Association between air pollutants and outpatient and emergency hospital visits for childhood asthma in Shenyang city of
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ORIGINAL PAPER
Association between air pollutants and outpatient and emergency hospital visits for childhood asthma in Shenyang city of China Qing Chang 1 & Shu Liu 2 & Zongjiao Chen 2 & Biao Zu 2 & Hehua Zhang 1 Received: 23 October 2019 / Accepted: 30 April 2020 # ISB 2020
Abstract Effects of air pollution on asthma vary in different study areas, and long-term time series research on the effects of air pollution on asthma outpatients and emergency hospital visits has not been conducted in Northeast China. We assessed the impact of air pollutants on the risk of asthma outpatients and emergency hospital visits in Shenyang, China. A distributed lag non-linear model with a Poisson regression was used to assess the short-term effects of air pollutants on asthma outpatient and emergency hospital visits between January 1, 2013 and December 31, 2017. Confounding factors were adjusted using natural cubic splines. Ozone (O3), carbon monoxide (CO), and suspended particulates < 10 μm in aerodynamic diameter (PM10) were positively associated with the number of asthma hospital visits. The largest cumulative effects of O3, CO, and PM10 on hospital visits were on lag day 2 (RR = 1.163, 95% CI 1.051–1.287) for 0–5-year-old childhood asthma, on lag day 3 (RR = 1.386, 95% CI 1.136–1.69) for asthma in winter, and on lag day 10 (RR = 1.148, 95% CI 0.942–1.399) for female asthma, respectively. The cumulative effect of air pollution represented by the air quality index (AQI) was largest on lag day 10 for 0–5-year-old childhood asthma with an increase of 28.6% (95% CI 6.5–55.4) hospital visits every IQR increment of the AQI. CO, O3, and PM10 were the main air pollutants in Shenyang city. Children with bronchitis asthma were more vulnerable to air pollution during the cold season. Keywords Air pollution . Air quality index . Asthma . Hospital visit . Time series . DLNM
Introduction Asthma is one of the major non-communicable diseases among children in China with morbidity rates of 3–7%, which is a 100% increase than that of 10 years ago (Nhung et al. 2018; Chen et al. 2013; Zhang et al. 2018). Factors that affect asthma and asthmatic conditions (wheezing) are complex and
still under investigation, although air pollution (outdoor and indoor), allergy, heredity, pollen, and food are established risk factors (Tian et al. 2018; Khreis and Nieuwenhuijsen 2017). Of all of the risk factors associated with childhood asthma, the effects of air pollutants vary due to different weather and geographical conditions in different locations (O' Lenick et al. 2017).
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00484-020-01934-9) contains supplementary material, which is available to authorized users. * Hehua Zhang [email protected]
Biao Zu [email protected]
Qing Chang [email protected]
1
Shu Liu [email protected]
Clinical Research Center, Shengjing Hospital of China Medical University, Huaxiang Road, No. 39, Tiexi District, Shenyang, China
2
Department of Atmospheric Environment Monitorin
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