Urban air pollution and meteorological factors affect emergency department visits of elderly patients with chronic obstructive pulmonary disease in Taiwan

Ding, Pei-Hsiou; Wang, Gen-Shuh; Guo, Yang; Chang, Shuenn-Chin; Wan, Gwo-Hwa

doi:10.1016/j.envpol.2016.12.035

Cited by 48 publications

(30 citation statements)

References 38 publications

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“…As illustrated by Figure 3, the effect size was weaker among the older population (0.27% 95% CI: −0.02%, 0.57%). This borderline effect, however, lost its significance (0.30% 95% CI: −0.13%, 0.73%) after the estimates from Ding's study [39] which provided results for different temperature levels, were removed from our analyses. A significant effect was found during the warm but not the cold season, with an increment of 1.06% (95% CI: 0.26%, 1.87%) in COPD hospitalizations per 10 µ g/m 3 increase in maximum 8-h ozone level.…”

Section: Subgroup Analysesmentioning

confidence: 89%

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

Hui

Wang

et al. 2020

IJERPH

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Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally and ozone exposure is a main cause of its disease burden. However, studies on COPD hospitalizations from short-term ambient level ozone exposure have not generated consensus results. To address the knowledge gap, comprehensive and systematic searches in several databases were conducted using specific keywords for publications up to February 14, 2020. Random-effect models were used to derive overall excess risk estimates between short-term ambient-level ozone exposure and COPD hospitalizations. The influence analyses were used to test the robustness of the results. Both meta-regression and subgroup analyses were used to explore the sources of heterogeneity and potential modifying factors. Based on the results from 26 eligible studies, the random-effect model analyses show that a 10 µg/m3 increase in maximum 8-h ozone concentration was associated with 0.84% (95% CI: 0.09%, 1.59%) higher COPD hospitalizations. The estimates were higher for warm season and multiple-day lag but lower for old populations. Results from subgroup analyses also indicate a multiple-day lag trend and bigger significant health effects during longer day intervals. Although characteristics of individual studies added modest heterogeneity to the overall estimates, the results remained robust during further analyses and exhibited no evidence of publication bias. Our systematic review and meta-analysis indicate that short-term ambient level ozone exposure was associated with increased risk of COPD hospitalizations. The significant association with multiple-day lag trend indicates that a multiple-day exposure metric should be considered for establishing ambient ozone quality and exposure standards for improvement of population health. Future investigations and meta-analysis studies should include clinical studies as well as more careful lag selection protocol.

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Section: Subgroup Analysesmentioning

confidence: 89%

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

Hui

Wang

et al. 2020

IJERPH

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“…Very few studies have examined the joint effect between ambient air pollution and temperature on nonfatal health outcomes such as HAs, and these few studies produced inconsistent results. For instance, a study in Taiwan [ 16 ] found an increased risk of emergency department visits and HAs for COPD associated with ambient air pollution on higher temperature days, while studies in Hong Kong [ 17 , 18 ] and the United States [ 19 ] reported increased effect on cold days.…”

Section: Introductionmentioning

confidence: 99%

The Burden of COPD Morbidity Attributable to the Interaction between Ambient Air Pollution and Temperature in Chengdu, China

Qiu

Tan

Long

et al. 2018

IJERPH

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Evidence on the burden of chronic obstructive pulmonary disease (COPD) morbidity attributable to the interaction between ambient air pollution and temperature has been limited. This study aimed to examine the modification effect of temperature on the association of ambient air pollutants (including particulate matter (PM) with aerodynamic diameter <10 μm (PM10) and <2.5 μm (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO) and ozone (O3)) with risk of hospital admissions (HAs) for COPD, as well as the associated morbidity burden in urban areas of Chengdu, China, from 2015 to 2016. Based on the generalized additive model (GAM) with quasi-Poisson link, bivariate response surface model and stratification parametric model were developed to investigate the potential interactions between ambient air pollution and temperature on COPD HAs. We found consistent interactions between ambient air pollutants (PM2.5, PM10 and SO2) and low temperature on COPD HAs, demonstrated by the stronger associations between ambient air pollutants and COPD HAs at low temperatures than at moderate temperatures. Subgroup analyses showed that the elderly (≥80 years) and males were more vulnerable to this interaction. The joint effect of PM and low temperature had the greatest impact on COPD morbidity burden. Using WHO air quality guidelines as reference concentration, about 17.30% (95% CI: 12.39%, 22.19%) and 14.72% (95% CI: 10.38%, 19.06%) of COPD HAs were attributable to PM2.5 and PM10 exposures on low temperature days, respectively. Our findings suggested that low temperature significantly enhanced the effects of PM and SO2 on COPD HAs in urban Chengdu, resulting in increased morbidity burden. This evidence has important implications for developing interventions to reduce the risk effect of COPD morbidity.

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“…Zhao et al [ 10 ] also showed temperature-associated ED visits in 12 Chinese cities based on one-hospital data in each city. Two studies in Taiwan [ 11 ] and Shanghai [ 12 ], have utilized health data from their respective health insurance systems to investigate the temperature-associated ED visits.…”

Section: Introductionmentioning

confidence: 99%

Effects of ambient temperature on ambulance emergency call-outs in the subtropical city of Shenzhen, China

Zhan

Qian

et al. 2018

PLoS ONE

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The associations between meteorological factors and mortality have been well documented worldwide, but limited evidence is available for the non-fatal health impacts of ambient temperature, particularly there are few population-based investigations on the impacts of emergency ambulance dispatches in Asia. In this study, based on 809,906 ambulance emergency call-outs (AECOs) for the total population from 2010–2016 in the subtropical city of Shenzhen, China, a Poisson regression combined with a distributed lag nonlinear model was used to simultaneously assess the nonlinear and lag effects of daily mean temperature on AECOs. Stratified analyses by age and sex were performed to identify vulnerable subpopulations. A U-shaped relationship was found between temperature and AECOs. Cold effects were delayed and persisted for 3–4 weeks, with a cumulative relative risk (RR) and 95% confidence interval (CI) of 1.23 (1.10–1.38) and 1.25 (1.16–1.35) over lag 0–28 when comparing the 1st and 5th percentile of the temperature distribution to the optimal (i.e. minimum AECOs) temperature, respectively. Hot effects were immediate and diminished quickly in 5 days, with an increase of 19% (RR = 1.19, 95%CI: 1.14–1.23) and 21% (RR = 1.21, 95%CI: 1.16–1.26) in AECOs over lag 0–5 when comparing the 95th and 99th percentile of temperature to the optimal temperature. Children and the elderly were more vulnerable to cold effects. The youth and middle-aged people suffered more from high temperature. The effects of temperature were similar between males and females. In summary, significant increases were observed in the frequency of AECOs during cold and hot days, and the weather-associated increases in AECOs are different among age groups. This information has valuable implications in ambulance demand prediction and service provision planning.

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Urban air pollution and meteorological factors affect emergency department visits of elderly patients with chronic obstructive pulmonary disease in Taiwan

Cited by 48 publications

References 38 publications

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

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

The Burden of COPD Morbidity Attributable to the Interaction between Ambient Air Pollution and Temperature in Chengdu, China

Effects of ambient temperature on ambulance emergency call-outs in the subtropical city of Shenzhen, China

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