Ambient air pollution and hospitalization for chronic obstructive pulmonary disease: Benefits from Three-Year Action Plan

Wenfeng Lu; Qi Tian; Ruijun Xu; Lan Qiu; Zhaoyu Fan; Shuguang Wang; Tingting Liu; Jiayi Li; Yingxin Li; Yaqi Wang; Chunxiang Shi; Yuewei Liu; Yun Zhou

doi:10.1016/j.ecoenv.2021.113034

Ambient air pollution and hospitalization for chronic obstructive pulmonary disease: Benefits from Three-Year Action Plan

Ecotoxicol Environ Saf. 2021 Nov 30:228:113034. doi: 10.1016/j.ecoenv.2021.113034. Online ahead of print.

Authors

Wenfeng Lu¹, Qi Tian², Ruijun Xu³, Lan Qiu⁴, Zhaoyu Fan³, Shuguang Wang⁴, Tingting Liu³, Jiayi Li⁴, Yingxin Li³, Yaqi Wang³, Chunxiang Shi⁵, Yuewei Liu⁶, Yun Zhou⁷

Affiliations

¹ State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China; School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong 511436, China.
² Guangzhou Health Technology Identification & Human Resources Assessment Center, Guangzhou, Guangdong 510080, China.
³ Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
⁴ School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong 511436, China.
⁵ National Meteorological Information Center, China Meteorological Administration, Beijing 100081, China.
⁶ Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China. Electronic address: liuyuewei@mail.sysu.edu.cn.
⁷ State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China; School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong 511436, China. Electronic address: yunz@gzhmu.edu.cn.

PMID: 34861442
DOI: 10.1016/j.ecoenv.2021.113034

Abstract

Background: Chronic obstructive pulmonary disease (COPD) hospitalization has been linked with ambient air pollution. However, the evidence on respiratory health benefits from air pollution control policy in China is limited.

Objective: To investigate benefits from the Three-Year Action Plan to Win the Battle for a Blue Sky (TYAP) for tackling COPD hospitalization due to ambient air pollution.

Methods: We conducted a time-stratified case-crossover study of 138,015 COPD hospitalizations aged ≥ 60 years in Guangdong province, China during 2016-2019 to investigate respiratory health benefits from TYAP. Inverse distance weighting method was used to assess daily individual-level exposures to ambient air pollutants including particulate matter with an aerodynamic diameter ≤ 2.5 µm (PM_2.5), particulate matter with an aerodynamic diameter ≤ 10 µm (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and ozone (O₃). Conditional logistic regression model was applied to analyze the associations between ambient air pollutants and COPD hospitalization.

Results: TYAP can modify the associations. Each 10 μg/m³ increase of exposure to PM_2.5, PM₁₀, and NO₂ and 1 mg/m³ increase of exposure to CO were significantly associated with 2.5%, 2.0%, 3.0%, and 14.4% increase in odds of COPD hospitalization before TYAP, respectively; while 1.0%, 0.9%, 1.5%, and 5.8% increase in odds during TYAP. We found prominent declines in health burden of COPD hospitalizations due to air pollution among the elderly after TYAP implication when compared with that before TYAP.

Conclusion: Reduced levels of ambient air pollutants by TYAP can effectively lower the risk for COPD hospitalization among the elderly, which provides evidence on the respiratory health benefits from consistent and effective air pollution control policy.

Keywords: Air pollution; COPD hospitalization; Three-Year Action Plan.