Association between ambient particulate matter and hospital outpatient visits for chronic obstructive pulmonary disease in Lanzhou, China

Abstract

Until now, a number of epidemiological studies have focused on the association between ambient particulate matter pollution and chronic obstructive pulmonary disease (COPD), especially in developed countries. There are limited evidences on the association between short-term exposure to particulate matters (PM_2.5, PM_C, and PM₁₀) and overall hospital outpatient visits for COPD at the same time in China. Thus, a time-series analysis on the short-term association between three subtypes of PM (PM_2.5, PM_C, and PM₁₀) and daily hospital outpatients for COPD in Lanzhou, China was conducted, from 2014 to 2017.An over dispersed, generalized additive model was used to analyze the associations after controlling for time trend, weather conditions, day of the week, and holidays. Stratified analyses were also performed by age and gender. The results disclosed that a 10-μg/m³ increase in PM_2.5 concentration at a lag of 0-7 days was associated with 1.190% (95% CI 0.176~2.215%). For PM_c, therewere not statistically significant effects at any lag days, but we could find the greatest effect at lag07 that a 10-μg/m³ increase in concentration was associated with 0.014% (95% CI - 0.065~0.093%). PM₁₀ also exerted a high effect for COPD (0.185% increase; 95% CI - 0.046~0.417%) when 6 days of exposures (lag6), however, no significance relationship could be found. For COPD among males, positive results were observed for PM_2.5 with lags of 0-7 days, a 10-μg/m³ increase was 1.184% (95% CI 0.095~2.284%). The effect of PM_2.5 on females was also most significant at lag07, a 10-μg/m³ increase was 1.254% (95% CI 0.053~2.469%). For those aged < 65 years old, PM_2.5 was not statistically significant at all lag days, but it reached the maximum at lag07, a 10-μg/m³ increase was 0.978% (95% CI - 0.139~2.108%). For those aged 65 ≥ years old and older, PM_2.5 had a statistically significant lag effect at lag1, lag2, lag3, lag02, lag03, lag04, lag05, lag06, and lag07, and it was most significant at lag07; a 10-μg/m³ increase was 1.906% (95% CI 0.553~3.277%). Short-term exposure to PM_2.5 was associated with increased risk of hospital visits for COPD. In particular, the elderly (aged ≥ 65 years old) and males were relatively more sensitive to PM_2.5, and were affected right away after the PM_2.5 concentration went up.

Keywords: Chronic obstructive pulmonary disease; Daily outpatient visits; Generalized additive model; Particulate matter.