Respiratory Outpatient Visits Research Articles

The interactive effect of extreme weather events and PM2.5 on respiratory health among the elderly: a case-crossover study in a high-altitude city.

With climate change posing increasing threats and aging populations, understanding the complex relationship between extreme temperatures, PM2.5 pollution, and respiratory health among the elderly is crucial. While some research exists, there remains a significant gap in studying the combined effects of heat waves, cold spells, and PM2.5 on elderly respiratory health in high-altitude regions. We collected data from Xining (2016-2021), including respiratory disease outpatient visits, meteorological, and pollutant data. Employing a case-crossover design and conditional Poisson regression analysis, we investigated the individual and interactive impacts of heat wave, cold spell, and PM2.5 on outpatient visits for respiratory disease among the elderly. We used the relative excess odds due to interaction (REOI), proportion attributable to interaction (AP), and synergy index (S) as quantitative indicators of interaction. Our analysis revealed significant associations between heat wave, cold spell, PM2.5 exposure, and outpatient visits for respiratory disease among the elderly, with odds ratios of 1.10 (95%CI: 1.06, 1.15) and 1.16 (95%CI: 1.13, 1.20), respectively. Moreover, a synergistic effect between cold spell and PM2.5 was observed, particularly affecting vulnerable groups such as female and those aged ≥ 80. The combined exposure to cold spell and elevated PM2.5 levels was estimated to contribute to up to 0.18 (95%CI: 0.17, 0.27) of respiratory outpatient visits. This study underscores the need for urgent interventions, such as reducing PM2.5 exposure and enhancing extreme weather warning systems, to protect the respiratory health of the elderly, especially in high-altitude regions.

Cold waves and fine particulate matter in high-altitude Chinese cities: assessing their interactive impact on outpatient visits for respiratory disease.

Extreme weather events like heatwaves and fine particulate matter (PM2.5) have a synergistic effect on mortality, but research on the synergistic effect of cold waves and PM2.5 on outpatient visits for respiratory disease, especially at high altitudes in climate change-sensitive areas, is lacking. we collected time-series data on meteorological, air pollution, and outpatient visits for respiratory disease in Xining. We examined the associations between cold waves, PM2.5, and outpatient visits for respiratory disease using a time-stratified case-crossover approach and distributional lag nonlinear modeling. Our analysis also calculated the relative excess odds due to interaction (REOI), proportion attributable to interaction (AP), and synergy index (S). We additionally analyzed cold waves over time to verify climate change. Under different definitions of cold waves, the odds ratio for the correlation between cold waves and outpatient visits for respiratory disease ranged from 0.95 (95% CI: 0.86, 1.05) to 1.58 (1.47, 1.70). Exposure to PM2.5 was significantly associated with an increase in outpatient visits for respiratory disease. We found that cold waves can synergize with PM2.5 to increase outpatient visits for respiratory disease (REOI > 0, AP > 0, S > 1), decreasing with stricter definitions of cold waves and longer durations. Cold waves' independent effect decreased over time, but their interaction effect persisted. From 8.1 to 21.8% of outpatient visits were due to cold waves and high-level PM2.5. People aged 0-14 and ≥ 65 were more susceptible to cold waves and PM2.5, with a significant interaction for those aged 15-64 and ≥ 65. Our study fills the gap on how extreme weather and PM2.5 synergistically affect respiratory disease outpatient visits in high-altitude regions. The synergy of cold waves and PM2.5 increases outpatient visits for respiratory disease, especially in the elderly. Cold wave warnings and PM2.5 reduction have major public health benefits.

The influence of PM2.5 exposure duration and concentration on outpatient visits of urban hospital in a typical heavy industrial city.

To explain the duration and dose effects of pollutant exposure on public health and provide scientific data for air pollution prevention and control and disease prevention by examining the influence of PM2.5 concentration and exposure duration on daily outpatient visits among patients with cardiovascular, cerebrovascular, and respiratory diseases in a typical heavy industrial city in China. Daily outpatient data on cardiovascular, cerebrovascular, and respiratory diseases and regional PM2.5 exposure duration and concentration were collected from a provincial hospital in Taiyuan, China, from 2016 to 2021. The correlations of numeric variables were analyzed using the Pearson correlation method. A generalized additive model (GAMs) was also established to investigate the effects of PM2.5 concentration and exposure duration on outpatient visits. Correlation analysis showed that the outpatient visits in Taiyuan was significantly correlated with the PM2.5 concentration and exposure duration. The longer the exposure time of PM2.5 pollution, the stronger the correlation of PM2.5 with outpatient visits showed. Cardiovascular outpatient visits were extremely significant related with medium to long-term exposure of PM2.5 (exposure with more than 30days) (p < 0.001). In addition, outpatient visits of cerebrovascular and respiratory disease were extremely significant correlated with PM2.5 (exposures within 0-360days) (p < 0.001). The results of GAMs showed the linear or the nonlinear relationships between outpatient visits and exposure of PM2.5. Among the linear relationships, when average concentration of PM2.5 (exposure within less than 15days) increased by 1mg/m3, the cardiovascular outpatient visits increased most dramatically (by about 440 people). For nonlinear relationships, when the average PM2.5 concentration (exposure with over 30days or more) increased by 1mg/m3, the most dramatic increase occurred in cardiovascular outpatient visits (with a maximum increase of 7000), followed by cerebrovascular outpatient visits (with a maximum increase of 1200), and respiratory outpatient visits (with a maximum increase of 250). The GAMs also revealed a dose effect in the relationship between outpatient visits and PM2.5 exposure. In moderately polluted air (based on air quality standards of China, GB3095-2012), when the average concentration of PM2.5 increased by 1mg/m3, the cardiovascular outpatient visits increased the most (by 1200 people), followed by cerebrovascular outpatient visits (by 200 people) and respiratory outpatient visits (by 20 people). We concluded that outpatient visits in cardiovascular, cerebrovascular, and respiratory disease are closely correlated with the concentration and exposure duration of air pollution. There is a linear relationship between short-term air pollution exposure (exposure within less than 15days) and outpatient visits. As PM2.5 concentration increases, cardiovascular outpatient visits increase gradually, with its growth trend exceeding that of cerebrovascular and respiratory disease. There is a nonlinear relationship between medium and long-term air pollution exposure (exposure with more than 30days) and outpatient visits, with cardiovascular and cerebrovascular outpatient visits showed a nonlinear but overall upward trend when the atmosphere is moderately polluted.

Comparing the Clinical Courses of Children With Human Rhinovirus/Enterovirus to Children With Other Respiratory Viruses in the Outpatient Setting.

While infections caused by rhinoviruses and enteroviruses are common among children, the entirety of their clinical impact remains elusive. We compared the clinical outcomes of children with rhinovirus/enterovirus infections to other common respiratory viruses in outpatient settings. We conducted a retrospective analysis of nasopharyngeal samples singly positive for human rhinovirus/enterovirus (HRV/ENT), influenza A/B (FLU) or respiratory syncytial virus (RSV) from patients ≤17 years submitted for clinical testing via multiplex polymerase chain reaction between 2016 and 2019. We evaluated the following outpatient outcomes: days of respiratory symptoms before testing; visits for respiratory symptoms; receipt of a breathing treatment; receipt of antibiotics and hospital admission. Statistical analyses were conducted controlling for age and comorbid conditions. There were 1355 positive samples included in this analysis (HRV/ENT: n = 743, FLU: n = 303 and RSV: n = 309). Compared to HRV/ENT, children with FLU had 28% fewer days of respiratory symptoms (β: -0.32; 95% confidence interval: -0.46 to -0.18; P < 0.001), fewer visits for respiratory symptoms, and significantly decreased odds of receiving a breathing treatment or antibiotics, and admission to the hospital. Children with RSV had a similar number of days of respiratory symptoms, outpatient visits and odds of hospital admission, but significantly increased odds of receiving a breathing treatment and antibiotics compared to those with HRV/ENT. Clinicians should have a high level of vigilance when managing children with positive respiratory viral testing for HRV/ENT given the potential for clinical outcomes similar to and, in some instances, worse than known highly pathogenic viruses.

Air quality health index (AQHI) based on multiple air pollutants and mortality risks in Taiwan: Construction and validation

The currently used air quality index (AQI) is not able to capture the additive effects of air pollution on health risks and reflect non-threshold concentration-response relationships, which has been criticized. We proposed the air quality health index (AQHI) based on daily air pollution-mortality associations, and compared its validity in predicting daily mortality and morbidity risks with the existing AQI. We examined the excess risk (ER) of daily elderly (≥65-year-old) mortality associated with 6 air pollutants (PM2.5, PM10, SO2, CO, NO2, and O3) in 72 townships across Taiwan from 2006 to 2014 by performing a time-series analysis using a Poisson regression model. Random effect meta-analysis was used to pool the township-specified ER for each air pollutant in the overall and seasonal scenarios. The integrated ERs for mortality were calculated and used to construct the AQHI. The association of the AQHI with daily mortality and morbidity were compared by calculating the percentage change per interquartile range (IQR) increase in the indices. The magnitude of the ER on the concentration-response curve was used to evaluate the performance of the AQHI and AQI, regarding specific health outcomes. Sensitivity analysis was conducted using coefficients from the single- and two-pollutant models. The coefficients of PM2.5, NO2, SO2, and O3 associated with mortality were included to form the overall and season-specific AQHI. An IQR increase in the overall AQHI at lag 0 was associated with 1.90%, 2.96%, and 2.68% increases in mortality, asthma, and respiratory outpatient visits, respectively. The AQHI had higher ERs for mortality and morbidity on the validity examinations than the current AQI. The AQHI, which captures the combined effects of air pollution, can serve as a health risk communication tool to the public.

Association between PM2.5-bound metals and pediatric respiratory health in Guangzhou: An ecological study investigating source, health risk, and effect.

The adverse effects of 2.5-μm particulate matter (PM2.5) exposure on public health have become an increasing concern worldwide. However, epidemiological findings on the effects of PM2.5-bound metals on children's respiratory health are limited and inconsistent because PM2.5 is a complicated mixture. Given the vulnerability of children's respiratory system, aim to pediatric respiratory health, this study evaluated the potential sources, health risks, and acute health effects of ambient PM2.5-bound metals among children in Guangzhou, China from January 2017 to December 2019. Potential sources of PM2.5-bound metals were detected using positive matrix factorization (PMF). A health risk assessment was conducted to investigate the inhalation risk of PM2.5-bound metals in children. The associations between PM2.5-bound metals and pediatric respiratory outpatient visits were examined with a quasi-Poisson generalized additive model (GAM). During 2017-2019, the daily mean concentrations of PM2.5 was 53.39 μg/m3, and the daily mean concentrations of PM2.5-bound metals range 0.03 ng/m3 [thorium (Th) and beryllium (Be)] from to 396.40 ng/m3 [iron (Fe)]. PM2.5-bound metals were mainly contributed by motor vehicles and street dust. PM2.5-bound arsenic (As), cadmium (Cd), cobalt (Co), chromium (Cr)(VI), nickel (Ni), and lead (Pb) were found to pose a carcinogenic risk (CR). A quasi-Poisson GAM was constructed that showed there were significant associations between PM2.5 concentrations and pediatric outpatient visits for respiratory diseases. PM2.5 was significantly associated with pediatric outpatient visits for respiratory diseases. Moreover, with a 10 μg/m3 increase in Ni, Cr(VI), Ni, and As concentrations, the corresponding pediatric outpatient visits for respiratory diseases increased by 2.89% (95% CI: 2.28-3.50%), acute upper respiratory infections (AURIs) increased by 2.74% (2.13-3.35%), influenza and pneumonia (FLU&PN) increased by 23.36% (20.09-26.72%), and acute lower respiratory infections (ALRIs) increased by 16.86% (15.16-18.60%), respectively. Our findings showed that PM2.5 and PM2.5-bound As, Cd, Co, Cr(VI), Ni, and Pb had adverse effects on pediatric respiratory health during the study period. New strategies are required to decrease the production of PM2.5 and PM2.5-bound metals by motor vehicles and to reduce levels of street dust to reduce children's exposure to these pollutants and thereby increase child health.

Short-Term Effect of Moderate Level Air Pollution on Outpatient Visits for Multiple Clinic Departments: A Time-Series Analysis in Xi'an China.

There is limited evidence concerning the association between air pollution and different outpatient visits in moderately polluted areas. This paper investigates the effects of moderate-level air pollution on outpatient visits associated with six categories of clinic department. We analyzed a total of 1,340,791 outpatient visits for the pediatric, respiratory, ear-nose-throat (ENT), cardiovascular, ophthalmology, and orthopedics departments from January 2016 to December 2018. A distributed lag nonlinear model was used to analyze the associations and was fitted and stratified by age and season (central heating season and nonheating season). We found SO2 had the largest effect on pediatrics visits (RR = 1.105 (95%CI: 1.090, 1.121)). Meanwhile, PM2.5 and SO2 had greater effects on ENT visits for people under 50 years old. The results showed a strong association between O3 and cardiovascular outpatient visits in the nonheating season (RR = 1.273, 95% CI: 1.189,1.358). The results showed every 10 μg/m3 increase in SO2 was associated with a lower number of respiratory outpatient visits. Significant different associations were observed in PM2.5, NO2, CO, and O3 on ophthalmology visits between the heating and nonheating seasons. Although no significant association has been found in existing studies, our findings showed PM2.5 and NO2 were significantly related to orthopedic outpatient visits for people under 60 (RR = 1.063 (95%CI: 1.032, 1.095), RR = 1.055 (95%CI: 1.011, 1.101)). This study also found that the effect-level concentrations of air pollutants for some clinic departments were lower than the national standards, which means that people should also pay more attention when the air quality is normal.

Impact of initiation of amikacin liposome inhalation suspension on hospitalizations and other healthcare resource utilization measures: a retrospective cohort study in real-world settings

BackgroundMycobacterium avium complex lung disease (MAC-LD) is an infection that is increasing in frequency, associated with substantial disease burden, and often refractory to treatment. Amikacin liposome inhalation suspension (ALIS) is the first therapy approved for refractory MAC-LD. In the CONVERT study of adult patients with refractory MAC-LD, adding ALIS to a multidrug background regimen showed evidence of MAC infection elimination in sputum by month 6, which was maintained in most patients through the end of treatment (≤ 12 months post-conversion). This study assessed changes in healthcare resource utilization (HCRU) among patients initiating ALIS in real-world settings.MethodsThis retrospective cohort study of the All-Payer Claims Database (October 2018–April 2020) included patients aged ≥ 18 years with ≥ 1 pharmacy claim for ALIS and ≥ 12 months of continuous health plan enrollment pre- and post-ALIS initiation. Respiratory disease-related (and all-cause) HCRU (hospitalizations, length of stay [LOS], emergency department [ED] visits, and outpatient office visits) were compared 12 months pre- and post-ALIS initiation. Outcomes were reported at 6-month intervals; 0–6 months pre-ALIS initiation was the reference period for statistical comparisons.ResultsA total of 331 patients received ALIS, with HCRU highest in the 6 months pre-ALIS initiation. Compared with 26.9% during the reference period, respiratory-related hospitalizations decreased to 19.3% (P < 0.01) and 15.4% (P < 0.0001) during 0–6 and 7–12 months post-ALIS initiation, respectively. Mean number of respiratory disease-related hospitalizations per patient/6-month period decreased from 1.0 (reference period) to 0.6 (P < 0.0005) at both timepoints post-ALIS initiation. A similar pattern was observed for all-cause hospitalizations and hospitalizations per patient/6-month period (both P < 0.005). Reductions in all-cause and respiratory disease–related LOS post-ALIS initiation were significant (both P < 0.05). ED visits were few and unchanged during the study. Significant reductions per patient/6-month period in all-cause and respiratory-related outpatient office visits were observed post-ALIS initiation (all P < 0.01).ConclusionsIn this first real-world study of ALIS, respiratory disease-related (and all-cause) hospitalizations and outpatient visits were reduced in the 12 months following ALIS initiation. The results of this study provide HCRU-related information to better understand the impact of initiating ALIS treatment.Trial registrationNot appliable.

Association between ambient PM2.5 and outpatient visits of children's respiratory diseases in a megacity in Central China.

ObjectiveTo explore the relationship between ambient PM2.5 level and outpatient visits of children with respiratory diseases in a megacity, Zhengzhou, in central China.MethodsWe collected daily outpatient visit data, air pollutant data, and meteorological data at the monitoring points of Zhengzhou from the time period 2018 to 2020 and used Spearman's rank correlation to analyze the correlation between children's respiratory outpatient visits and air pollutants and meteorological factors. Generalized additive models were used to analyze the association between PM2.5 exposures and children's respiratory outpatient visits. A stratified analysis was further carried out for the seasons.ResultsFrom 2018 to 2020, the total number of outpatients with children's respiratory diseases was 79,1107, and the annual average concentrations of PM2.5, PM10, SO2, NO2, CO, and O3-8h in Zhengzhou were respectively 59.48 μg/m3, 111.12 μg/m3, 11.10 μg/m3, 47.77 μg/m3, 0.90 mg/m3 and 108.81 μg/m3. The single-pollutant model showed that the risk of outpatient visits for children with respiratory disease increased by 0.341% (95%CI: 0.274–0.407%), 0.532% (95%CI: 0.455–0.609%) and 0.233% (95%CI: 0.177–0.289%) for every 10 μg/m3 increase in PM2.5 with a 3-day lag, 1-day lag, and 1-day lag respectively for the whole year, heating period, and non-heating period. The multi-pollutant model showed that the risk of PM2.5 on children's respiratory disease visits was robust. The excess risk of PM2.5 on children's respiratory disease visits increased by 0.220% (95%CI: 0.147–0.294%) when SO2 was adjusted. However, the PM2.5 effects were stronger during the heating period than during the non-heating period.ConclusionThe short-term exposure to PM2.5 was significantly associated with outpatient visits for children's respiratory diseases. It is therefore necessary to strengthen the control of air pollution so as to protect children's health.

Association between ambient temperature and cause-specific respiratory outpatient visits: A case-crossover design with a distributed lag nonlinear model in Lanzhou, China

Little is known about the association between air temperature and causes-specific respiratory diseases (RD), especially in northwest China. A time-stratified case crossover design with a distributed lag nonlinear model (DLNM) was conducted to assess the nonlinear and delayed effects of temperature on total and cause-specific outpatient visits, with analyses stratified by gender and age. The cumulative effects of temperature were irregular M-shaped curves for total and upper respiratory tract infection (URTI), with inverted U-shaped curve for pneumonia, bronchitis and chronic obstructive pulmonary disease (COPD). Positive cold and heat effects were observed for URTI, pneumonia, bronchitis and COPD, bronchitis was most vulnerable to cold but pneumonia was more affected to heat. Heat effects were immediate whereas cold effects were delayed and lasted longer. The magnitude of temperature effects varies greatly by age, gender, and disease. Notably, the cold effect was greater for children aged 0–14 than that of other age groups. This study suggested that both cold and hot temperatures exposure could increase all-cause and cause-specific respiratory outpatient visits in Lanzhou, China. The harmful effect and duration of cold were greater than that of heat, and children aged 0–14 were more sensitive to cold. Protection against extreme temperatures should be strengthened.

Disproportionate reduction in respiratory vs. non-respiratory outpatient clinic visits and antibiotic use in children during the COVID-19 pandemic.

BackgroundThe COVID-19 pandemic led to improved hygiene and reduced social encounters. Near elimination of the activity of respiratory syncytial virus and influenza viruses were observed, worldwide. Therefore, we assessed the rates of pediatric outpatient clinic visits and medications prescribed at those visits during the coronavirus disease 2019 (COVID-19) pandemic and pre-COVID-19 period (2016–2019).MethodsMonthly and annual incidence rates for respiratory and non-respiratory diagnoses and dispensed prescription rates were calculated. Acute gastroenteritis (AGE) visits were analyzed separately since the mode of transmission is influenced by hygiene and social distancing.ResultsOverall, 5,588,702 visits were recorded. Respiratory and AGE visits declined by 49.9% and 47.3% comparing the COVID-19 and pre-COVID-19 periods. The respective rate reductions for urinary tract infections, trauma, and skin and soft tissue infections were 18.2%, 19.9%, and 21.8%. Epilepsy visits increased by 8.2%. Overall visits rates declined by 21.6%. Dispensed prescription rates of antibiotics and non-antibiotics respiratory medications declined by 49.3% and 44.4%, respectively. The respective declines for non-respiratory antibiotics and non-antibiotics were 15.1% and 0.2%. Clinic visits and prescription rates reductions were highest in April–May, following the first lockdown in Israel.ConclusionsCOVID-19 pandemic resulted in a substantial reduction in respiratory outpatient clinic visits and dispensed respiratory drugs, with only a mild reduction seen for non-respiratory visits. These trends were probably driven by COVID-19 mitigation measures and by the profound disruption to non-SARS COV-2 respiratory virus activity.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12887-022-03315-0.

Association Between Air Pollutants and Pediatric Respiratory Outpatient Visits in Zhoushan, China.

ObjectiveThis study aimed to explore the time-series relationship between air pollutants and the number of children's respiratory outpatient visits in coastal cities.MethodsWe used time series analysis to investigate the association between air pollution levels and pediatric respiratory outpatient visits in Zhoushan city, China. The population was selected from children aged 0–18 who had been in pediatric respiratory clinics for eight consecutive years from 2014 to 2020. After describing the population and weather characteristics, a lag model was used to explore the relationship between outpatient visits and air pollution.ResultsWe recorded annual outpatient visits for different respiratory diseases in children. The best synergy lag model found a 10 μg/m3 increase in PM2.5 for every 4–10% increase in the number of pediatric respiratory outpatient visits (P < 0.05). The cumulative effect of an increase in the number of daily pediatric respiratory clinics with a lag of 1–7 days was the best model.ConclusionsPM2.5 is significantly related to the number of respiratory outpatient visits of children, which can aid in formulating policies for health resource allocation and health risk assessment strategies.

Size-Specific Particulate Matter Associated With Acute Lower Respiratory Infection Outpatient Visits in Children: A Counterfactual Analysis in Guangzhou, China

The burden of lower respiratory infections is primarily evident in the developing countries. However, the association between size-specific particulate matter and acute lower respiratory infection (ALRI) outpatient visits in the developing countries has been less studied. We obtained data on ALRI outpatient visits (N = 105,639) from a tertiary hospital in Guangzhou, China between 2013 and 2019. Over-dispersed generalized additive Poisson models were employed to evaluate the excess risk (ER) associated with the size-specific particulate matter, such as inhalable particulate matter (PM10), coarse particulate matter (PMc), and fine particulate matter (PM2.5). Counterfactual analyses were used to examine the potential percent reduction of ALRI outpatient visits if the levels of air pollution recommended by the WHO were followed. There were 35,310 pneumonia, 68,218 bronchiolitis, and 2,111 asthma outpatient visits included. Each 10 μg/m3 increase of 3-day moving averages of particulate matter was associated with a significant ER (95% CI) of outpatient visits of pneumonia (PM2.5: 3.71% [2.91, 4.52%]; PMc: 9.19% [6.94, 11.49%]; PM10: 4.36% [3.21, 5.52%]), bronchiolitis (PM2.5: 3.21% [2.49, 3.93%]; PMc: 9.13% [7.09, 11.21%]; PM10: 3.12% [2.10, 4.15%]), and asthma (PM2.5: 3.45% [1.18, 5.78%]; PMc: 11.69% [4.45, 19.43%]; PM10: 3.33% [0.26, 6.49%]). The association between particulate matter and pneumonia outpatient visits was more evident in men patients and in the cold seasons. Counterfactual analyses showed that PM2.5 was associated with a larger potential decline of ALRI outpatient visits compared with PMc and PM10 (pneumonia: 11.07%, 95% CI: [7.99, 14.30%]; bronchiolitis: 6.30% [4.17, 8.53%]; asthma: 8.14% [2.65, 14.33%]) if the air pollutants were diminished to the level of the reference guidelines. In conclusion, short-term exposures to PM2.5, PMc, and PM10 are associated with ALRI outpatient visits, and PM2.5 is associated with the highest potential decline in outpatient visits if it could be reduced to the levels recommended by the WHO.

Cardio-respiratory disease with contrasted air pollution levels in three municipalities of Abidjan district hospitals, Cote d’Ivoire

BACKGROUND AND AIM: The human health effects for both particulate matter and gaseous contaminants are global public health concern. The objective of this study was to assess any variations of air pollution in contributions from waste burning, heavy motor vehicle traffic and biomass burning and the impact on health in Abidjan, with special attention to cardiorespiratory diseases, METHODS: A survey was conducted during two years in 5 hospitals, 3 months during the rainy and the dry season. We estimated air pollution levels simultaneously with health care assessment with a particular attention for cardio-respiratory diseases. PM2.5 concentration and cardiorespiratory diseases outcomes were recorded in a questionnaire sheet in the district hospitals. The relative Risks (RR) of the relationship between the observed cardiorespiratory outcomes and air pollution exposure were estimated using a Poisson regression model. RESULTS:The results showed that PM2.5 Concentrations from the waste burning and traffic sites were comparable with annual averages of 28.51 µg/m3 and 29.69 µg/m3 respectively. In Yopougon, where domestic fires are common, the annual average is drastically higher at 155.1 µg/m3. PM2.5 were elevated in both seasons with an average of 145µ/m3; more than the one recommended by WHO. Also, cardiorespiratory diseases occurred in 66% and the most affected were women (54%) and children under 18 years old. The highest PM2.5 concentrations were due to biomass burning, seen in Yopougon. Outpatient visits for cardiorespiratory symptoms showed a significant association with PM2.5 concentrations during the rainy season and respiratory outpatient visits were significant throughout the entire year. Overall, we estimate that 143 hospital visits could have been avoided during the rainy seasons of our study period CONCLUSIONS:Accessing to air pollution data has been difficult in developing countries. This survey was one the first conducted so far in Côte d’Ivoire addressing pollutant concentrations and cardiorespiratory outcomes. KEYWORDS: Air pollution, Cardio-respiratory disease, health care

An association between PM2.5 and pediatric respiratory outpatient visits in four Chinese cities

BackgroundThe effects of exposure to particulate matter with aerodynamic diameter less than 2.5 μm (PM2.5) on children's respiratory system were investigated in numerous epidemiological literatures. However, studies on the association between PM2.5 and pediatric outpatient visits for respiratory diseases, especially considering the multicenter studies were limited in China. ObjectivesTo study the association between the short-term exposure to PM2.5 and the number of children's outpatient visits for respiratory diseases in four Chinese cities as well as the pooled health effects. MethodsData of pediatric outpatient visits for respiratory diseases (RD, ICD: J00-J99) from representative hospitals in Shijiazhuang (SJZ), Xi'an (XA), Nanjing (NJ) and Guangzhou (GZ) in China from 2015 to 2018 were collected and the air quality data for the same period were collected from environmental protection departments. Generalized additive model (GAM) with quasi-Poisson regression was conducted to analyze the effects of PM2.5 on the number of pediatric outpatient visits in each city. Single-day lag model (lag0 to lag7) and moving average lag model (lag01 and lag07) were used to examine the lag effects and cumulative effects. Random-effects meta-analysis was used to pool the estimated risks of four cities. The interactions between PM2.5 and temperature were also explored. ResultsThe average daily/total outpatient visits for RD, in SJZ, XA, NJ and GZ from 2015 to 2018 were 854.2/1,245,384, 2353.9/3,439,025, 1267.2/1,851,438 and 1399.5/2,044,740 respectively. The percentages of acute upper respiratory infections (URD, ICD: J00-J06) and other acute lower respiratory infections (LRD, ICD: J20-J22) in RD were 33%, 13% (SJZ), 43%, 32% (XA), 26%, 21% (NJ) and 54%, 26% (GZ). The largest pooled estimates of single-day lag effects for RD, URD, and LRD were at lag0, lag0 and lag1. Every 10 μg/m3 increase in PM2.5 concentration was associated with a 0.46% (95%CI: 0.21%–0.70%), 0.50% (95%CI: 0.19%–0.81%) and 0.42% (95%CI: 0.06%–0.79%) increased number of outpatient visits significantly. While max cumulative effects which were all at lag 07 were 1.10% (95%CI: 0.46%–1.74%), 0.96% (95%CI: 0.20%–1.73%) and 1.06% (95%CI: 0.12%–2.00%). Less polluted cities (GZ and NJ) showed greater city-specific excess risks, but the excess risks significantly decreased after adjusting for NO2 in two-pollutant models. Generally, PM2.5 showed larger health hazards on lower temperature days. ConclusionsOur study showed that exposure to the ambient PM2.5 was associated with the increase of the number of outpatient visits with pediatric respiratory diseases in four Chinese cities. The health effects of PM2.5 may not be independent of other air pollutants and could be modified by temperature.

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.

Childhood Respiratory Outpatient Visits Correlate With Socioeconomic Status and Drive Geographic Patterns in Antibiotic Prescribing.

Reducing geographic disparities in antibiotic prescribing is a central public health priority to combat antibiotic resistance, but drivers of this variation have been unclear. We measured how variation in outpatient visit rates (observed disease) and antibiotic prescribing rates per visit (prescribing practices) contributed to geographic variation in per capita antibiotic prescribing in Massachusetts residents younger than 65 years between 2011 and 2015. Of the difference in per capita antibiotic prescribing between high- and low-prescribing census tracts in Massachusetts, 45.2% was attributable to variation in outpatient visit rates, while 25.8% was explained by prescribing practices. Outpatient visits for sinusitis, pharyngitis, and suppurative otitis media accounted for 30.3% of the gap in prescribing, with most of the variation in visit rates concentrated in children younger than 10 years. Outpatient visits for these conditions were less frequent in census tracts with high social deprivation index. Interventions aimed at reducing geographic disparities in antibiotic prescribing should target the drivers of outpatient visits for respiratory illness and should account for possible underutilization of health services in areas with the lowest antibiotic consumption. Our findings challenge the conventional wisdom that prescribing practices are the main driver of geographic disparities in antibiotic use.

Association between atmospheric PM2.5 and daily outpatient visits for children's respiratory diseases in Lanzhou.

The relationship between fine particulate matter (PM2.5) and respiratory disease outcomes among children aged 0 to 14years in Lanzhou, China, was evaluated. We utilized a generalized additive model linked by a quasi-Poisson distribution to examine the associations between PM2.5 and paediatric respiratory outpatient visits for time lags of 0 up to 7days, and stratified by gender, age, and season. Cases of respiratory disease in children were collected from 3 large hospitals for the years 2014-2017 and then linked with air pollutant concentrations from 4 air quality monitoring stations by date. We observed positive and significant associations between PM2.5 and respiratory disease from the lag to lag 7, and from lag01 to lag07, with ER reaching the maximum value at lag07. For each 10μg/m3 increase in PM2.5 (lag07), the associated increment in respiratory diseases was 2.83% (95% CI 1.80%-3.86%). Males were more sensitive to the adverse effects, and the association was more significant in spring (from March to May) and winter (from December to the next February). Overall, the child group (age 3-6years) demonstrated a higher risk of respiratory disease after PM2.5 exposure. The associations between ambient PM2.5 and respiratory hospital outpatients among young children became partially attenuated after the adjustment for gaseous pollutants in subgroups. The exposure-response curves were positive and generally nonlinear but flatted at concentrations over 60μg/m3. This research found a significant association between ambient PM2.5 levels and hospital outpatient visits in child with respiratory diseases in Lanzhou, China.

Cross-sectional study at the secondary health care level on Cardio-respiratory disease in three municipalities of Abidjan district hospitals with contrasted levels of air pollution

Background/Aim The human health effects for both particulate matter and gaseous contaminants are global public health concern. The objective of this study was to assess any variations of air pollution in contributions from waste burning, heavy motor vehicle traffic and biomass burning and the impact on health in Abidjan, with special attention to cardiorespiratory diseases, Methods A survey was conducted during two years in 5 hospitals, 3 months during the rainy and the dry season. We estimated air pollution levels simultaneously with health care assessment with a particular attention for cardio-respiratory diseases. PM2.5 concentration and cardiorespiratory diseases outcomes were recorded in a questionnaire sheet in the district hospitals. The relative Risks (RR) of the relationship between the observed cardiorespiratory outcomes and air pollution exposure were estimated using a Poisson regression model. Results The results showed that PM2.5 Concentrations from the waste burning and traffic sites were comparable with annual averages of 28.51 µg/m3 and 29.69 µg/m3 respectively. In Yopougon, where domestic fires are common, the annual average is drastically higher at 155.1 µg/m3. PM2.5 were elevated in both seasons with an average of 145µ/m3; more than the one recommended by WHO. Also, cardiorespiratory diseases occurred in 66% and the most affected were women (54%) and children under 18 years old. The highest PM2.5 concentrations were due to biomass burning, seen in Yopougon. Outpatient visits for cardiorespiratory symptoms showed a significant association with PM2.5 concentrations during the rainy season and respiratory outpatient visits were significant throughout the entire year. Overall, we estimate that 143 hospital visits could have been avoided during the rainy seasons of our study periodConclusion: Accessing to air pollution data has been difficult in developing countries. This survey was one the first conducted so far in Côte d’Ivoire addressing pollutant concentrations and cardiorespiratory outcomes.

Short-term exposure to ambient particulate matter and hospital outpatient visits for respiratory diseases among children: A five-city time-series study in China

Background: Evidence concerning the association between ambient particulate matter (PM) and outpatient visits for respiratory diseases is quite limited, especially in children at a multicity level. Methods: A time-series study was performed in five Chinese cities from 2013 to 2018 among children aged 0-14 years. The city-specific effects of PM were estimated for time lags of zero up to seven days using the overdispersed generalized additive models after adjusting for time trends, meteorological variables, day of the week and holidays. Meta-analyses using random effects models were applied to pool the effect estimates in the five cities. The exposure-response relationship curves were also evaluated. Results: Exposure to PM was dose-responsive related to an increased respiratory outpatient visits among children. The cumulative lag effects of PM showed higher estimates than that of single-day exposure, and the lag07 (moving averages for the present day and the previous 7 days) concentrations of fine particles (PM2.5) and inhalable particles (PM10) produced the largest estimates. Each 10 μg/m3 increment in PM2.5 and PM10 at the lag07 was associated with a 1.39% (95% CI: 0.36%, 2.43%) and 1.11% (95% CI: 0.38%, 1.84%) increase in outpatient visits for all respiratory diseases among children, respectively, and the associations remained statistically significant at levels below the current Chinese Ambient Air Quality Standards (CAAQS). The effect estimates for acute lower respiratory infections (ALRIs) tended to be higher. Children 7-14 years old and 4-6 years old are the most susceptible groups for acute upper respiratory infections (AURIs) and ALRIs, respectively, but no sex differences were observed. Moreover, the effects of PM were stronger in the transition season of Beijing and Xining, whereas stronger in the cold season of the other 3 cities. Conclusions: Ambient PM concentrations, even at levels below the CAAQS, was dose-responsive associated with increased respiratory outpatient visits among children.