Air pollution and hospitalization of patients with idiopathic pulmonary fibrosis in Beijing: a time-series study

Respir Res. 2022 Apr 5;23(1):81. doi: 10.1186/s12931-022-01998-8.

Abstract

Background: A small number of studies suggested that air pollution was associated with idiopathic pulmonary fibrosis (IPF) exacerbation, incidence and mortality. However, no studies to date were conducted in regions where air pollution is substantial. We aimed to investigate whether there are associations between acute increases in air pollution and hospitalization of patients with a confirmed primary diagnosis of IPF in Beijing.

Methods: Daily count of IPF hospitalizations (International Classification of Disease-10th Revision, J84.1) was obtained from an administrative database for 2013-2017 while daily city-wide average concentrations of PM10, PM2.5, NO2, Ozone, SO2 were obtained from 35 municipal monitoring stations for the same period. The association between daily IPF hospitalization and average concentration of each pollutant was analyzed with a generalized additive model estimating Poisson distribution.

Results: Daily 24-h mean PM2.5 concentration during 2013-2017 was 76.7 μg/m3. The relative risk (RR) of IPF hospitalization per interquartile range (IQR) higher (72 μg/m3) in PM2.5 was 1.049 (95% CI 1.024-1.074) and 1.031 (95% CI 1.007-1.056) for lag0 and moving averages 0-1 days respectively. No significant associations were observed for other lags. Statistically significant positive associations were also observed at lag0 with SO2, Ozone and NO2 (in men only). Positive associations were seen at moving averages 0-30 days for PM10 (RR per 86 μg/m3: 1.021, 95% CI 0.994-1.049), NO2 (RR per 30 μg/m3: 1.029, 95% CI 0.999-1.060), and SO2 (RR per 15 μg/m3: 1.060 (95% CI 1.025-1.097), but not with PM2.5 or Ozone.

Conclusions: Despite improvement in air quality since the implementation of clean air policy in 2013, acute exposure to higher levels of air pollution is significantly associated with IPF hospitalization in Beijing. Air quality policy should be continuously enforced to protect vulnerable IPF populations as well as the general public.

Keywords: Air pollutants; Developing countries; Disease progression; Interstitial lung diseases; Particulate matter.

MeSH terms

  • Air Pollutants* / adverse effects
  • Air Pollutants* / analysis
  • Air Pollution* / adverse effects
  • Air Pollution* / analysis
  • Beijing / epidemiology
  • China / epidemiology
  • Environmental Exposure / adverse effects
  • Environmental Exposure / analysis
  • Hospitalization
  • Humans
  • Idiopathic Pulmonary Fibrosis* / diagnosis
  • Idiopathic Pulmonary Fibrosis* / epidemiology
  • Male
  • Particulate Matter / adverse effects
  • Particulate Matter / analysis

Substances

  • Air Pollutants
  • Particulate Matter