Ambient air pollution and hospital admission in Shanghai, China.

No prior studies exist in Mainland China examining the association of outdoor air pollution with hospital admissions. In this study, we conducted a time-series analysis to examine the association of outdoor air pollutants (PM(10), SO(2), and NO(2)) with both total and cause-specific hospital admission in Shanghai, using three years of daily data (2005-2007). Hospital admission and air pollution data were collected from the Shanghai Health Insurance Bureau and Shanghai Environmental Monitoring Center. Natural spline model was used to analyze the data. We found outdoor air pollution was associated with increased risk of total and cardiovascular hospital admission in Shanghai. The effect estimates of air pollutants varied by lag (L) structures of pollutants' concentrations. For lag 5, a 10 microg/m(3) increase in concentration of PM(10), SO(2) and NO(2) corresponded to 0.18% (95% CI: -0.15%, 0.52%), 0.63% (95% CI: 0.03%, 1.23%), and 0.99% (95% CI: 0.10%, 1.88%) increase of total hospital admission; and 0.23% (95% CI: -0.03%, 0.48%), 0.65% (95% CI: 0.19%, 1.12%), and 0.80% (95% CI: 0.10%, 1.49%) increase of cardiovascular hospital admission. The associations appeared to be more evident in the cool season (from November to April) than in the warm season (from May to October). We found significant effects of gaseous pollutants (SO(2) and NO(2)) after adjustment for PM(10). Our analyses provide the first evidence in China that the current air pollution level has an effect on hospital admission and strengthen the rationale for further limiting air pollution levels in Shanghai.

[1]  Douglas W Dockery,et al.  Health effects of particulate air pollution. , 2009, Annals of epidemiology.

[2]  D. Dockery,et al.  Association of air pollution with hospital outpatient visits in Beijing. , 1995, Archives of environmental health.

[3]  Stefan Ma,et al.  A tale of two cities: effects of air pollution on hospital admissions in Hong Kong and London compared. , 2001, Environmental health perspectives.

[4]  S L Zeger,et al.  The National Morbidity, Mortality, and Air Pollution Study. Part I: Methods and methodologic issues. , 2000, Research report.

[5]  Joel Schwartz,et al.  The association of daily sulfur dioxide air pollution levels with hospital admissions for cardiovascular diseases in Europe (The Aphea-II study). , 2003, European heart journal.

[6]  Joel Schwartz,et al.  Simultaneous immunisation with influenza vaccine and pneumococcal polysaccharide vaccine in patients with chronic respiratory disease , 1997, BMJ.

[7]  J. Schwartz,et al.  Acute effects of particulate air pollution on respiratory admissions: results from APHEA 2 project. Air Pollution and Health: a European Approach. , 2001, American journal of respiratory and critical care medicine.

[8]  J. Schwartz,et al.  Individual-level modifiers of the effects of particulate matter on daily mortality. , 2006, American journal of epidemiology.

[9]  Xiping Xu,et al.  Air Pollution and Daily Mortality in Shenyang, China , 2000, Archives of environmental health.

[10]  D. Strachan,et al.  Air pollution and daily mortality in London: 1987-92 , 1996, BMJ.

[11]  T S Nawrot,et al.  Stronger associations between daily mortality and fine particulate air pollution in summer than in winter: evidence from a heavily polluted region in western Europe , 2007, Journal of Epidemiology and Community Health.

[12]  F. Dominici,et al.  Adverse Health Effects of Particulate Air Pollution: Modification by Air Conditioning , 2009, Epidemiology.

[13]  F. Dominici,et al.  Seasonal and regional short-term effects of fine particles on hospital admissions in 202 US counties, 1999-2005. , 2008, American journal of epidemiology.

[14]  Bert Brunekreef,et al.  Health effects of air pollution observed in cohort studies in Europe , 2007, Journal of Exposure Science and Environmental Epidemiology.

[15]  A. Hedley,et al.  Does ozone have any effect on daily hospital admissions for circulatory diseases? , 1999, Journal of epidemiology and community health.

[16]  J. Schwartz,et al.  Ambient Gas Concentrations and Personal Particulate Matter Exposures: Implications for Studying the Health Effects of Particles , 2005, Epidemiology.

[17]  Duanping Liao,et al.  Association of daily cause-specific mortality with ambient particle air pollution in Wuhan, China. , 2007, Environmental research.

[18]  Antonella Zanobetti,et al.  Air conditioning and source-specific particles as modifiers of the effect of PM(10) on hospital admissions for heart and lung disease. , 2001, Environmental health perspectives.

[19]  H. Kan,et al.  Short‐term Effects of Ambient Gaseous Pollutants and Particulate Matter on Daily Mortality in Shanghai, China , 2008, Journal of occupational health.

[20]  B. Li,et al.  Air pollution and unscheduled hospital outpatient and emergency room visits. , 1995, Environmental health perspectives.

[21]  D. Dockery,et al.  Health Effects of Fine Particulate Air Pollution: Lines that Connect , 2006, Journal of the Air & Waste Management Association.

[22]  Stefan Ma,et al.  Cardiorespiratory and all-cause mortality after restrictions on sulphur content of fuel in Hong Kong: an intervention study , 2002, The Lancet.

[23]  H. Kan,et al.  Season, Sex, Age, and Education as Modifiers of the Effects of Outdoor Air Pollution on Daily Mortality in Shanghai, China: The Public Health and Air Pollution in Asia (PAPA) Study , 2008, Environmental health perspectives.

[24]  Kristin Aunan,et al.  Exposure-response functions for health effects of ambient air pollution applicable for China -- a meta-analysis. , 2004, The Science of the total environment.

[25]  Particulate matter, sulfur dioxide, and daily mortality in Chongqing, China. , 2003 .

[26]  T. Hastie,et al.  Improved Semiparametric Time Series Models of Air Pollution and Mortality , 2004 .

[27]  J. Zhang,et al.  Ambient sulfate concentration and chronic disease mortality in Beijing. , 2000, The Science of the total environment.

[28]  M. Bell,et al.  The effect of sandstorms and air pollution on cause-specific hospital admissions in Taipei, Taiwan , 2007, Occupational and Environmental Medicine.

[29]  Joel Schwartz,et al.  Estimating the Exposure–Response Relationships between Particulate Matter and Mortality within the APHEA Multicity Project , 2004, Environmental health perspectives.

[30]  Haidong Kan,et al.  Exposures and health outcomes from outdoor air pollutants in China. , 2004, Toxicology.

[31]  D. Dockery,et al.  Health Effects of Fine Particulate Air Pollution: Lines that Connect , 2006, Journal of the Air & Waste Management Association.

[32]  D. Dockery,et al.  Air pollution and daily mortality in residential areas of Beijing, China. , 1994, Archives of environmental health.

[33]  F. Dominici,et al.  Time-series studies of particulate matter. , 2004, Annual review of public health.

[34]  P J Catalano,et al.  Gaseous pollutants in particulate matter epidemiology: confounders or surrogates? , 2001, Environmental health perspectives.

[35]  K. Katsouyanni,et al.  Daily mortality and "winter type" air pollution in Athens, Greece--a time series analysis within the APHEA project. , 1996, Journal of epidemiology and community health.

[36]  Haidong Kan,et al.  Public Health and Air Pollution in Asia (PAPA): A Multicity Study of Short-Term Effects of Air Pollution on Mortality , 2008, Environmental health perspectives.

[37]  Joel Schwartz,et al.  Transitional Regression Models, with Application to Environmental Time Series , 2000 .

[38]  F. Dominici,et al.  Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases. , 2006, JAMA.