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Air Quality Improvement During 2013-2017 and Hospitalisations for Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Beijing, China

23 Pages Posted: 27 Dec 2018

See all articles by Lirong Liang

Lirong Liang

Capital Medical University - Department of Clinical Epidemiology & Tobacco Dependence Treatment Research

Yutong Cai

University of London - MRC-PHE Centre for Environment and Health

Benjamin Barratt

University of London - MRC-PHE Centre for Environment and Health

Baolei Lyu

Huayun Sounding (Beijing) Meteorological Technology Co. Ltd

Queenie Chan

University of London - MRC-PHE Centre for Environment and Health

Anna L. Hansell

University of Leicester

Wuxiang Xie

Imperial College London - Department of Epidemiology and Biostatistics

Di Zhang

Capital Medical University

Frank J. Kelly

University of London - MRC-PHE Centre for Environment and Health; University of London - Analytical, Environmental and Forensic Sciences Department

Zhaohui Tong

Capital Medical University - Department of Respiratory and Critical Care Medicine

More...

Abstract

Background: Air pollution levels in Beijing have been improving through implementation of the Air Pollution Prevention and Control Action Plan (2013-2017) but implication for respiratory morbidity have not been directly investigated.  

Methods: Daily city-wide mean concentrations of PM10, PM2·5, NO2, SO2, CO and Ozone in 2013-17 were averaged from 35 monitoring stations across the city. PMcoarse was derived by subtracting PM2·5 from PM10. A generalized additive Poisson time-series model was applied to estimate the percentage change with 95% confidence interval (CI) on hospitalisations for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing.  

Findings: During 18/January/2013-31/December/2017, 161,613 AECOPD hospitalisations were recorded. Ambient concentrations of SO2 and PM2·5 decreased by 68% and 33% over this five-year period. AECOPD hospitalisations increased by 0·3%(95%CI:0·3%-0·4%), 0·4%(95%CI:0·3%-0·5%), 0·7%(95%CI:0·5%-0·9%), 1·2%(95%CI:0·9%-1·4%), 1·2%(95%CI:0·9%-1·6%), 3·0%(95%CI:2·3%-3·6%) and 0·3%(95%CI:0·1%-0·5%) for same day PM10, PM2·5, PMcoarse, NO2, SO2, CO and Ozone (warm season) respectively per 10 µg/m3 (except per 1 mg/m3 for CO) increment. Females and patients aged ≥65 years were more susceptible. In 2013, there were 12,679 AECOPD cases advanced by PM2·5 pollution over expected rates if daily levels had not exceeded the World Health Organisation target, whereas in 2017 the respective figure was 7,377 cases.  

Interpretation: Increased acute air pollution exposures were significantly associated with increased hospitalisations for AECOPD in Beijing despite improvement in overall air quality. Our findings however highlight the importance and effectiveness of stringent air pollution control policy on reducing COPD morbidity and provide rationale for long-term multidimensional policy to safeguard public health.  

Funding: None.  

Declaration of Interest: None declared.

Ethical Approval: This study was approved by the Research Ethics Board of Beijing Chaoyang Hospital (IRB00009511).

Keywords: air pollution policy, COPD exacerbation, China, Epidemiology, Time-series

Suggested Citation

Liang, Lirong and Cai, Yutong and Barratt, Benjamin and Lyu, Baolei and Chan, Queenie and Hansell, Anna L. and Xie, Wuxiang and Zhang, Di and Kelly, Frank J. and Tong, Zhaohui, Air Quality Improvement During 2013-2017 and Hospitalisations for Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Beijing, China (December 17, 2018). Available at SSRN: https://ssrn.com/abstract=3304309 or http://dx.doi.org/10.2139/ssrn.3304309

Lirong Liang

Capital Medical University - Department of Clinical Epidemiology & Tobacco Dependence Treatment Research

Beijing
China

Yutong Cai

University of London - MRC-PHE Centre for Environment and Health

London, SE1 9NH
United Kingdom

Benjamin Barratt

University of London - MRC-PHE Centre for Environment and Health

London, SE1 9NH
United Kingdom

Baolei Lyu

Huayun Sounding (Beijing) Meteorological Technology Co. Ltd

China

Queenie Chan

University of London - MRC-PHE Centre for Environment and Health

London, SE1 9NH
United Kingdom

Anna L. Hansell

University of Leicester

University Road
Leicester, LE1 7RH
United Kingdom

Wuxiang Xie

Imperial College London - Department of Epidemiology and Biostatistics

St Mary's Campus
Norfolk Pl, Paddington
London, W2 1QN
United Kingdom

Di Zhang

Capital Medical University

China

Frank J. Kelly

University of London - MRC-PHE Centre for Environment and Health

London, SE1 9NH
United Kingdom

University of London - Analytical, Environmental and Forensic Sciences Department

London
United Kingdom

Zhaohui Tong (Contact Author)

Capital Medical University - Department of Respiratory and Critical Care Medicine ( email )

China

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