Gaseous air pollutants and hospitalizations for mental disorders in 17 Chinese cities: Association, morbidity burden and economic costs

Hang Qiu; Liya Wang; Li Luo; Minghui Shen

doi:10.1016/j.envres.2021.111928

Gaseous air pollutants and hospitalizations for mental disorders in 17 Chinese cities: Association, morbidity burden and economic costs

Environ Res. 2022 Mar;204(Pt A):111928. doi: 10.1016/j.envres.2021.111928. Epub 2021 Aug 23.

Authors

Hang Qiu¹, Liya Wang², Li Luo³, Minghui Shen⁴

Affiliations

¹ School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China; Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China. Electronic address: qiuhang@uestc.edu.cn.
² Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China.
³ Business School, Sichuan University, Chengdu, China.
⁴ Health Information Center of Sichuan Province, Chengdu, China.

PMID: 34437848
DOI: 10.1016/j.envres.2021.111928

Abstract

The short-term morbidity effects of gaseous air pollutants on mental disorders (MDs), and the corresponding morbidity and economic burdens have not been well studied. We aimed to explore the associations of ambient sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃) and carbon monoxide (CO) with MDs hospitalizations in 17 Chinese cities during 2015-2018, and estimate the attributable risk and economic costs of MDs hospitalizations associated with gaseous pollutants. City-specific relationships between gaseous pollutants and MDs hospitalizations were evaluated using over-dispersed generalized additive models, then combined to obtain the pooled effect. Concentration-response (C-R) curves of gaseous pollutants with MDs from each city were pooled to allow regional estimates to be derived. The morbidity and economic burdens of MDs hospitalizations attributable to gaseous pollutants were further assessed. A total of 171,939 MDs hospitalizations were included. We observed insignificant association of O₃ with MDs. An interquartile range increase in SO₂ at lag0 (9.1 μg/m³), NO₂ at lag0 (16.7 μg/m³) and CO at lag2 (0.4 mg/m³) corresponded to a 3.02% (95%CI: 0.72%, 5.38%), 5.03% (95%CI: 1.84%, 8.32%) and 2.18% (95%CI: 0.40%, 4.00%) increase in daily MDs hospitalizations, respectively. These effects were modified by sex, season and cause-specific MDs. The C-R curves of SO₂ and NO₂ with MDs indicated nonlinearity and the slops were steeper at lower concentrations. Overall, using current standards as reference concentrations, 0.27% (95%CI: 0.07%, 0.48%) and 0.06% (95%CI: 0.02%, 0.10%) of MDs hospitalizations could be attributable to extra SO₂ and NO₂ exposures, and the corresponding economic costs accounted for 0.34% (95%CI: 0.08%, 0.60%) and 0.07% (95%CI: 0.03%, 0.11%) of hospitalization expenses, respectively. Moreover, using threshold values detected from C-R curves as reference concentrations, the above mentioned morbidity and economic burdens increased a lot. These findings suggest more strict emission control regulations are needed to protect mental health from gaseous pollutants.

Keywords: Attributable risk; Economic cost; Gaseous air pollution; Hospitalization; Mental disorders.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Air Pollutants* / analysis
Air Pollutants* / toxicity
Air Pollution* / adverse effects
Air Pollution* / analysis
China / epidemiology
Cities
Hospitalization
Humans
Mental Disorders*
Morbidity
Nitrogen Dioxide / analysis
Nitrogen Dioxide / toxicity
Particulate Matter / analysis
Sulfur Dioxide / analysis
Sulfur Dioxide / toxicity

Substances

Air Pollutants
Particulate Matter
Sulfur Dioxide
Nitrogen Dioxide