Daily Outpatient Visits Research Articles

The Spatio-temporal Epidemiology of Asthma Patient Visits in Relation to Meteorological Parameters and Air Pollution Factors as a Result of Seasonal Change in Songkhla Province

Objective: To investigate the demographic characteristics, seasonal variations, effects associated with air pollution, and geographic morbidity of asthma in Songkhla.Material and Methods: This research conducted a time series analysis of secondary data from 1 January, 2013 to 31 December, 2017. The distributed lag non-linear model was employed to analyze associations between air pollutants and daily asthma outpatient visits, and the Bayesian hierarchical modelling was used to map asthma morbidity spatiotemporally.Results: A total of 250,127 asthma diagnoses corresponding to 36,761 patients were found in the medical records. Most asthma outpatients were female (61.1%); males (1-5 years) constituted the majority of individuals during the first peak, while females (40-50 years) predominated the second peak. The trend analysis revealed a seasonal variation in the number of asthma outpatient visits; the highest rates were during the June-December period. The regression coefficient analysis revealed carbon monoxide (CO), nitrogen dioxide (NO2 ), relative humidity, and visibility to have the most significant positive effect on asthma, while the cos (wind direction) had the highest negative effect/impact. Significant associations were found between outpatient gender and age and CO, NO2 , sulfur dioxide, ozone, and particulate matter less than 10 micron. The Hat Yai and Central districts of Songkhla province were identified as morbidity hotspots.Conclusion: The number of asthma-related outpatient visits increased during the rainy season. Asthma affected primarily young boys and middle-aged women in this province, and they constitute the most sensitive group to air pollutants such as CO and NO2 and meteorological conditions like relative humidity and visibility. The highest morbidity rates were found in urbanized habitats.

Association Between the Ambient Fine Particulate Pollution and the Daily Internal Medicine Outpatient Visits in Zhoushan, China: A Time-Series Study.

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.

Effects of Temperature on Outpatient Visits for Urticaria among Lanzhou Residents Based on Distributed Lag Non-linear Model

Objective To evaluate the influence of temperature on the outpatient visits for urticaria in Lanzhou City and its hysteresis and to find out the sensitive populations by sex and age stratification.Methods We collected the urticaria outpatient data in three grade A class three hospitals as well as the meteorological data and air pollutant data in Lanzhou from January 2011 to December 2017.The distributed lag non-linear model(DLNM)was employed to analyze the influence of daily mean temperature on the outpatient visits for urticaria.Stratification analysis was performed for different age groups(0-14,15-59,≥60 years)and different sex populations.Results Temperature had a non-linear relationship with the outpatient visits for urticaria,and there existed hysteresis.During the research period,the average daily outpatient visits for urticaria at the three hospitals in Lanzhou was 25,ranging from 1 to 76.With the rise in the daily mean temperature within 0-10 ℃,the risk of outpatient visits for urticaria first increased and then decreased.When the daily mean temperature was 2 ℃,hysteresis occurred on the 18th day,and the relative risk(RR)reached the maximum(1.12,95% CI:1.04-1.20)at the lag of 21 days.The risk of urticaria increased with the rise in temperature at high temperature.In addition,the effect of high temperature on the outpatient visits for urticaria in Lanzhou presented hysteresis,and the hysteresis was more obvious at higher temperatures.At the lag of 21 days,when the temperatures were 19.9 ℃ and 25.5 ℃,the RR values were 1.20(95% CI:1.12-1.27)and 1.39(95% CI:1.31-1.48),respectively.The results of stratified analysis showed that the effect of high temperature was more sensitive for those of 0-14 years and 15-59 years as well as the female population,and the RR values at a lag of 21 days were 1.60(95% CI:1.45-1.71),1.34(95% CI:1.25-1.43),and 1.43(95% CI:1.33-1.53)for the population of 0-14 years,the population of 15-59 years,and female population,respectively.Low temperature mainly affected the people aged ≥60 years,with a maximum RR of 1.38(95% CI:1.03-1.85)when the daily mean temperature was -4.8 ℃ at a lag of 12 days.It did not affect other populations.Conclusions The daily mean temperature in Lanzhou share a close relationship with the outpatient visits for urticaria.High temperature will increase the risk of urticaria for people at the age of 0-14 years and 15-59 years,while low temperature will increase the risk of urticaria for people above 60 years.

Constructing an Air Quality Health Index for children: A case study in Shanghai, China

BackgroundThe Air Quality Health Index (AQHI) based on the association between excess mortality risk and air pollutants was established by Canadian scientists in 2008 and it has been widely used for predicting multiple air pollutants related health risks. However, it remains unclear whether AQHI is a better indicator in predicting other health risks like respiratory diseases for vulnerable populations. ObjectiveThis study aimed to propose a case on constructing an AQHI based on the association between air pollution and hospital outpatient visits for respiratory diseases among children and to determine whether the index adequately predicts early risk of respiratory diseases in children. MethodData of air pollutants, including particulate matter of less than 2.5 μm in aerodynamic diameter (PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3) were collected from Shanghai Environmental Monitoring Center from January 1, 2015 to December 31, 2019. Daily number of hospital outpatient visits for pediatric (0–12 years old) respiratory diseases were also obtained. Time-series analysis with a generalized additive model (GAM) during warm (Apr. to Sep.) and cool periods (Oct. to Mar.) was conducted to estimate the associations between respiratory-related hospital outpatient visits in children and the concentrations of air pollutants including PM2.5, SO2, NO2, and O3 in Shanghai from 2015 to 2018. The sum of excess risk (ER) of hospital outpatient visits in warm and cool periods was used to construct the AQHI for children (AQHIc). As AQHIc was established using the data from 2015 to 2018, we examined the validity of the index with data from 2017 to 2019. We also compared the predictive power of AQHIc and the currently used Air Quality Index (AQI) with the data of daily hospital outpatient visits from 2017 to 2019. ResultAccording to one- and two-pollutant models of GAM, the concentration-response coefficients of PM2.5, SO2, NO2, and O3 were selected to construct the AQHIc in the warm period, while only SO2, NO2, and PM2.5 were included for the construction of AQHIc in the cool period as O3 was negatively correlated with the hospital outpatient visits. There were almost linear exposure-response correlations between AQHIc and daily hospital outpatient visits. AQHIc and AQI showed similar results with the annual data in terms of model fit statistics. When the data was divided into warm and cool periods, the power of AQHIc was slightly stronger than that of AQI in predicting the air pollution-related health risks. ConclusionAQHIc we developed might comprehensively reflect the combined effects of air pollution in Shanghai and it could be a more valid prediction index for evaluating air pollution-related health risks in children.

Impact of the COVID-19 Pandemic on Urological Care Delivery in the United States.

We examined changes in urological care delivery due to COVID-19 in the U.S. based on patient, practice, and local/regional demographic and pandemic response features. We analyzed real-world data from the American Urological Association Quality (AQUA) Registry collected from electronic health record systems. Data represented 157 outpatient urological practices and 3,165 providers across 48 U.S. states and territories, including 3,297,721 unique patients, 12,488,831 total outpatient visits and 2,194,456 procedures. The primary outcome measure was the number of outpatient visits and procedures performed (inpatient or outpatient) per practice per week, measured from January 2019 to February 2021. We found large (>50%) declines in outpatient visits from March 2020 to April 2020 across patient demographic groups and states, regardless of timing of state stay-at-home orders. Nonurgent outpatient visits decreased more across various nonurgent procedures (49%-59%) than for procedures performed for potentially urgent diagnoses (38%-52%); surgical procedures for nonurgent conditions also decreased more (43%-79%) than those for potentially urgent conditions (43%-53%). African American patients had similar decreases in outpatient visits compared with Asians and Caucasians, but also slower recoveries back to baseline. Medicare-insured patients had the steepest declines (55%), while those on Medicaid and government insurance had the lowest percentage of recovery to baseline (73% and 69%, respectively). This study provides real-world evidence on the decline in urological care across demographic groups and practice settings, and demonstrates a differential impact on the utilization of urological health services by demographics and procedure type.

Air Pollutants and Daily Outpatient Visits for Cardiovascular and Cerebrovascular Diseases in Central Taiwan

BACKGROUND AND AIM: This study aimed to evaluate the health impacts of air pollutants and meteorological factors (fog, haze, and low cloud) under megacity conditions in central Taiwan. In addition, we used the Kriging interpolation and land use regression for more accurate exposure assessment. METHODS: We retrieved daily records of outpatient department (OPD) visits from the Health and Welfare Data Science Center of the Ministry of Health and Welfare of Taiwan and included those for ischemic heart and cerebrovascular diseases (ICD-9 codes 410 to 414 and 430 to 438; ICD-10 codes: I20 to 25 and I60 to I69) in 2016. We combined the air pollution data on the level of fine aerosol and chemical components obtained from the air quality monitoring stations established by the Environmental Protection Administration in the Taichung and Nantou areas with the meteorological data obtained from the Central Weather Bureau to assess their associations with the OPD visits. Autoregressive integrated moving average and classification and regression trees models were constructed to evaluate and describe the effects of air pollutants and meteorological factors on the OPD visits for ischemic heart and cerebrovascular diseases. RESULTS:The PM2.5 measured at station in Nantou and Changhua were significantly higher than those measured at stations in Taichung. The OPD visits for cardiovascular and cerebrovascular diseases by residents nearby the station in Nantou and Changhua were also significantly more than those paid by residents nearby the stations in Taichung. OPD visits for ischemic heart and cerebrovascular diseases had positive association with PM2.5 concentration on the same day and the day before. CONCLUSIONS:The level of PM2.5 was associated with OPD visits for ischemic heart and cerebrovascular diseases on the same day and the next day. Further studies are needed to identify the susceptible populations and evaluate the impacts. KEYWORDS: Fine particulate matters, air pollution, and cardiovascular diseases

Associations Between Air Pollution Exposure and Daily Pediatric Outpatient Visits for Dry Eye Disease: A Time-Series Study in Shenzhen, China.

Objectives: This study aimed to investigate the associations between air pollution exposure and pediatric outpatient visits for dry eye disease (DED) in Shenzhen, China.Methods: Generalized additive models were utilized to explore the acute effects of air pollution exposure on pediatric outpatient visits for DED.Results: Single-day lag exposures to NO2, O3, PM2.5, and PM10 were associated with DED outpatient visits at lag days 0, 6, 4 and 2. Relative risks (RRs) for DED given a 10-μg/m3 increase in NO2, O3, PM2.5, and PM10 concentrations were 1.062[95% confidence interval (CI) 1.003, 1.123], 1.015(95% CI 1.001, 1.031), 1.052(95% CI 1.001, 1.115), and 1.038 (95% CI 1.002, 1.076), respectively. RR for DED given a 10-μg/m3 increase in NO2 over cumulative lag days 0–1 was 1.075 (95% CI 1.009, 1.147), and RR for DED given a 10-μg/m3 increase in PM10 over cumulative lag days 0–4 was 1.051 (95% CI 1.003, 1.102).Conclusion: The observed associations between air pollution and outpatient visits for DED may provide evidence for policy makers to consider implementing measures to reduce the risk of DED owing to air pollution in China.

The association between diurnal temperature range and clinic visits for upper respiratory tract infection among college students in Wuhan, China.

The effects of daily mean temperature on health outcomes have been discussed in many previous studies, but few have considered the adverse impacts on upper respiratory tract infection (URTI) due to variance of temperature in one day. Diurnal temperature range (DTR) was a novel indicator calculated as maximum temperature minus minimum temperature on the same day. In this study, generalized additive model (GAM) with quasi-Poisson distribution was used to investigate the association between DTR and the number of daily outpatient visits for URTI among college students. Data about meteorological factors and air pollutants were provided by Hubei Meteorological Bureau and Wuhan Environmental Protection Bureau, respectively. Outpatient visits data were collected from the Hospital of Wuhan University from January 1, 2016, to December 31, 2018. Short-term exposure to DTR was associated with the increased risk of outpatient for URTI among all college students. Per 1 °C increased in DTR was associated with 0.73% (95%CI: 0.24, 1.21) increased in outpatient visits of all college students for URTI at lag 0 day. The greatest effect values were observed in males [1.35% (95%CI: 0.33,2.39)] at lag 0-6 days, and in females [0.86% (95%CI: 0.24, 1.49)] at lag 0-1 days. DTR had more adverse health impact in autumn and winter. Public health departments should consider the negative effect of DTR to formulate more effective prevention and control measures for protecting vulnerable people.

Exposure-lag-response associations between weather conditions and ankylosing spondylitis: a time series study

BackgroundPatients with ankylosing spondylitis (AS) have reported that their pain becomes worse when the local weather changes. However, there is limited evidence verifying the short-term associations between meteorological factors and outpatient visits for patients with AS. Therefore, this study evaluates this possible association.MethodsMeteorological data and data on daily AS outpatient visits to a general hospital in Hefei, China, from 2014 to 2019 were collected and analysed. Distributed lag nonlinear models and Poisson regression models were employed to determine the association between weather conditions and outpatient visits; the results were also stratified by gender and age.ResultsHigh relative humidity is significantly associated with all patient visits in lag 1 (RR = 1.113, 95% CI 1.021 to 1.213) and lag 7 days (RR = 1.115, 95% CI 1.014 to 1.227). A low relative risk to the nadir is observed in lag 4 days (RR = 0.920, 95% CI 0.862 to 0.983). Male and young patients (< 65 years) are more vulnerable to damp weather, and elderly people (≥ 65 years) are significantly affected by high temperatures in lag 7 days (RR = 3.004, 95% CI 1.201 to 7.510).ConclusionsOur findings suggest a potential relationship between exposure to weather conditions and increased risk of AS outpatient visits. These results can aid hospitals in preparing for and managing hospital visits by AS patients when the local weather conditions change.

Interactive Effects between Temperature and Humidity on Outpatient Visits of Respiratory Diseases in Lanzhou, China

AbstractThis study assessing the lag and interactive effects between the daily average temperature and relative humidity on respiratory disease (RD) morbidity in Lanzhou, China, using data from daily outpatient visits for RD between 2014 and 2017 and meteorological and pollutant data during the same period analyzed with Poisson generalized linear model and distributed lag nonlinear models; the effects are further explored by classifying the RD by gender, age, and disease type. The results showed that the effect of temperature and relative humidity on outpatient visits of different populations and types of RD is nonlinear, with a significant lag effect. Relative to 11°C, every 1°C decrease in temperature is associated with 10.98% [95% confidence interval (CI): 9.87%–12.11%] increase for total RD. Chronic obstructive pulmonary disease is affected only by low temperature, upper respiratory tract infection is affected by both low and high temperatures, and asthma is influenced by high temperature. When the relative humidity is less than 32%, every 1% decrease in relative humidity is associated with 6.00% (95% CI: 3.00%–9.11%) increase for total RD; relative humidity has different effects on the outpatient risk of different types of RD. Temperature and relative humidity have an obvious interactive effect on different types and populations of RD: when both temperature and humidity are at low levels, the number of outpatient visits for RD is higher. When the relative humidity is ≤50% and the temperature is ≤11°C, total RD outpatient visits increase by 4.502% for every 1°C drop in temperature; that is, a dry environment with low temperature has the most significant impact on RD.

Risks of hospital outpatient visits for overall and cause-specific respiratory disease associated with particulate matter pollution in Lanzhou, China

Until now, few epidemiological studies have focused on the association between ambient particulate matter (PM) pollution and hospital outpatient visits for overall and cause-specific respiratory disease, especially in Lanzhou. This study aimed to evaluate the short-term effects of PM2.5, PMC, and PM10 on hospital outpatient visits for overall and subtypes of respiratory disease in Lanzhou, China, during 2007–2017, using a generalized additive model (GAM). We further assessed the impact of ambient size-fractioned PM on daily total and cause-specific respiratory morbidity, following a series of air quality improvement action in the area with overall and period-specific analyses. Positive associations were identified between PM2.5, PMC, and PM10 and daily morbidity rates from overall respiratory diseases, upper respiratory tract infection, lower respiratory tract infection, pneumonia, and COPD at different lag pattern. Each 10 μg/m3 increase in PM2.5 at lag07, PMC at lag03, and PM10 at lag06 corresponded to an increase of 1.353% (95% CI: 1.249%, 1.457%), 0.052% (95%CI: 0.015%, 0.089%), and 0.201% (95% CI: 0.165%, 0.236%) in daily hospital outpatient visits for total respiratory, respectively. We did not find significant effects of PM2.5, PMC, and PM10 on asthma. For specific subtypes of respiratory diseases, the effects of PM were strongest on pneumonia morbidity, with an increase of 3.712% (95% CI: 3.308%, 4.117%), 0.874% (95% CI: 0.698%, 1.051%), and 0.967% (95% CI: 0.836%, 1.099%) per 10 μg/m3 increment in PM2.5, PMC, and PM10, respectively. The exposure-response association was non-linear across the full range of exposures. With drastic reductions in annual PM levels, the three size-specific PM associate and respiratory morbidity risk showed decreasing trend over time. This study suggests that PM could exert adverse influences on the outcomes of all-cause and cause-specific respiratory outpatient visits in Lanzhou, China. PM2.5 would have significant effects on pneumonia and RTI. Strategies should be considered to further reduce levels of ambient PM2.5.

Impact of the COVID-19 pandemic on mental health service use among psychiatric outpatients in a tertiary hospital

BackgroundThe aim was to explore the impact of the COVID-19 pandemic on mental health service use according to mental disorder diagnosis among psychiatric outpatients. MethodsPsychiatric outpatient visits and patient diagnostic information were extracted from the EHR(electronic health records) of a Korean tertiary hospital during 3 months of the COVID-19 pandemic and 3 months before the COVID-19 outbreak. Visit rates of psychiatric outpatients according to primary psychiatric diagnosis category before and after the COVID-19 pandemic were compared using an over-dispersed Poisson regression model. The temporal associations between the number of daily outpatient visits and the daily number of newly confirmed cases were examined by time-series analysis within each diagnosis category. ResultsTotal daily outpatient visit rate was significantly reduced during the pandemic. Among the nine most prevalent diagnosis categories, the daily visit rates for anxiety disorders, depressive disorders, and schizophrenia-spectrum disorders were significantly reduced by about 29.8%, 14.8%, and 13.3% respectively. Time-series analysis showed significant temporal correlations between the daily number of newly confirmed cases and the daily visit rates for anxiety disorders and depressive disorders, whereas patients with schizophrenia-spectrum disorders showed no significant temporal association. LimitationsPotential confounding factors unrelated to the pandemic might have influenced the results. ConclusionsThe present findings suggest that patients with anxiety or depressive disorders may have concerns regarding the spread of COVID-19, and may be more reluctant to visit psychiatry outpatient clinics. Delivery strategies for mental healthcare services, such as telepsychiatry, would be helpful to enhance continuity of care during the pandemic.

Short-term effects of outdoor particulate matter pollution on outpatient visits for urticaria in Lanzhou, China

The associations of particulate matter pollution with the outpatient visits of urticaria, remains poorly studied. This study aimed to evaluate the short-term effects of PM (PM2.5, PM10, and PMc) on daily outpatient visits for urticaria diseases in Lanzhou, China, during 2013–2017. A total of 74,232 outpatient visits for urticaria were collected during the 5 years. A generalized additive Poisson model, based on a sex and age subgroups, was applied to analyze the daily outpatient visits for urticaria diseases. ER and 95% CI were calculated to evaluate the association between every 10 μg/m3 increment of PM pollutants and clinical visits. Increased concentrations of ambient PM2.5, PM10, and PMc were significantly associated with increased numbers of outpatient visits over the 5 years. The largest significant effects for PM2.5, PM10, and PMc on urticaria outpatient visits were observed at lag0, lag6, and lag6, respectively. A 10 μg/m3 increment in concentration of PM2.5, PM10, and PMc were associated with 0.406 (95% CI − 0.093, 0.909), 0.307 (95% CI 0.004, 0.515), and 0.199 (95% CI 0.007, 0.391) increases in urticaria outpatient visits. The younger and elderly populations were susceptible to PM. The association of PM10 and female urticaria outpatient visit was long lag periods, while in males, was short lag periods. PM concentration indicates the increased risk of urticaria. The gaps among both sexes and ages for urticaria should have biological and pollution control implications.

Effect of Gaseous Pollutant Concentration on the Number of Daily Outpatient Visits for Acne in Lanzhou

Objective To determine the relationship between air pollutants [SO2,NO2,8 hours average concentration of ozone(O38h)] and outpatient visits for acne in Lanzhou,China. Methods Data of daily outpatient visits for acne and concentrations of air pollutants(SO2,NO2,and O38h)from January 2013 to December 2017 were collected.With the control of long-term trend and day-of-week effect,a distributed lag nonlinear model was used to analyze the lag and cumulative effects of air pollutants on the outpatient visits.The model was established based on the different groups of gender and age. Results During the study period,the average daily outpatient visits were 34.94±15.27,and the average concentrations of SO2,NO2,and O38h were 24.09,43.77,and 82.94 μg/m3,respectively.The Spearman's correlation analysis showed that the daily outpatient visits for acne were positively correlated with NO2 concentration while negatively correlated with O38h concentration;SO2 concentration was negatively correlated with O38h concentration;NO2 concentration was positively correlated with SO2 and O38h concentrations.A 10 μg/m3 increase in daily concentrations of NO2 and SO2 was respectively associated with 2.61%(95% CI=0.98%-4.27%)and 1.71%(95% CI=0.54%-2.89%)increase in the outpatient visits for acne.A 10 μg/m3 increase in O38h concentration was associated with -0.62%(95% CI=-1.12%--0.11%)increase in the outpatient visits.Multipollutant models indicated that air pollutant concentrations were significantly associated with the daily outpatient visits for acne. Conclusions SO2 and NO2 are positively associated with daily dermatological department visits for acne in Lanzhou,while O38h concentration has a negative correlation with the visits.The sensitivity of acne daily outpatient visits to changes in SO2,NO2,and O38h varies among patients of different genders and at different ages.

NO2 exposure increases eczema outpatient visits in Guangzhou, China: an indication for hospital management

BackgroundAmbient nitrogen dioxide (NO2) is a common air pollutant in developing countries and causes skin conditions, but its effect on eczema in subtropical areas is not clear in China.ObjectTo measure the effect of short-term exposure of NO2 on the incidence of eczema and the change of outpatient visits.MethodsData of daily temperature, air pollutants, and outpatient visits from 2013 to 2018 were collected in a row. The generalized additive model (GAM) and Poisson distribution were used to assess the association between short-term exposure of NO2 and the outpatient visits of patients with eczema. The cumulative exposure effect of lag 0–3 days and the displacement effect of NO2 and other pollutants were considered as well. A single pollutant model was used to examine the independent association, and a two-pollutant model was adopted to control the confounding effect.ResultsThe daily outpatient visits of eczema increased from 75.26 to 190.85 from 2013 to 2018 (P < 0.001). The combined influence of NO2 and the related pollutant exerted a stronger influence on the incidence of eczema. The maximum effect of NO2 appeared on the exposed day.(lag 0) and disappeared on day 4 (lag 3). The children and seniors were more vulnerable to NO2 exposure.ConclusionExposure to NO2 is tightly associated with eczema incidence and outpatient visits. The hospitals should react to the visit fluctuations and adjust physician duty shifts to improve outpatient service efficiency.

Association between short-term exposure to fine particulate pollution and outpatient visits for ulcerative colitis in Beijing, China: A time–series study

Environmental factors play an important role in the development of ulcerative colitis (UC). However, only few studies have examined the effects of air pollution on UC occurrence. We conducted a time–series analysis to explore the association between short-term exposure to fine particulate matter (PM2.5) and outpatient visits for UC in Beijing, China. In total, 84,000 outpatient visits for UC were retrieved from the Beijing Medical Claim Data for Employees between January 1, 2010 and June 30, 2012. Measurements of daily PM2.5 concentrations were obtained from the United States Embassy air-monitoring station. A generalized additive model with quasi-Poisson link was applied to examine the association between PM2.5 concentrations and outpatient visits for UC stratified by sex, age, and season. We found that short-term exposure to PM2.5 was significantly associated with increased daily outpatient visits for UC at lag 0 day. A 10 μg/m3 increase in PM2.5 concentration at lag 0 day corresponded to a 0.32% increase in outpatient visits for UC (95% confidence interval (CI), 0.05–0.58%; P = 0.019). There was a clear concentration–response association between daily outpatient visits for UC and PM2.5 concentrations. The PM2.5 effects were significant across all sex and season subgroups, without evidence of effect modification by sex (P = 0.942) or season (P = 0.399). The association was positive in patients younger than 65 years old but negative in those 65 years old or older, although the difference was not significant (P = 0.883). In conclusion, our study demonstrated that short-term exposure to ambient PM2.5 was significantly associated with an increased risk of daily outpatient visits for UC, especially in younger people. Additional studies are warranted to confirm our findings.

Association between short-term ambient air pollution exposure and depression outpatient visits in cold seasons: a time-series analysis in northwestern China

ABSTRACT Depression is known to be one of the most common mental disorders raising global concerns. However, evidence regarding the association between short-term air pollution exposure and risk of development of depression is limited. The aim of this was to assess the relationship between short-term ambient air pollution exposure and depression in outpatient visits in Xi’an, a northwestern Chinese metropolis. Data for air pollutants including particulate matter (PM10), sulfur dioxide (SO2), and nitrogen dioxide (NO2) levels from October 1, 2010 to December 31, 2013 and number of daily depression outpatient visits (92,387 in total) were collected. A time-series quasi-Poisson regression model was adopted to determine the association between short-term air pollutant concentrations and frequency of outpatient visits for depression with different lag models. Consequently, 10 μg/m3 increase of SO2 and NO2 levels corresponded to significant elevation in number of outpatient-visits for depression on concurrent days (lag 0), and this relationship appeared stronger in cool seasons (October to March). However, the association of PM10 was only significant in males aged 30–50 at lag 0. Evidence indicated that short-term exposure to ambient air pollutants especially in cool seasons might be associated with increased risk of outpatient visits for depression.

The short-term association of ambient fine particulate air pollution with hypertension clinic visits: A multi-community study in Guangzhou, China

BackgroundThe association of ambient fine particulate pollution with daily outpatient clinic visits (OCV) for hypertension in China remains to be investigated. ObjectivesThis study aimed to examine short-term impacts of exposure to fine particulate matter of aerodynamic diameter < 2.5μm (PM2.5) on daily OCV for hypertension, using a large-scale multi-center community database in Guangzhou, one of the most densely-populated cities in Southern China. MethodsWe collected a total of 28,548 individual records of OCV from 22 community healthcare facilities in Guangzhou from January 1st to May 7th 2020. Hourly data on air pollutants and daily information on meteorological factors were obtained. According to the World Health Organization air-quality guidelines, daily excessive concentration hours (DECH) was calculated. PM2.5 daily mean, hourly-peak concentration and DECH were used as the exposure variables. Based on a case-time-control design, the Cox regression model was applied to evaluate the short-term relative risks (RR) of daily OCV for hypertension. Sensitivity analyses were conducted, with nitrogen dioxide, sulfur dioxide, carbon monoxide, and ozone being adjusted. ResultsDaily mean and hourly-peak of PM2.5 were significantly associated with daily OCV for hypertension, while weaker associations were observed for DECH. The estimated RRs at lag day 0 were 1.039 (95% confidence interval [CI]: 1.037, 1.040), 1.851 (95%CI: 1.814, 1.888), and 1.287 (95%CI: 1.276, 1.298), respectively, in association with a 1-unit increase in DECH, daily mean, and hourly-peak concentration of PM2.5. For the lagged effect, lag4 models estimated the greatest RRs for PM2.5 DECH and hourly-peak, whereas a lag2 model produced the highest for PM2.5 daily mean. DiscussionThis study consolidates the evidence for a positive correlation between ambient PM2.5 exposure and risks of hypertensive OCV. It also provides profound insight regarding planning for health services needs and establishing early environmental responses to the worsening air pollution in the communities.

Short-term exposure to nitrogen dioxide and outpatient visits for cause-specific conjunctivitis: A time-series study in Jinan, China

BackgroundThough the conjunctiva are directly contacting with the atmospheric environment, the association between air pollution and conjunctival disease has not been well documented. ObjectiveTo explore the association between ambient nitrogen dioxide (NO2) and daily outpatient visits for cause-specific conjunctivitis in Jinan, China. MethodsDaily concentrations of air pollution were obtained from the air quality sharing platform of China, and daily outpatient visits for conjunctivitis were collected from Qilu Hospital. The association between daily NO2 level and outpatient visits for conjunctivitis was examined by a generalized additive Poisson model, and stratified analyses by sex, age and season were further performed. ResultsA total of 42,123 outpatient visits for conjunctivitis were recorded during 2014–2019, including 8504 infective conjunctivitis, 6429 allergic conjunctivitis and 27,190 unspecified conjunctivitis. Each 10 μg/m3 increase in NO2 was associated with a 1.00% (95% CI: 0.13%, 1.87%) increment in daily outpatient visits for conjunctivitis. Significant associations between NO2 and conjunctivitis were observed in the female population [excess risk, ER = 1.09% (95% CI: 0.05%, 2.15%)], in people aged 18–65 years [ER = 1.15% (95% CI: 0.15%, 2.15%)] and in cold season [ER = 1.67% (95% CI: 0.58%, 2.77%)]. Moreover, we also found significant associations of NO2 with infective conjunctivitis [ER = 2.60% (95% CI: 0.69%, 4.54%)], but not with allergic conjunctivitis [ER = −0.43% (95% CI: −2.38%, 1.56%)]and unspecified conjunctivitis [ER = 0.16% (95% CI: −0.96%, 1.29%)]. ConclusionThis study suggests that short-term exposure to NO2 might induce conjunctivitis, and air pollution control measures should be encouraged to keep ocular surface healthy.

Impact of solar ultraviolet radiation on daily outpatient visits of atopic dermatitis in Shanghai, China.

The potential roles of solar ultraviolet radiation (UVR) as an environmental risk factor in inducing atopic dermatitis (AD) have not been well quantified. To determine the short-term associations between UVR and AD outpatient visits, we obtained daily outpatient visits of AD in Shanghai Skin Disease Hospital from 2013 to 2018. Data of hourly ground UVR were collected. We applied overdispersed generalized additive model to explore its associations. We found that daily exposure to UVR-A rather than UVR-B was positively associated with AD outpatient visits. The visits increased on the present day (lag 0 days) and decreased appreciably with longer lags and became insignificant at lag 4 days. For 10 w/m2 increase in daytime mean and noontime mean exposure to overall UVR and UVR-A from lag 0 to 6 days, the cumulative relative risk of AD was 1.12/1.13 and 1.08/1.08, respectively. Stronger effects of UVR exposure on AD occurred in patients aged 0-7 and > 45 years and in the cold seasons. This study contributed to the few epidemiological evidences that acute exposure to solar UVR may elevate the risks of AD.