Abstract
Background: There has been a recent worsening of air pollution in China, which poses a huge threat to public health by inducing and promoting circulatory and respiratory diseases. This study aimed to explore the association between the concentration of air pollution and daily internal medicine outpatient visits registered for the treatment of circulatory and respiratory symptoms in Zhoushan, China using a time-series method.Methods: We validated and acquired the daily internal medicine outpatient visits records between January 1, 2014, and December 31, 2019, from the Zhoushan Center for Disease Control and Prevention in Zhejiang, China. Further, we collected the daily average records of the ambient air pollutants from the Zhoushan Environmental Monitoring Centre within the same duration. A generalized additive model with the natural splines was constructed to explore the association between the ambient air pollutants and daily internal medicine outpatient visits. Further, we conducted a lag analysis by using the distributed lag non-linear model to estimate the time-delayed effects of the air pollutants on the daily internal medicine outpatient visits.Results: A total of 2,190,258 daily internal medicine outpatient visits with a mean of 202.4 visits per day were recorded. The non-linear relationships were found among particulate matter2.5 (PM2.5), sulfur dioxide (SO2), and the daily internal medicine outpatient visits. Overall, PM2.5 was positively correlated with the daily internal medicine outpatient visits. Both ozone (O3) and SO2 had significant delayed effects on the daily internal medical outpatient numbers; however, PM2.5 only showed a short-term risk.Conclusion: Short-term exposure to PM2.5 was associated with an increase in the daily internal medicine outpatient visits for circulatory and respiratory diseases/symptoms in Zhoushan, China. SO2 and O3 were shown to induce significant effects after a concentration-dependent time lag.
Highlights
China has recently embarked on large-scale urbanization and industrialization, which have posed serious environmental challenges [1]
This study was conducted at the Zhoushan Hospital, which is the only tertiary medical center in Zhoushan City
We obtained the meteorological data within the same period from the China Meteorological Data Sharing Service System
Summary
China has recently embarked on large-scale urbanization and industrialization, which have posed serious environmental challenges [1]. In China, circulatory and respiratory diseases represent substantial healthcare burdens. Respiratory infections adversely affect the quality of life; chronic respiratory diseases accounted for 9% of all the deaths from non-communicable diseases in China in 2016. Exposure to ambient air pollution can have serious adverse health effects and is considered a risk factor for acute or chronic respiratory diseases including chronic obstructive pulmonary disease [5, 6]. There have been numerous studies on the association of environmental pollution with morbidity and mortality due to circulatory diseases including heart disease [7, 8] and stroke [9]. There has been a recent worsening of air pollution in China, which poses a huge threat to public health by inducing and promoting circulatory and respiratory diseases. This study aimed to explore the association between the concentration of air pollution and daily internal medicine outpatient visits registered for the treatment of circulatory and respiratory symptoms in Zhoushan, China using a time-series method
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