Associations between Different Ozone Indicators and Cardiovascular Hospital Admission: A Time-Stratified Case-Crossover Analysis in Guangzhou, China

Xiangxue Zhang; Kamal Jyoti Maji; Zhuoqing Wang; Fiona Fan Yang; Guobin Wang; Changxiu Cheng

doi:10.3390/ijerph20032056

Associations between Different Ozone Indicators and Cardiovascular Hospital Admission: A Time-Stratified Case-Crossover Analysis in Guangzhou, China

Int J Environ Res Public Health. 2023 Jan 23;20(3):2056. doi: 10.3390/ijerph20032056.

Authors

Xiangxue Zhang^{1

2}, Kamal Jyoti Maji³, Zhuoqing Wang⁴, Fiona Fan Yang⁵, Guobin Wang⁵, Changxiu Cheng^{1

6}

Affiliations

¹ State Key Laboratory of Earth Surface Processes and Resource Ecology, Beijing Normal University, Beijing 100875, China.
² Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, 7514 AE Enschede, The Netherlands.
³ School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA.
⁴ Department of Scientific Research & Discipline Development, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China.
⁵ School of Geography and Planning, Sun Yat-Sen University, Guangzhou 510006, China.
⁶ National Tibetan Plateau Data Center, Beijing 100101, China.

Abstract

Epidemiological studies reported that ozone (O₃) is associated with cardiovascular diseases. However, only few of these studies examined the impact of multiple O₃ indicators on cardiovascular hospital admissions. This study aimed to explore and compare the impacts of different O₃ indicators on cardiovascular hospital admissions in Guangzhou, China. Based upon the data on daily cardiovascular hospital admissions, air pollution, and meteorological factors in Guangzhou from 2014 to 2018, a time-stratified case-crossover design model was used to analyze the associations between different O₃ indicators and cardiovascular hospital admissions. Moreover, the sensitivities of different age and gender groups were analyzed for the whole year and different seasons (i.e., warm and cold). During the warm season, for the single-pollutant model, the odds ratio (OR) value of cardiovascular hospital admissions was 1.0067 (95% confidence interval (CI): 1.0037, 1.0098) for every IQR increase in MDA8 O₃ at a lag of five days. The effect of O₃ on people over 60 year was stronger than that on the 15-60 years age group. Females were more sensitive than males to O₃ exposure. These results provided valuable references for further scientific research and environmental improvement in Guangzhou. Given that short-term O₃ exposure poses a threat to human health, the government should therefore pay attention to prevention and control policies to reduce and eliminate O₃ pollution and protect human health.

Keywords: cardiovascular diseases; hospital admissions; ozone; time-stratified case crossover.

Publication types

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

MeSH terms

Air Pollutants* / analysis
Air Pollution* / analysis
China / epidemiology
Female
Heart
Hospitals
Humans
Male
Ozone* / analysis
Particulate Matter / analysis
Seasons

Substances

Ozone
Air Pollutants
Particulate Matter

Grants and funding

This work was supported by the National Key Research and Development Plan of China (2019YFA0606901); the National Natural Science Foundation of China (42071178, 41671139); and the Visiting Fellowship from China Scholarship Council (No. 202106040072). The authors gratefully acknowledge the Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente for hosting the first author to carry out this study.