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      Associations between daily air quality and hospitalisations for acute exacerbation of chronic obstructive pulmonary disease in Beijing, 2013–17: an ecological analysis

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          Summary

          Background

          Air pollution in Beijing has been improving through implementation of the Air Pollution Prevention and Control Action Plan (2013–17), but its implications for respiratory morbidity have not been directly investigated. We aimed to assess the potential effects of air-quality improvements on respiratory health by investigating the number of cases of acute exacerbations of chronic obstructive pulmonary disease (COPD) advanced by air pollution each year.

          Methods

          Daily city-wide concentrations of PM 10, PM 2·5, PM coarse (particulate matter >2·5–10 μm diameter), nitrogen dioxide (NO 2), sulphur dioxide (SO 2), carbon monoxide (CO), and ozone (O 3) in 2013–17 were averaged from 35 monitoring stations across Beijing. A generalised additive Poisson time-series model was applied to estimate the relative risks (RRs) and 95% CIs for hospitalisation for acute exacerbation of COPD associated with pollutant concentrations.

          Findings

          From Jan 18, 2013, to Dec 31, 2017, 161 613 hospitalisations for acute exacerbation of COPD were recorded. Mean ambient concentrations of SO 2 decreased by 68% and PM 2·5 decreased by 33% over this 5-year period. For each IQR increase in pollutant concentration, RRs for same-day hospitalisation for acute exacerbation of COPD were 1·029 (95% CI 1·023–1·035) for PM 10, 1·028 (1·021–1·034) for PM 2·5, 1·018 (1·013–1·022) for PM coarse, 1·036 (1·028–1·044) for NO 2, 1·019 (1·013–1·024) for SO 2, 1·024 (1·018–1·029) for CO, and 1·027 (1·010–1·044) for O 3 in the warm season (May to October). Women and patients aged 65 years or older were more susceptible to the effects of these pollutants on hospitalisation risk than were men and patients younger than 65 years. In 2013, there were 12 679 acute exacerbations of COPD cases that were advanced by PM 2·5 pollution above the expected number of cases if daily PM 2·5 concentrations had not exceeded the WHO target (25 μg/m 3), whereas the respective figure in 2017 was 7377 cases.

          Interpretation

          Despite improvement in overall air quality, increased acute air pollution episodes were significantly associated with increased hospitalisations for acute exacerbations of COPD in Beijing. Stringent air pollution control policies are important and effective for reducing COPD morbidity, and long-term multidimensional policies to safeguard public health are indicated.

          Funding

          UK Medical Research Council.

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          Most cited references38

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          Size, source and chemical composition as determinants of toxicity attributable to ambient particulate matter

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            Fine Particulate Air Pollution and Daily Mortality. A Nationwide Analysis in 272 Chinese Cities.

            Evidence concerning the acute health effects of air pollution caused by fine particulate matter (PM2.5) in developing countries is quite limited.
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              Health impact of China's Air Pollution Prevention and Control Action Plan: an analysis of national air quality monitoring and mortality data

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                Author and article information

                Contributors
                Journal
                Lancet Planet Health
                Lancet Planet Health
                The Lancet. Planetary Health
                Elsevier B.V
                2542-5196
                1 June 2019
                June 2019
                : 3
                : 6
                : e270-e279
                Affiliations
                [a ]Clinical Epidemiology and Tobacco Dependence Treatment Research Department, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
                [b ]Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
                [c ]MRC-PHE Centre for Environment and Health, Department of Analytical, Environmental and Forensic Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
                [d ]Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
                [e ]Huayun Sounding (Beijing) Meteorological Technology Co, Beijing, China
                [f ]Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
                [g ]Peking University Clinical Research Institute, Peking University Health Science Centre, Beijing, China
                Author notes
                [* ]Correspondence to: Prof Zhaohui Tong, Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China tongzhaohuicy@ 123456sina.com
                [†]

                Joint first authors

                Article
                S2542-5196(19)30085-3
                10.1016/S2542-5196(19)30085-3
                6610933
                31229002
                1491378e-007e-4458-bdd5-02c7585da720
                © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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