The short term burden of ambient gaseous air pollution on chronic obstructive pulmonary disease in Pudong New Area, China: A time-stratified case-crossover study with a distributed lag nonlinear model 

Abstract

Background: Air pollution is a severe and dangerous public health problem. However, the effect of ambient gaseous air pollution exposure on years of life lost (YLL) attributable to chronic obstructive pulmonary disease (COPD) mortality has not been quantitatively verified.Methods: We collected the data of 12,781 COPD deaths and ambient gaseous air pollutants, including sulfur dioxide (SO2), nitrogen dioxide (NO2), Carbon monoxide (CO), and ozone (O3), during the years 2013-2019 in the Shanghai Pudong New Area (PNA). Then we performed a time-stratified case-crossover study combined with a distributed lag nonlinear model (DLNM) to estimate the impact of those air pollutants on daily COPD deaths counts and YLL. The confounders including long-term trend and meteorological factors have been controlled for, and effects of age and educational attainment as effect modifiers have also been evaluated.Results: During the 2013-2019 time frame, increases of 10μg/m3 in SO2 and NO2 were associated with a 4.93% (95% CI: 1.47%, 8.50%) and 1.47% (95% CI: 0.14%, 2.82%) in daily COPD death counts at lag0-1day, respectively, a 2.52 (95% CI: 0.31, 4.72) YLL increase and 0.85 (95% CI: 0.01, 1.68) YLL increase at lag0-1day, respectively. A 1mg/m3 increase in CO was associated with a 9.46% (95% CI: 0.40%, 19.35%) at lag0 increase in daily COPD death counts. No significant impact from O3 on both daily COPD deaths counts and YLL (P>0.05). The impact of gaseous air pollutants on the daily COPD death count and YLL were significant in populations of older adults and the lower educated population, while an insignificant effect was observed in the younger population and higher educated population. The YLL due to COPD related to SO2 and CO for the lower educated population was significantly higher than those for the higher educated population.Conclusion: Reducing specific gaseous air pollutants will help to control COPD deaths and improve the population’s life expectancy.