation statements)

References 35 publications

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“…First, limited xed-site air monitoring stations were used in this study to re ect exposures to ambient NO 2 in Fuyang as a whole, which could mask the differences in NO 2 exposure levels among different counties. Nevertheless, minor differences in NO 2 between rural and urban regions (22.53 µg/m 3 VS. 22.19 µg/m 3 ) reported in a previous study may provide the reasonable endorsement for our study (Zhang et al 2022).…”

Section: Discussionsupporting

confidence: 73%

“…A study using China Death Cause Monitoring Dataset found that the mortality attributed to air pollution were higher in rural regions than in urban regions, indicating that rural population may be more sensitive to air pollution than urban population in China (Zhao et al 2021). Another study, however, found a positive association between NO 2 and CVD hospitalizations in urban regions but not in rural regions (Zhang et al 2022). The mixed ndings on urbanrural differences on the relation of air pollution with CVDs suggested that more studies should be conducted in rural population.…”

Section: Introductionmentioning

confidence: 93%

“…However, related studies carried out in rural regions were limited and received inconsistent results. A study conducted in Pingliang, Northwest China indicated that NO 2 was the most contributor to hospital admission costs of CVDs among seven air pollutants(Zha et al 2022), whereas another study performed in Guangxi province, China did not nd a signi cant relation between NO 2 and cardiovascular hospital admission(Zhang et al 2022). The reasons for the inconsistent results remain unclear.…”

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confidence: 99%

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Ambient nitrogen dioxide and cardiovascular diseases in rural regions: a time-series analyses using data from the new rural cooperative medical scheme in Fuyang, East China

Dong

Zha

Sun³

et al. 2023

Environ Sci Pollut Res

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BackgroundMost of studies relating ambient cardiovascular hospital admissions exposure to hospital admissions for cardiovascular diseases (CVDs) were conducted among urban population. Whether and to what extent these results could be generalizable to rural population remains unknown. We addressed this question using data from the New Rural Cooperative Medical Scheme (NRCMS) in Fuyang, Anhui, China. MethodsDaily hospital admissions for total CVDs, ischaemic heart disease, heart failure, heart rhythm disturbances, ischaemic stroke, and hemorrhagic stroke in rural regions of Fuyang, China were extracted from NRCMS between January 2015 and June 2017. A two-stage time-series analysis method was used to assess the associations between NO 2 and CVD hospital admissions and the disease burden fractions attributable to NO 2 . ResultsIn our study period, the average number (standard deviation) of hospital admissions per day were 488.2 (117.1) for total CVDs, 179.8 (45.6) for ischaemic heart disease, 7.0 (3.3) for heart rhythm disturbances, 13.2 (7.2) for heart failure, 267.9 (67.7) for ischaemic stroke, and 20.2 (6.4) for hemorrhagic stroke. The 10 µg/m 3 increase of NO 2 was related to an elevated risk of 1.9% (RR: 1.019, 95% CI: 1.005 to 1.032) for hospital admissions of total CVDs at lag0-2 day, 2.1%(1.021, 1.006 to 1.036) for ischaemic heart disease, and 2.1% (1.021, 1.006 to 1.035) for ischaemic stroke, respectively. While no signi cant association was observed between NO 2 and hospital admissions for heart rhythm disturbances, heart failure, and hemorrhagic stroke. The attributable fractions of total CVDs, ischaemic heart disease, and ischaemic stroke to NO 2 were 6.52% (1.87-10.94%), 7.31% (2.19-12.17%) and 7.12% (2.14-11.85%), respectively. ConclusionsOur ndings suggest that CVD burdens in rural population are also partly attributed to short-term exposure to NO2. More studies across rural regions are required to replicate our ndings.

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 93%

mentioning

confidence: 99%

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Ambient nitrogen dioxide and cardiovascular diseases in rural regions: a time-series analyses using data from the new rural cooperative medical scheme in Fuyang, East China

Dong

Zha

Sun³

et al. 2023

Environ Sci Pollut Res

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“…These activities release pollutants such as carbon dioxide (CO2), nitrogen oxides (NOx), particulate matter, and other harmful chemical compounds into the air, consequently affecting CRF 20,21,22 . In rural areas, it is expected that this pollution will be lower compared to urban areas, even though there are negative effects of agricultural activity on the atmosphere, such as burning, pesticide spraying, and fertilizer use 9,20,21,22,23,24 .…”

Section: Resultsmentioning

confidence: 99%

Hemoglobin-to-platelet-count ratio is an independent predictor of cardiovascular fitness in children: Does residential air quality provide the mechanism?

Nevill

Reuter

Brand

et al. 2023

Preprint

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Cardiorespiratory fitness (CRF) is a well-known and robust indicator of health in childhood, as well as a valuable predictor of all-cause mortality in adulthood. Understanding the associations and possible mechanisms between CRF and residential location is an important focus for public health research. A cross-sectional sample of 2250 children and adolescents, aged 6 to 17 years, were recruited from public and private schools in Santa Cruz do Sul, Rio Grande do Sul, Brazil. In addition to age, sex, and body size measurements, we also recorded hemoglobin and platelet count measurements using venous blood samples (10ml). CRF was predicted using the 6-minute run/walk test. The association between CRF and a range of possible predictors was explored using allometry. Results identified a novel and independent association between the hemoglobin-to-platelet count ratio and children’s CRF, having controlled for the usual confounding variables of age, sex, and body size. We also provide evidence of a possible mechanism for this association, having identified reduced measures of hemoglobin and increased platelet counts observed in children living in urban (vs rural) areas. These results suggest the need for more effective public health practices and policies related to the health effects of the built environment for children and adults in Brazil. We can also speculate that similar changes in health policy are necessary in congested cities worldwide, such as the introduction of ultra-low emission zones in London (introduced in April 2019).

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“…A study identified that the health risks from short-term NO 2 exposure increased with the urbanization process based on data from the Pearl River Delta region [ 9 ]. A comparative study of urban and rural areas in Guangxi Province, China, also suggested that the effects of NO 2 on CVD hospitalizations were not significant in rural areas, whereas urban residents were significantly and negatively affected by NO 2 exposure [ 10 ]. In contrast, Li et al found that rural residents were more sensitive to short-term NO 2 exposure than urban residents in terms of CVD mortality, but the differences were not significant [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Urban–rural disparities in the association of nitrogen dioxide exposure with cardiovascular disease risk in China: effect size and economic burden

Zhang,

Hu,

Xiang

et al. 2024

Int J Equity Health

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Background Together with rapid urbanization, ambient nitrogen dioxide (NO2) exposure has become a growing health threat. However, little is known about the urban–rural disparities in the health implications of short-term NO2 exposure. This study aimed to compare the association between short-term NO2 exposure and hospitalization for cardiovascular disease (CVD) among urban and rural residents in Shandong Province, China. Then, this study further explored the urban–rural disparities in the economic burden attributed to NO2 and the explanation for the disparities. Methods Daily hospitalization data were obtained from an electronic medical records dataset covering a population of 5 million. In total, 303,217 hospital admissions for CVD were analyzed. A three-stage time-series analytic approach was used to estimate the county-level association and the attributed economic burden. Results For every 10-μg/m3 increase in NO2 concentrations, this study observed a significant percentage increase in hospital admissions on the day of exposure of 1.42% (95% CI 0.92 to 1.92%) for CVD. The effect size was slightly higher in urban areas, while the urban–rural difference was not significant. However, a more pronounced displacement phenomenon was found in rural areas, and the economic burden attributed to NO2 was significantly higher in urban areas. At an annual average NO2 concentration of 10 μg/m3, total hospital days and expenses in urban areas were reduced by 81,801 (44,831 to 118,191) days and 60,121 (33,002 to 86,729) thousand CNY, respectively, almost twice as much as in rural areas. Due to disadvantages in socioeconomic status and medical resources, despite similar air pollution levels in the urban and rural areas of our sample sites, the rural population tended to spend less on hospitalization services. Conclusions Short-term exposure to ambient NO2 could lead to considerable health impacts in either urban or rural areas of Shandong Province, China. Moreover, urban–rural differences in socioeconomic status and medical resources contributed to the urban–rural disparities in the economic burden attributed to NO2 exposure. The health implications of NO2 exposure are a social problem in addition to an environmental problem. Thus, this study suggests a coordinated intervention system that targets environmental and social inequality factors simultaneously.

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Rural-urban differences in associations between air pollution and cardiovascular hospital admissions in Guangxi, southwest China

Cited by 18 publications

References 35 publications

Ambient nitrogen dioxide and cardiovascular diseases in rural regions: a time-series analyses using data from the new rural cooperative medical scheme in Fuyang, East China

Ambient nitrogen dioxide and cardiovascular diseases in rural regions: a time-series analyses using data from the new rural cooperative medical scheme in Fuyang, East China

Hemoglobin-to-platelet-count ratio is an independent predictor of cardiovascular fitness in children: Does residential air quality provide the mechanism?

Urban–rural disparities in the association of nitrogen dioxide exposure with cardiovascular disease risk in China: effect size and economic burden

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