Aug 2026· Medicine· Vol 105· 0 citations· 43 references
Medicine
TL;DR
Short-term exposure to PM2.5, PM10, SO2, NO2, and CO was associated with increased AECOPD hospitalization risk, with nonlinear, lagged, and cumulative effects, and older adults and females may be more susceptible to ambient air pollution.
Abstract
Evidence regarding the short-term effects of ambient air pollution on acute exacerbations of chronic obstructive pulmonary disease (AECOPD) across multiple cities in northern China remains limited. This study aimed to evaluate the associations between major ambient air pollutants and AECOPD hospitalizations, as well as their lagged effects. We conducted an ecological time-series study of 14,786 AECOPD hospitalizations recorded at 49 hospitals in Shijiazhuang, Handan, and Chengde, Hebei Province, from January 1, 2018, to December 31, 2020. City-specific associations between daily concentrations of fine particulate matter (PM2.5), inhalable particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and 8-hour ozone and AECOPD hospitalizations were estimated using distributed lag nonlinear models, with adjustment for long-term trends, temperature, relative humidity, day of the week, public holidays, and stages of the coronavirus disease 2019 pandemic. Single-day lag effects from lag 0 to lag 5, cumulative lag effects from lag 0–1 to lag 0–5, effects of extreme pollutant concentrations, and associations stratified by age and sex were evaluated. City-specific estimates were subsequently pooled using random-effects multivariate meta-analysis. Associations were expressed as relative risks with 95% confidence intervals. During the 1096-day study period, 14,786 AECOPD hospitalizations were recorded. Compared with the 25th-percentile concentrations, the 75th-percentile concentrations of PM2.5, PM10, SO2, NO2, and CO generally showed stronger cumulative associations with longer lag periods, with the largest estimates usually observed at lag 0–5 days, whereas single-day effects were weak. All 6 pollutants exhibited nonlinear cumulative exposure–response relationships. Compared with median concentrations, the 99th-percentile concentrations of PM2.5, PM10, SO2, NO2, and CO were associated with higher hospitalization risks. High PM2.5 reached its maximum effect at lag 0–5 days (relative risk, 1.391; 95% confidence interval, 1.169–1.658). Higher 8-hour ozone concentrations were generally associated with lower hospitalization risk. Associations were more pronounced among adults aged ≥65 years and males. Short-term exposure to PM2.5, PM10, SO2, NO2, and CO was associated with increased AECOPD hospitalization risk, with nonlinear, lagged, and cumulative effects. Older adults and females may be more susceptible to ambient air pollution.
PM2.5, PM10, NO2, and CO exposures were associated with COPD hospitalization in Kashi, precautionary measures should be taken with a focus on vulnerable subgroups, to control hospitalization for COPD associated with air pollutants.
Li Li, Ayiguli Alimu, Jingran Xu et al.· International Journal of COP...· 0 citations
The health hazards caused by air pollution vary significantly depending on factors such as the composition of pollutants in the region, climate, and the susceptibility of the population. Although numerous studies have explored the relationship between air quality and pneumonia, specific research evidence from a particular inland energy city like Qingyang in China is still scarce. This study aims to quantify the short-term impact of air pollution in this under-researched region on pneumonia hospitalizations. We collected the medical records of patients with pneumonia from January 1, 2015, to December 31, 2019, and also obtained data on 6 types of common air pollutants and meteorological conditions. We performed a time series analysis using a generalized additive model and a distributed nonlinear lag model. All measured data exhibited pronounced seasonality: particulate matter less than 2.5 μm in diameter, particulate matter less than 10 μm in diameter, sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) concentrations and pneumonia admissions were higher in the cold season and lower in the warm season, a pattern conversely mirrored by ozone (O3) concentrations, average temperature, and relative humidity. In the single pollutant model, for every 10 μg/m3 increase in exposure levels of particulate matter less than 2.5 μm in diameter, particulate matter less than 10 μm in diameter, SO2, NO2, and O3 8 hours and for every 1 mg/m3 increase in CO exposure level, the risk of pneumonia admission was 1.004 (0.991, 1.017), 1.004 (0.999, 1.010), 1.035 (1.022, 1.048), 1.221 (1.174, 1.271), 0.999 (0.981, 1.017), and 1.382 (1.230, 1.552), respectively. The strongest effects occur in lag 1, lag 7, lag 07, lag 07, lag 3, and lag 05, respectively. Our study identifies significant gender- and age-specific susceptibilities to air pollution in Qingyang. Men were more vulnerable to SO2, whereas women were more affected by CO. Children aged ≤14 years constituted a high-risk group. Furthermore, we observed a distinct seasonal pattern: SO2, NO2, and CO were key drivers of pneumonia admissions with stronger effects in the cold season, in contrast to O3, which exhibited adverse effects only during the warm season.
Lisha Zhu, Jiyuan Dong, Jianhua You et al.· Medicine· 0 citations
This study examines the long-term associations between ambient air pollutants and the burden of major respiratory and infectious diseases in this geographically sensitive region. A retrospective analysis was conducted using ICD-10-coded hospital records of patients diagnosed with asthma, chronic obstructive pulmonary disease (COPD), bronchitis, and tuberculosis from January 2020 to June 2026. These data were integrated with in situ air quality measurements, including PM10, PM2.5, and SO2, as well as satellite-derived Aerosol Optical Depth (AOD) from MODIS. Disease incidence was stratified by year, sex, and age groups (0–85+ years) to assess demographic susceptibility patterns. Respiratory diseases constituted a substantial public health burden over the study period. Asthma showed a marked female predominance (≈29,700 females vs. ≈16,000 males) and a bimodal age distribution with peaks in early childhood (0–5 years) and mid-adulthood (35–50 years). COPD was predominantly observed in males (≈8300 males vs. ≈5500 females), with a higher median age range (≈67–70 years). Bronchitis exhibited a similar bimodal pattern, disproportionately affecting both pediatric and elderly populations, while overall case numbers declined over time. Tuberculosis incidence was approximately threefold higher in males than females, with notable age-related divergence, affecting younger females (≈30–32 years) and middle-aged males (≈42–45 years). The findings suggest a spatial–temporal correspondence between elevated pollutant concentrations and respiratory disease prevalence in the Iğdır Basin. The observed sex- and age-specific disparities underscore the potential value of region-specific environmental health strategies, strengthened air quality management, and continuous epidemiological surveillance in enclosed basin environments.
Melahat Batu Ağırkaya, Fatma Şencan, Mehmet Ali Çelik· Pollutants· 0 citations
Short-term absolute changes in ambient air pollution levels may result in disease events such as depression, whereas evidence from large-scale epidemiological studies has been insufficient. A time-stratified case-crossover study was performed to investigate the associations between air pollution increases between neighboring days (APINs, generated as the differences in absolute air pollution concentrations on the current days minus those on the previous days) and morbidity risks of depression based on hospital admission and outpatient visit data from 239 Chinese cities of prefecture-level or above during 2013-2017. Daily absolute concentrations of particulate matter with an aerodynamic diameter ≤ 2.5 μm (PM2.5), particulate matter with an aerodynamic diameter ≤ 10 μm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO) and ozone (8 h O3) were obtained, and conditional logistic regression models were used to evaluate the associations between absolute concentrations and APINs of major air pollutants with morbidity risks of depression. A total of 330,610 hospital admissions and 3,726,390 outpatient visits for depression were included. Per interquartile range (IQR) increase in APINs of major air pollutants at lag 0-3 were associated with increases ranging from 0.59% (0.06%, 1.13%) (8 h O3) to 1.66% (1.09%, 2.22%) (NO2) in hospital admissions for depression; and with increases ranging from 0.42% (0.15%, 0.68%) (8 h O3) to 0.85% (0.56%, 1.14%) (NO2) in outpatient visits for depression, which were robust to adjustments for absolute concentrations of major air pollutants (with the exception of 8 h O3). This study provides novel evidence that short-term absolute increases in air pollution levels are associated with elevated risks of depression, which is worth consideration in future disease prevention practices.
Yating Ma, Chenlu Yang, Lijun Bai et al.· Ecotoxicology and Environmen...· 0 citations
Findings provide the first long-term evidence from Guangzhou that short-term NO2 and SO2 exposure is positively associated with childhood bronchopneumonia hospitalization, with older children and boys being the susceptible subgroups.
Qi Yue, Qian Nie, Weiling Liu et al.· Frontiers in Public Health· 0 citations
Background: Air quality in New York City has improved substantially in the past 2 decades due to reductions in both transported aerosols and local emissions. We estimated the short-term risk changes for three criteria air pollutants and corresponding attributable burdens. Methods: Trends in percent excess risk (PER) per same pollution increment and attributable counts and fractions for fine particles (PM2.5), nitrogen dioxide (NO2), and ozone (warm season only) were examined for Emergency Department (ED) visits (2005–2019) and hospitalizations (2000–2019) for youth asthma (ages 5–17), adult cardiovascular disease (CVD) (ages 40+), and older adult respiratory causes (ages 65+). Time-series models considered up to 3-day lag, adjusted for seasonal trends, day of week, holidays, and concurrent and delayed temperature. Results: Most pollutant-outcome pairs did not exhibit trends in PERs over time. NO2-attributable burden was higher than PM2.5 burden for asthma and CVD outcomes. We estimated about 4500 (17%) youth asthma ED visits and 1000 (2%) CVD hospitalizations on average annually (2005–2019) attributable to NO2 compared with 1900 (7%) youth asthma ED visits and 450 (1%) CVD hospitalizations attributable to PM2.5. NO2- and PM2.5-attributable health impacts declined about 50%–70%, driven by decreasing pollution levels and total morbidity burden depending on outcome, pollutant, and season. Ozone-attributable burden was mostly unchanged over time. Conclusion: With less decline and greater attributable impact than PM2.5, NO2 is increasingly important for measuring morbidity impacts from local sources (i.e., traffic and buildings) in New York City. Ozone impacts from regional source emissions persist.
A. Spira-Cohen, Rebecca Goldberg, Sarah Johnson et al.· Environmental Epidemiology· 0 citations
