Ambient air pollution and hospital admission in Shanghai, China

Abstract

No prior studies exist in Mainland China examining the association of outdoor air pollution with hospital admissions. In this study, we conducted a time-series analysis to examine the association of outdoor air pollutants (PM 10, SO 2, and NO 2) with both total and cause-specific hospital admission in Shanghai, using three years of daily data (2005–2007). Hospital admission and air pollution data were collected from the Shanghai Health Insurance Bureau and Shanghai Environmental Monitoring Center. Natural spline model was used to analyze the data. We found outdoor air pollution was associated with increased risk of total and cardiovascular hospital admission in Shanghai. The effect estimates of air pollutants varied by lag (L) structures of pollutants’ concentrations. For lag 5, a 10 μg/m 3 increase in concentration of PM 10, SO 2 and NO 2 corresponded to 0.18% (95% CI: −0.15%, 0.52%), 0.63% (95% CI: 0.03%, 1.23%), and 0.99% (95% CI: 0.10%, 1.88%) increase of total hospital admission; and 0.23% (95% CI: −0.03%, 0.48%), 0.65% (95% CI: 0.19%, 1.12%), and 0.80% (95% CI: 0.10%, 1.49%) increase of cardiovascular hospital admission. The associations appeared to be more evident in the cool season (from November to April) than in the warm season (from May to October). We found significant effects of gaseous pollutants (SO 2 and NO 2) after adjustment for PM 10. Our analyses provide the first evidence in China that the current air pollution level has an effect on hospital admission and strengthen the rationale for further limiting air pollution levels in Shanghai.