Hospitalizations For Respiratory Diseases Research Articles

PM2.5-related health and economic loss assessment for 338 Chinese cities

China is in a critical stage of ambient air quality management after global attention on pollution in its cities. Industrial development and urbanization have led to alarming levels of air pollution with serious health hazards in densely populated cities. The quantification of cause-specific PM2.5-related health impacts and corresponding economic loss estimation is crucial for control policies on ambient PM2.5 levels. Based on ground-level direct measurements of PM2.5 concentrations in 338 Chinese cities for the year 2016, this study estimates cause-specific mortality using integrated exposure-response (IER) model, non-linear power law (NLP) model and log-linear (LL) model followed by morbidity assessment using log-linear model. The willingness to pay (WTP) and cost of illness (COI) methods have been used for PM2.5-attributed economic loss assessment. In 2016 in China, the annual PM2.5 concentration ranged between 10 and 157 μg/m3 and 78.79% of the total population was exposed to >35 μg/m3 PM2.5 concentration. Subsequently, the national PM2.5-attributable mortality was 0.964 (95% CI: 0.447, 1.355) million (LL: 1.258 million and NPL: 0.770 million), about 9.98% of total reported deaths in China. Additionally, the total respiratory disease and cardiovascular disease-specific hospital admission morbidity were 0.605 million and 0.364 million. Estimated chronic bronchitis, asthma and emergency hospital admission morbidity were 0.986, 1.0 and 0.117 million respectively. Simultaneously, the PM2.5 exposure caused the economic loss of 101.39 billion US$, which is 0.91% of the national GDP in 2016. This study, for the first time, highlights the discrepancies associated with the three commonly used methodologies applied for cause-specific mortality assessment. Mortality and morbidity results of this study would provide a measurable assessment of 338 cities to the provincial and national policymakers of China for intensifying their efforts on air quality improvement.

Burden and Epidemiology of Influenza- and Respiratory Syncytial Virus-Associated Severe Acute Respiratory Illness Hospitalization in Madagascar, 2011-2016

Burden and Epidemiology of Influenza- and Respiratory Syncytial Virus-Associated Severe Acute Respiratory Illness Hospitalization in Madagascar, 2011-2016

Anxiety and depression among patients at a tertiary care respiratory clinic in Sri Lanka

Background Chronic respiratory diseases are associated with increased risk of mood and anxiety disorders. These disorders in turn may lead to frequent hospital admissions and lower treatment adherence among patients with respiratory disease. Aims The objective of this study was to describe the prevalence of anxiety and depression among patients with chronic lung diseases and their association with socio demographic factors. Methods A descriptive cross sectional study was conducted among patients at a respiratory outpatient clinic at the National Hospital for Respiratory Diseases, Welisara. Demographic data was collected using an interviewer administered questionnaire; a selfadministered Hospital Anxiety and Depression scale was used to examine for the presence of anxiety or depression. Consecutive patients who gave written informed consent to were included in the study. Results A total of 451 patients were participated in the study, of whom 274 (60.8%) were females. The mean age was 57.4 (SD=15.3) years and the majority (74.7%) were married. The education level of 226 (50.1%) was between grade 5 and grade 11. There was no permanent income for 196 (43.5%). The majority had bronchial asthma (60.3%) and 151 (33.5%) had one or more co-morbid medical illness. The mean score for the anxiety component was 6.78 (SD=3.59) and for the depression component it was 7.03 (SD=3.11). Seventy (15.5%) screened positive for anxiety and another 100 (22.2%) were doubtful cases. Sixty five (14.4%) screened positive for depression and another 128 (28.4%) were doubtful cases. Participants who were unmarried, divorced, separated or widowed had significantly higher levels of anxiety compared to those who were married (p=0.005). Patients who had a monthly income also had more anxiety compared to those who did not have an income (p=0.003). Conclusions One fifth of the patients attending the respiratory clinic screened positive for anxiety and depression. This indicates the importance of addressing the psychological morbidity among patients with chronic lung disease.

Health Impacts of Citywide and Localized Power Outages in New York City.

Background:Previous studies investigated potential health effects of large-scale power outages, including the massive power failure that affected the northeastern United States and Ontario, Canada, in August 2003, and outages associated with major storms. However, information on localized outages is limited.Objective:The study sought to examine potential health impacts of citywide and localized outages in New York City (NYC).Methods:Along with the citywide 2003 outage, localized outages in July 1999 and July 2006 were identified. We additionally investigated localized, warm- and cold-weather outages that occurred in any of 66 NYC electric-grid networks during 2002–2014 using New York State Public Service Commission data. Mortality and hospitalizations were geocoded and linked to the networks. Associations were estimated using Poisson time-series regression, including examining distributed lags and adjusting for temperature and temporal trends. Network-specific estimates were pooled by season.Results:Respiratory disease hospitalizations were associated with the 2006 localized outage [cumulative relative risk [CRR] over 0–1 lag day, (95% confidence interval [CI]: 1.08, 4.74)] and the 2003 citywide outage, but not with other localized, warm-weather outages. Renal disease hospitalizations were associated with the 2003 citywide outage, and with localized, warm-weather outages, pooled across networks [RR at (95% CI: 1.00, 1.34)], but not the 2006 localized outage. All-cause mortality was positively associated with the 1999, 2003, and 2006 outages (significant for the 2003 outage only), but not with other localized, warm-weather outages. Localized, cold-weather outages were associated with all-cause mortality [ (95% CI: 1.01, 1.12)] and cardiovascular disease hospitalizations [ (95% CI: 1.03, 1.26)], and fewer respiratory disease hospitalizations [ (95% CI: 0.61, 0.97)].Conclusions:Localized outages may affect health. This information can inform preparedness efforts and underscores the public health importance of ensuring electric grid resiliency to climate change. https://doi.org/10.1289/EHP2154

The Relationship Between Laoshan Winds and Respiratory and Cardiovascular Diseases in Hengchun Peninsula, Taiwan

Background: The north-easterly monsoons originating from Siberia-Mongolia predominantly determine the weather patterns during the cold and dry seasons in Taiwan. Laoshan Winds (LWs), which have been recorded since 1894, can influence agricultural activities and cause an increase in the amount of dust during the dry period in the Hengchun Peninsula. Methods: This study investigated the associations among weather changes, Particulate Matter (PM), LW, and public health impact in Hengchun Peninsula during January to April and October to December 2006 to 2010. The data regarding weather conditions, PM with aerodynamic diameters smaller than or equal to 2.5 μm (PM2.5), PM with aerodynamic diameters smaller than or equal to 10 µm (PM10), and hospital and clinic admissions for respiratory and cardiovascular diseases were obtained from several governmental sources in Taiwan. Disease admissions data were categorised to four age groups: zero to four: Infants, five to fourteen: Children, 15 to 64: Adults; and > 65: Elderly. The Australian apparent temperature, poisson regression model, and parametric test (z statistic for a one-tailed test) were used to analyse the data. Results: The results showed that LWs cause a significant reduction in relative humidity and surface air temperature and a significant increase in air pressure and wind speed, which induces a significant decrease in the apparent temperature. Significant increases were noted in the mean number of admissions in the adults group for respiratory diseases; there was a 13.4% [95% CI, 2.13% to 25.8%] increase on the LW days (P < 0.05). Conclusions: These results imply that the LWs along with the cold weather and strong local winds caused an increase in the incidence of respiratory diseases, which was also associated with winter monsoon and topographical characteristics.

Respiratory syncytial virus prophylaxis in cystic fibrosis: the Canadian registry of palivizumab data (2005-2016).

Respiratory syncytial virus (RSV) may cause severe illness in cystic fibrosis (CF) children, but recommendations vary on prophylaxis. CARESS is a prospective registry of children who received palivizumab in 32 Canadian sites from 2005 to 2016. Demographic data were collected at enrollment and respiratory illness-related events recorded monthly. We reviewed respiratory illness hospitalization (RIH) and RSV hospitalization (RSVH) in CF children aged < 24months versus those prophylaxed for standard indications (SI; prematurity, chronic lung disease [CLD] and congenital heart disease [CHD]), and complex medical disorders (CM). Of 23,228 children analyzed, 19,452 (83.8%) were SI, 3349 (14.4%) were CM, and 427 (1.8%) were CF. CF children were more likely to be Caucasian, heavier at birth and enrollment, and less likely to have a sibling or live in crowded conditions. CF children were similar to the other groups in daycare attendance, history of atopy, and exposure to smoking. RIH incidences were 4.3% (premature), 13.8% CLD, 11.5% CHD, 11.7% CM, and 6.8% CF. RSVH incidence in CF children was similar to that in the SI and CM groups: 1.1, 1.5, and 2.0% groups respectively. Cox regression analyses showed that compared to CF children, the HRs for RSVH in SI (HR 2.0 95% CI 0.5-8.3, p = 0.3) and CM (HR 2.4, 95% CI 0.6-9.8, p = 0.2) did not differ. CF children are equally at risk for RSVH relative to those prophylaxed for other indications. Pending robust evidence from prospective trials, palivizumab could perhaps be considered in the interim, for young CF patients born early during the RSV season with evidence of serious lung disease.

PIN20 - Respiratory Illness (RI) and Respiratory Syncytial Virus (RSV)-Related Hospitalization (RSVH) in Infants with Congenital Diaphragmatic Hernia (CDH) in the Caress Registry (2005-2017)

To compare the hazard ratio for RI hospitalization (RIH) and RSVH in CDH infants versus: 1) non- risk infants (NR; those without morbidities, who received RSV prophylaxis as part of multiple births) and 2) infants prophylaxed for standard indications (SI; prematurity ≤35 weeks gestational age, chronic lung disease or significant congenital heart disease) in the Canadian RSV Evaluation Study of Palivizumab (CARESS). CARESS is a prospective study of children who received ≥1 injection of palivizumab across 32 Canadian sites. Neonatal and demographic data were collected at enrolment. Utilization, adherence, and respiratory illness event data were collected monthly. Demographic comparisons were performed using t-tests and chi-square tests. Cox proportional hazards analyses were conducted to compare RIH and RSVH risks across groups adjusted for potential confounders. 25,003 infants were enrolled; 163 CDH, 339 NR, and 20,551 SI. Palivizumab adherence, defined as receiving all expected injections during the RSV season within appropriate dose intervals, was 75% overall and similar across groups. 1724 infants were hospitalized on 2054 occasions (crude RIH rates: CDH 8.6%; NR: 2.4%; SI: 6.2%). CDH infants had a significantly increased RIH risk versus NR (HR=2.6, 95%CI 1.0-6.7, p=0.05) but not SI infants (HR= 1.0, 95%CI 0.6-1.8, p=0.92). Crude RSVH rates were: 0.6% (CDH), 0.3% (NR), and 1.3% (SI), with no significant difference in RSVH risk between CDH infants and the other two groups (NR: HR= 2.5, 95%CI 0.2-40.4, p=0.52; SI: HR= 0.6, 95%CI 0.1-4.3, p=0.61). Due to lung abnormalities and complex ventilation modalities in the neonatal period, CDH infants had an approximately 3-fold increased risk of RIH compared to NR but not SI infants. RSVH risk was similar across all groups. These findings imply that CDH infants may benefit from palivizumab, similar to other high risk groups.

Working at a dedicated hospital for respiratory diseases from the perspective of an anesthesiologist

Despite subsequent improvements at the last eighty years, thoracic surgery is still ranked at top spots by means of mortality and morbidity on the occasion of dealing with high risk patients mostly. This fact legitimates the stress and anxiety of anesthesiologists employed in high-volume thoracic surgery centers. To evaluate the level of satisfaction and determine major concerns, a survey was formed and sent to 30 anesthesiologists working at four major centers dedicated to respiratory diseases. 19 Replies were received and the collected data was shared. Degree of expertise and how it had been gained, quantity of night shifts, measures of personal relationships, availability of certain diagnostic and therapeutic tools, contribution to research activities and eventually level of satisfaction at all was questioned and ratings were noted. The level of acceptable satisfaction was determined to be 68.4%. Major concerns were seemed to be excess of night shifts; inability to use certain modalities like ecmo, ila, picco, ultrasound and video laryngoscopy; inadequate participation at research acts, and unfavorable inter-disciplinary relationships. Participants specified basic potential improvements to overcome these adversities as taking place in scientific activities and publishing process more frequently(38.8%) And regulating personal relationships (36.8%). Concisely, by taking concrete steps for solving these issues, a favorable work environment can be consituted. It is mandatory to emphasize that reciprocal acts of both anesthesists and respiratory disease specialists will certainly help promoting not only the institutions but also the quality of health service.

Virome and bacteriome characterization of children with pneumonia and asthma in Mexico City during winter seasons 2014 and 2015.

BackgroundAcute asthma exacerbations and pneumonia are important causes of morbidity and mortality in children and may coexist in the same children, although symptom overlap may lead to difficulties in diagnosis. Microbial and viral diversity and differential abundance of either may play an important role in infection susceptibility and the development of acute and chronic respiratory diseases.ObjectivesTo describe the virome and bacteriome present in the upper respiratory tract of hospitalized children with a clinical diagnosis of asthma and pneumonia during an acute exacerbation and an acute respiratory illness ARI episode respectively.MethodsDuring the winter seasons of 2013–2014 and 2014–2015, 134 nasopharyngeal swabs samples of children <15 years of age with ARI hospitalized at a referral hospital for respiratory diseases were selected based on clinical diagnosis of asthma or pneumonia. The virome and bacteriome were characterized using Whole Genome Sequencing (WGS) and in-house bioinformatics analysis pipeline.ResultsThe Asthma group was represented mainly by RV-C, BoV-1 and RSV-B and the pneumonia group by Bacteriophage EJ-1 and TTMV. TTV was found in both groups with a similar amount of reads. About bacterial composition Moraxella catarrhalis, Propionibacterium acnes and Acinetobacter were present in asthma and Veillonella parvula and Mycoplasma pneumoniae in pneumonia. Streptococcus pneumoniae and Haemophilus influenzae were mostly found with both asthma and pneumonia.ConclusionsOur results show a complex viral and bacterial composition in asthma and pneumonia groups with a strong association of RV-C presence in asthmatic children. We observed Streptococcus pneumoniae and Haemophilus influenzae concurrently in both groups.

The effects of climate on hospitalization for respiratory diseases by age group

The effects of climate on hospitalization for respiratory diseases by age group

Finding Out the Possibilities of Improving OPD Services

Introduction: National Hospital for Respiratory Diseases (NHRD) at Welisara is the Premier tertiary care hospital in Sri Lanka for respiratory diseases. No studies have been done in its OPD set up to collect data which could have been invaluable for future planning and implementation. This study was done to gather such vital information in view of improving services rendered by NHRD OPD. Few parameters like socio-demographic details, distance to the hospital, cost for the visit, having a referral letter given by a doctor, number of persons accompanied the patient and reasons to visit NHRD were studied.Methodology: This was a descriptive cross sectional study of patients who attended OPD of NHRD. Interviewer administered questionnaire was given to randomly selected 420 patients who were above 18 years of age and who were on their first visit to the hospital.Results: Majority of patients were less educated and were coming from a low socio-economic background. Both sexes presented equally to the OPD. 68% of patients were coming from within 20 km of distance from the hospital and for 62%, the cost for the visit was found to be 200 rupees or less. Only for 7% of people, NHRD was the nearest hospital. 95% of patients has presented with respiratory related conditions while only 2% had a referral letter with them. Most of the patients (around 80%) were accompanied by 2 or 3 persons. More than 70% visited NHRD due to its reputation as the leading hospital in the country for respiratory diseases.Conclusion: Middle aged less educated people with a low socio-economic status were the people who mostly visited the NHRD OPD. Most had respiratory system related presenting complaints. This is of significance and should be considered in giving health education to these patients. Majority of the patients resided close by to the hospital and their cost for the visit roughly showed similarities to the distances they travel. Though most patients visit NHRD after using nearby health facilities, lack of a proper referral system and accompained too many people can worsen the overcrowding at OPD. Strengthening the usage of nearby healthcare facilities can reduce this as NHRD was found to be the nearest hospital for very few of this population. Most common reason for visiting NHRD OPD was the reputation NHRD has gained as the leading hospital of the country for Respiratory disease, which should be conserved.

HRCT morphological characteristics distinguishing minimally invasive pulmonary adenocarcinoma from invasive pulmonary adenocarcinoma appearing as subsolid nodules with a diameter of ≤3 cm

To differentiate retrospectively the morphological characteristics at high-resolution computed tomography (CT) between minimally invasive pulmonary adenocarcinoma (MIA) and invasive pulmonary adenocarcinoma (IAC) appearing as subsolid nodules (SNs) with a diameter of ≤3cm and to provide information to help operative decision-making. The patient notes of 260 patients with SNs of ≤3cm in diameter (98 with MIA and 162 with IAC) confirmed at surgery and histopathology from September 2008 to June 2012 were reviewed retrospectively at the Department of Radiology, Weifang Respiratory Disease Hospital. Sixty-seven patients had pure ground-glass nodules (PGGNs) and 193 had mixed ground-glass nodules (MGGNs). Patients were grouped according to the final pathology: minimally invasive MIA and IAC. The HRCT characteristics were compared between the two groups. There were statistically significant differences in the pattern, shape, diameter of solid components, proportion of solid components, CT radiodensity values of the ground-glass and solid components, borders, margins, air bronchograms, microvascular signs, and pleural indentations of the nodules between the two groups (all p<0.05). Multivariate and receiver operating characteristic (ROC) analyses indicated significant predictors of MIAs were as follows: small lesion diameter (≤14.7mm), solid components ≤7mm, <50% of solid components, low CT radiodensity values of the solid components (≤-107HU), air bronchograms in the ground-glass opacity components, and microvascular signs. The morphological characteristics at high-resolution CT can be used to differentiate between MIAs and IACs appearing as SNs with a diameter of ≤3cm and provide information to help operative decision-making.

The national burden of influenza‐associated severe acute respiratory illness hospitalization in Zambia, 2011‐2014

BackgroundEstimates of influenza‐associated hospitalization are limited in low‐ and middle‐income countries, especially in Africa.ObjectiveTo estimate the national number of influenza‐associated severe acute respiratory illness (SARI) hospitalization in Zambia.MethodsWe conducted active prospective hospital‐based surveillance for SARI at the University Teaching Hospital (UTH) situated in Lusaka Province during 2011‐2014. Upper respiratory tract samples were tested for influenza virus using a reverse transcriptase polymerase chain reaction assay. We estimated age‐specific rates of influenza‐associated SARI hospitalizations for the UTH using census and secondary data on respiratory hospitalizations following estimation approaches recommended by the World Health Organization. We used the UTH hospitalization rates as a proxy for Lusaka Province. These rates were adjusted for each of the remaining 9 provinces based on their prevalence of risk factors for pneumonia and healthcare‐seeking behavior. Rates were expressed per 100,000 population.Results SARI cases accounted for 77.1% (13 389/17 354) of respiratory admissions at the UTH; 82.7% (11 859/14 344) and 50.8% (1530/3010) among individuals aged <5 and ≥5 years, respectively. Among SARI cases tested, the influenza virus detection rate was 5.5% (152/2734), 4.8% (48/998), and 6.0% (104/1736) among individuals aged <5 and ≥5 years, respectively. The mean annual national number of influenza‐associated SARI hospitalizations was 6181 (95% CI: 4321‐8041—rate: 43.9; 95% CI: 30.7‐57.1); 4669 (95% CI: 3287‐6051—rate: 187.7; 95% CI: 132.1‐243.3) among children aged <5 years; and 1512 (95% CI: 1037‐1987—rate: 13.1; 95% CI: 9.0‐17.2) among individuals aged ≥5 years.ConclusionsThe burden of influenza‐associated SARI hospitalizations was substantial and was highest among children aged <5 years.

Air pollution and hospitalizations in the largest Brazilian metropolis.

ABSTRACTOBJECTIVE To evaluate the impact of air pollution on hospitalizations for respiratory and cardiovascular diseases in the largest Brazilian metropolis.METHODS This study was carried out at the Metropolitan Region of São Paulo, Brazil. Environmental data were obtained from the network of monitoring stations of nine municipalities. Air pollution exposure was measured by daily means of PM10 (particles with a nominal mean aerodynamic diameter ≤ 10 μm) per municipality, while daily counts of hospitalizations for respiratory and cardiovascular diseases within the Brazilian Unified Health System were the outcome. For each municipality a time series analysis was carried out in which a semiparametric Poisson regression model was the framework to explain the daily fluctuations on counts of hospitalizations over time. The results were combined in a meta-analysis to estimate the overall risk of PM10 in hospitalizations for respiratory and cardiovascular diseases at the Metropolitan Region of São Paulo.RESULTS Regarding hospitalizations for respiratory diseases, the effect estimates were statistically significant (p < 0.05) for all municipalities, except Santo André and Taboão da Serra. The RR (Relative Risk) of this outcome for an increase of 10 µg/m3 in the levels of PM10 ranged from 1.011 (95%CI 1.009–1.013) for São Paulo to 1.032 (95%CI 1.024–1.040) in São Bernardo do Campo. The RR of hospitalization for respiratory diseases in children for an increase of 10 µg/m3 of PM10 ranged from 1.009 (95%CI 1.001–1.017) in Santo André to 1.077 (95%CI 1.056–1.098) in Mauá. Only São Paulo and São Bernardo do Campo presented positive and statistically significant results for hospitalizations for cardiovascular diseases.CONCLUSIONS This is the first study to estimate the risk of illness from air pollution in the set of municipalities of the Metropolitan Region of São Paulo, Brazil. Global estimates of the effect of exposure to pollution in the region indicated associations only with respiratory diseases. Only São Paulo and São Bernardo do Campo showed an association between the levels of PM10 and hospitalizations for cardiovascular diseases.

The national burden of influenza-associated severe acute respiratory illness hospitalization in Rwanda, 2012-2014.

BackgroundEstimates of influenza‐associated hospitalization are severely limited in low‐ and middle‐income countries, especially in Africa.ObjectivesTo estimate the national number of influenza‐associated severe acute respiratory illness (SARI) hospitalization in Rwanda.MethodsWe multiplied the influenza virus detection rate from influenza surveillance conducted at 6 sentinel hospitals by the national number of respiratory hospitalization obtained from passive surveillance after adjusting for underreporting and reclassification of any respiratory hospitalizations as SARI during 2012‐2014. The population at risk was obtained from projections of the 2012 census. Bootstrapping was used for the calculation of confidence intervals (CI) to account for the uncertainty associated with all levels of adjustment. Rates were expressed per 100 000 population. A sensitivity analysis using a different estimation approach was also conducted.Results SARI cases accounted for 70.6% (9759/13 813) of respiratory admissions at selected hospitals: 77.2% (6783/8786) and 59.2% (2976/5028) among individuals aged <5 and ≥5 years, respectively. Overall, among SARI cases tested, the influenza virus detection rate was 6.3% (190/3022): 5.7% (127/2220) and 7.8% (63/802) among individuals aged <5 and ≥5 years, respectively. The estimated mean annual national number of influenza‐associated SARI hospitalizations was 3663 (95% CI: 2930‐4395—rate: 34.7; 95% CI: 25.4‐47.7): 2637 (95% CI: 2110‐3164—rate: 168.7; 95% CI: 135.0‐202.4) among children aged <5 years and 1026 (95% CI: 821‐1231—rate: 11.3; 95% CI: 9.0‐13.6) among individuals aged ≥5 years. The estimates obtained from both approaches were not statistically different (overlapping CIs).ConclusionsThe burden of influenza‐associated SARI hospitalizations was substantial and was highest among children aged <5 years.

Impact of the use of immunoglobulin palivizumab in the State of São Paulo: a cohort study

ABSTRACTIntroduction:the use of palivizumab as prophylaxis of the respiratory syncytial virus is not a consensus. In Brazil, it is a public health program, but other countries do not consider it cost-effective. Objective:to identify the rate of hospitalization in Intensive Care Unit for respiratory illness or symptoms among children who received the immunoglobulin palivizumab, the proportion of children who failed to take any of the recommended doses and the impact of that failure on hospitalization. Method:cohort study conducted with 693 children enrolled in the palivizumab program in 2014 (85.1% of the population), with monthly assessment from April to September through a telephone call to the mothers or caregiver. The probability of hospitalization in the Intensive Care Unit related to failure in taking the palivizumab, was analyzed through multiple logistic regression, with p<0,05. Results:the hospitalization rate was 18.2%; 2.3% of the children did not receive all the recommended immunoglobulin doses; the probability of hospitalization for respiratory illness or symptoms increased by an average of 29% at each missed dose (p=0.007; OR=1.29, CI=1.07-1.56). Conclusion:the increase in the chance of hospitalization related to missed immunoglobulin doses indicates the need to implement health education actions and active search for absent children by the health services.

Estimating the Causal Effect of Low Levels of Fine Particulate Matter on Hospitalization.

In 2012, the EPA enacted more stringent National Ambient Air Quality Standards (NAAQS) for fine particulate matter (PM2.5). Few studies have characterized the health effects of air pollution levels lower than the most recent NAAQS for long-term exposure to PM2.5 (now 12 μg/m). We constructed a cohort of 32,119 Medicare beneficiaries residing in 5138 US ZIP codes who were interviewed as part of the Medicare Current Beneficiary Survey (MCBS) between 2002 and 2010 and had 1 year of follow-up. We considered four outcomes: all-cause hospitalizations, hospitalizations for circulatory diseases and respiratory diseases, and death. We found that increasing exposure to PM2.5 from levels lower than 12 μg/m to levels higher than 12 μg/m is associated with increases in all-cause admission rates of 7% (95% CI = 3%, 10%) and in circulatory admission hazard rates of 6% (95% CI = 2%, 9%). When we restricted analysis to enrollees with exposure always lower than 12 μg/m, we found that increasing exposure from levels lower than 8 μg/m to levels higher than 8 μg/m increased all-cause admission hazard rates by 15% (95% CI = 8%, 23%), circulatory by 18% (95% CI = 10%, 27%), and respiratory by 21% (95% CI = 9%, 34%). In a nationally representative sample of Medicare enrollees, changes in exposure to PM2.5, even at levels consistently below standards, are associated with increases in hospital admissions for all causes and cardiovascular and respiratory diseases. The robustness of our results to inclusion of many additional individual level potential confounders adds validity to studies of air pollution that rely entirely on administrative data.

Assessment of hospitalization and mortality from exposure to PM10 using AirQ modeling in Ilam, Iran.

The aims of this study were to assess the health impact of PM10 on inhabitants and to investigate the trend of PM10 concentrations in Ilam, Iran, from 2012 to 2015. For these aims, daily average concentration of PM10 was obtained from continuous monitoring stations in the study area. Mortality and morbidity due to PM10 were assessed by AirQ software developed by World Health Organization (WHO). Based on the results, the annual mean concentrations of PM10 in all of years were more than WHO guideline and PM10 concentration had a decreasing trend in this study period. Total mortality attributed to PM10 was found to be 49 cases in 2012, 25 in 2013, and 33 in 2014. Hospital admission due to respiratory diseases was the most impact due to PM10. Increase in relative risk (RR) with every 10μg/m3 increase in PM10 from 2012 to 2015years for total mortality, respiratory disease hospitalization, and hospital admissions were 0.6, 0.8, and 0.9%, respectively. The results of this study indicated that air pollution is one of the major problems in this urban area and AirQ model as simple tool can help to design preventive and controlling programs in order to reduce human health effects of pollutants.

Contributions of COPD, asthma, and ten comorbid conditions to health care utilization and patient-centered outcomes among US adults with obstructive airway disease.

BackgroundAmong persons with obstructive airway disease, the relative contributions of chronic obstructive pulmonary disease (COPD), asthma, and common comorbid conditions to health care utilization and patient-centered outcomes (PCOs) have not been previously reported.MethodsWe followed a total of 3,486 persons aged ≥40 years with COPD, asthma, or both at baseline, from the Medical Expenditure Panel Survey (MEPS) cohorts enrolled annually from 2008 through 2012 for 1 year. MEPS is a prospective observational study of US households recording self-reported COPD, asthma, and ten medical conditions: angina, arthritis, cancer, coronary heart disease, cognitive impairment, diabetes, hypertension, lung cancer, myocardial infarction, and stroke/transient ischemic attack. We studied the separate contributions of these conditions to health care utilization (all-cause and respiratory disease hospitalization, any emergency department [ED] visit, and six or more outpatient visits) and PCOs (seven or more days spent in bed due to illness, incident loss of mobility, and incident decline in self-perceived health).ResultsCOPD made the largest contributions to all-cause and respiratory disease hospitalization and ED visits, while arthritis made the largest contribution to outpatient health care. Arthritis and COPD, respectively, made the greatest contributions to the PCOs.ConclusionCOPD made the largest and second largest contributions to health care utilization and PCOs among US adults with obstructive airway disease. The twelve medical conditions collectively accounted for between 52% and 61% of the health care utilization outcomes and between 53% and 68% of the PCOs. Cognitive impairment, diabetes, hypertension, and stroke also made significant contributions.

Associations of short-term exposure to air pollution with respiratory hospital admissions in Arak, Iran

BackgroundAmbient air pollution, is one of the most frequently stated environmental problems. Many epidemiological studies have documented adverse health effects for ambient air pollution. This study aimed to investigate the association between ambient air pollution and respiratory hospital admissions.MethodsIn this ecological time series study data about air pollutant concentrations including CO, NO2, O3, PM2.5, PM10 and SO2 and, respiratory hospital admissions in the urban population of Arak, from January 1st 2010 to December 31st 2015; were inquired, from the Arak Department of Environment, and two major hospitals, respectively. Meteorological data were inquired for the same period as well. Time-series regression analysis with a distributed lag model, controlled for seasonality long-time trends, weather and day of the week, was used for data analysis.ResultsEvery 10 μg/m3 increase in NO2, and PM10 and every 1 mg/m3 increase in CO at lag 0 corresponded to a RR = 1.032 (95%CI, 1.003–1.06), RR = 1.01 (95%CI, 1.004–1.017) and RR = 1.09 (95%CI, 1.04–1.14), increase in respiratory disease hospitalizations, respectively. Males and the elderly were found to be more susceptible than females and other age groups to air pollutants in regard to respiratory disease admissions.ConclusionsThe results of this study showed that outdoor air pollutants significantly increase respiratory hospital admissions; especially among the men and elders in Arak.