Short-term effects and economic burden of air pollutants on acute lower respiratory tract infections in children in Southwest China: a time-series study

Abstract

Background There are few studies on the effects of air pollutants on acute lower respiratory tract infections (ALRI) in children. Here, we investigated the relationship of fine particulate matter (PM2.5), inhalable particulate matter (PM10), sulfur dioxide (SO2), and nitrogen dioxide (NO2) with the daily number of hospitalizations for ALRI in children in Sichuan Province, China, and to estimate the economic burden of disease due to exposure to air pollutants. Methods We collected records of 192,079 cases of childhood ALRI hospitalization between January 1, 2017 and December 31, 2018 from nine municipal/prefecture medical institutions as well as the simultaneous meteorological and air pollution data from 183 monitoring sites in Sichuan Province. A time series-generalized additive model was used to analyze exposure responses and lagged effects while assessing the economic burden caused by air pollutant exposure after controlling for long-term trends, seasonality, day of the week, and meteorological factors. Results Our single-pollutant model shows that for each 10 μg/m3 increase in air pollutant concentration (1 μg/m3 for SO2), the effect estimates of PM2.5, PM10, SO2, and NO2 for pneumonia reached their maximum at lag4, lag010, lag010, and lag07, respectively, with relative risk (RR) values of 1.0064 (95% CI, 1.0004–1.0124), 1.0168(95% CI 1.0089–1.0248), 1.0278 (95% CI 1.0157–1.0400), and 1.0378 (95% CI, 1.0072–1.0692). By contrast, the effect estimates of PM2.5, PM10, SO2, and NO2 for bronchitis all reached their maximum at lag010, with RRs of 1.0133 (95% CI 1.0025–1.0242), 1.0161(95% CI 1.0085–1.0238), 1.0135 (95% CI 1.0025–1.0247), and 1.1133(95% CI 1.0739–1.1541). In addition, children aged 5–14 years were more vulnerable to air pollutants than those aged 0–4 years (p < 0.05). According to the World Health Organization’s air quality guidelines, the number of ALRI hospitalizations attributed to PM2.5, PM10, and NO2 pollution during the study period was 7551, 10,151, and 7575, respectively, while the incurring economic burden was CNY 2847.06, 3827.27, and 2855.91 million. Conclusion This study shows that in Sichuan Province, elevated daily average concentrations of four air pollutants lead to increases in numbers of childhood ALRI hospitalizations and cause a serious economic burden.

Association of Air Pollution with the Number of Common Respiratory Visits in Children in a Heavily Polluted Central City, China

“…The effects of PM 10 and SO 2 on the number of BCT visits in children in the two-pollutant model were smaller than the effects of the pollutants on the number of visits in the single-pollutant model. He et al [45] reached similar conclusions when they investigated the effects of PM 10 and SO 2 on the number of hospital admissions for BCT in children. The study found that some of the results of the two-pollutant GAM were smaller or no longer significant than the single-pollutant results.…”

“…The effect of NO 2 on the number of PNMN visits in children was no longer significant after the introduction of PM 2.5 , and the effect of NO 2 was reduced after the introduction of PM 10 , SO 2 , and CO. He et al [45] reached a similar conclusion that the effect of NO 2 on the number of childhood PNMN admissions was no longer significant after the introduction of PM 2.5 , PM 10 , or SO 2 into the model. The effect of SO 2 on the number of PNMN visits in children was stable when PM 2.5 , PM 10 , or CO was included.…”

Short-term effects of air pollution on hospitalization for acute lower respiratory infections in children: a time-series analysis study from Lanzhou, China

“…Similarly, the harmful effects of air pollutants on the respiratory tract of children have been found in several studies in China [ 17 – 19 ]. However, studies on the association of air pollutants with lower respiratory tract infections in children have focused on the harmful effects of ambient particulate matter in China and the majority of studies were from economically developed regions in eastern China.…”

“…A study conducted in Sichuan, China, found a 1.23% (95% CI: 0.21,2.26) increase in the risk of hospitalization for childhood bronchitis for every 10 µg/m 3 increase in PM 2.5 at lag0-7 [ 28 ]. Another study in the region, Sichuan, found that for each 10 µg/m 3 increase in PM 2.5 at lag4 and PM 10 at lag0-10, the relative risk of hospitalization for childhood pneumonia was 1.0064 (95% CI:1.0004,1.0124) and 1.0168 (95% CI:1.0089,1.0248), respectively [ 19 ]. A study in Jinan, China found a correlation between PM 2.5 and PM 10 and childhood pneumonia admissions, with each 10 µg/m 3 increase in PM 2.5 and PM 10 associated with 6% (95% CI:1.02,1.10) increase in lag1 and 4% (95% CI:1.00,1.08) increase in lag2, respectively [ 37 ].…”

Association between short-term exposure to ambient air pollutants and the risk of hospital visits for acute upper respiratory tract infections among adults: a time-series study in Ningbo, China

“…Many studies have investigated the association between air pollution and lower respiratory diseases [ 25 , 29 ]. Our study found stronger associations are consistent with previous epidemiological studies in China [ 18 , 27 , 30 ], Europe [ 31 , 32 ], and USA [ 33 , 34 ].…”