Abstract
BackgroundGlobal environmental pollution caused by human activities has become a threat to public health. Children are especially susceptible to adverse environmental conditions owing to their unique physiological and behavioral characteristics. A number of studies have demonstrated associations between the incidence of some childhood diseases and adverse environmental conditions. Shanghai is the largest and most important economic center in China. After rapid population expansion in recent decades, the shortage of pediatric medical resources is becoming a serious public health problem. This study aimed to identify and characterize the social and environmental effect of adverse environmental conditions on overall pediatric admissions at hospitals in Shanghai, China.MethodsThis was a multi-center study spanning from January, 2013 to November, 2014. Daily pediatric admission data (~ 12,000 overall pediatric admissions/day) of three tertiary pediatric hospitals were collected from the large-scale health information exchange network of Shanghai. We linked the admission data with local environmental data. A seasonal decomposition method was applied to a time-trend analysis of the admission data; a generalized additive model was applied to model the association between environmental measurements and admissions data.ResultsAdmissions to outpatient and emergency departments were highly influenced by calendar factors; however, these same factors showed opposite effects on different clinical departments. The effect of nitrogen dioxide was a 0.27% increase (95% confidence interval (CI) 0.23% to 0.32%) in outpatient admissions and 0.78% (95% CI 0.68% to 0.88%) increase in emergency admissions. Concentrations of fine particles ≤ 2.5 micrometers in diameter (PM2.5) and carbon monoxide (CO) showed multi-faceted effects on pediatric admissions. PM2.5 and CO concentrations were significantly associated with decreased current-day outpatient admissions but also significantly associated with increased current-day emergency admissions at all three hospitals.ConclusionsBased on the health information exchange network of Shanghai, we conducted a large-scale, multi-center retrospective study of the association between adverse environmental conditions and pediatric admissions. Our study contributes to environmental health research in children and may guide decision-making regarding pediatric resource planning and policies.
Highlights
It is well known that a turbulently changing or polluted environment can directly create health risks and induce illnesses
The focus of this work was to uncover the environmental effects on pediatric hospital admissions in Shanghai, by using statistical modeling, admission data sourced from three tertiary pediatric hospitals in Shanghai; and meteorological and air quality data
In summary, we conducted a retrospective study of daily hospital admission data from three regional tertiary pediatric hospitals in Shanghai
Summary
It is well known that a turbulently changing or polluted environment can directly create health risks and induce illnesses. Studies of adverse environmental conditions in relation to causing or exacerbating childhood illnesses are increasingly being emphasized [8, 11,12,13] Such childhood illnesses can result in pediatric hospital admissions [14, 15], school absences, dysfunction of the respiratory or immune systems, bronchitis and chronic cough, and increased infant mortality [11]. Some of these studies have not reached a clear conclusion, it has been recognized that adverse environmental conditions can have a serious impact on a child’s health. This study aimed to identify and characterize the social and environ‐ mental effect of adverse environmental conditions on overall pediatric admissions at hospitals in Shanghai, China
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