Ambient air pollution and cause-specific risk of hospital admission in China: A nationwide time-series study

Background The impacts of air pollution on circulatory and respiratory systems have been extensively studied. However, the associations between air pollution exposure and the risk of noncommunicable diseases of other organ systems, including diseases of the digestive, musculoskeletal, and genitourinary systems, remain unclear or inconclusive. We aimed to systematically assess the associations between short-term exposure to main air pollutants (fine particulate matter [PM2.5] and ozone) and cause-specific risk of hospital admission in China over a wide spectrum of human diseases. Methods and findings Daily data on hospital admissions for primary diagnosis of 14 major and 188 minor disease categories in 252 Chinese cities (107 cities in North China and 145 cities in South China) from January 1, 2013, to December 31, 2017, were obtained from the Hospital Quality Monitoring System of China (covering 387 hospitals in North China and 614 hospitals in South China). We applied a 2-stage analytic approach to assess the associations between air pollution and daily hospital admissions. City-specific associations were estimated with quasi-Poisson regression models and then pooled by random-effects meta-analyses. Each disease category was analyzed separately, and thePvalues were adjusted for multiple comparisons. A total of 117,338,867 hospital admissions were recorded in the study period. Overall, 51.7% of the hospitalized cases were male, and 71.3% were aged <65 years. Robust positive associations were found between short-term PM(2.5)exposure and hospital admissions for 7 major disease categories: (1) endocrine, nutritional, and metabolic diseases; (2) nervous diseases; (3) circulatory diseases; (4) respiratory diseases; (5) digestive diseases; (6) musculoskeletal and connective tissue diseases; and (7) genitourinary diseases. For example, a 10-mu g/m(3)increase in PM(2.5)was associated with a 0.21% (95% CI 0.15% to 0.27%; adjustedP< 0.001) increase in hospital admissions for diseases of the digestive system on the same day in 2-pollutant models (adjusting for ozone). There were 35 minor disease categories significantly positively associated with same-day PM(2.5)in both single- and 2-pollutant models, including diabetes mellitus, anemia, intestinal infection, liver diseases, gastrointestinal hemorrhage, renal failure, urinary tract calculus, chronic ulcer of skin, and back problems. The association between short-term ozone exposure and respiratory diseases was robust. No safety threshold in the exposure-response relationships between PM(2.5)and hospital admissions was observed. The main limitations of the present study included the unavailability of data on personal air pollution exposures. Conclusions In the Chinese population during 2013-2017, short-term exposure to air pollution, especially PM2.5, was associated with increased risk of hospitalization for diseases of multiple organ systems, including certain diseases of the digestive, musculoskeletal, and genitourinary systems; many of these associations are important but still not fully recognized. The effect estimates and exposure-response relationships can inform policy making aimed at protecting public health from air pollution in China. Author summaryWhy was this study done? Besides the well-known cardiorespiratory effects of air pollution, an increasing number of studies suggest that air pollution might be associated with certain non-cardiorespiratory diseases. Evidence of associations between air pollution exposure and the risk of many non-cardiorespiratory diseases is still scarce and inconclusive. Few studies have characterized the acute health effects of air pollution on multiple organ systems using uniform methodology and databases. What did the researchers do and find? We conducted a national time-series study using data of 117,338,867 hospital admissions for 14 major and 188 minor disease categories in 252 Chinese cities from 2013 to 2017, to assess the associations between short-term exposure to fine particulate matter (PM2.5) and ozone and cause-specific risk of hospital admission on a national scale. City-specific associations were estimated with quasi-Poisson regression models and then pooled by random-effects meta-analyses. Each disease category was analyzed separately, and the values were adjusted for multiple comparisons. Short-term PM2.5 exposure was significantly positively associated with hospital admissions for 13 major disease categories (of which 7 associations were considered robust, including for diseases of the digestive, musculoskeletal, and genitourinary systems) and 35 minor disease categories, whether adjusted for ozone or not. The association between short-term ozone exposure and respiratory diseases was robust. What do these findings mean? To our knowledge, this is the first national study in China aimed at systematically investigating possible ways in which short-term air pollution exposure may be associated with severe illnesses requiring hospitalization. Our findings highlight the extensive adverse impacts of air pollution on human health, and indicate the significant social benefits of effective mitigation measures.