Intraday effects of ambient PM1 on emergency department visits in Guangzhou, China: A case-crossover study

Linjiong Liu; Fujian Song; Jiaying Fang; Jing Wei; Hung Chak Ho; Yimeng Song; Yuanyuan Zhang; Lu Wang; Zhiming Yang; Chengyang Hu; Yunquan Zhang

doi:10.1016/j.scitotenv.2020.142347

Intraday effects of ambient PM₁ on emergency department visits in Guangzhou, China: A case-crossover study

Linjiong Liu
, Fujian Song
, Jiaying Fang
, Jing Wei
, Hung Chak Ho
, Yimeng Song
, Yuanyuan Zhang
, Lu Wang
, Zhiming Yang
, Chengyang Hu
, Yunquan Zhang^*

^*Corresponding author for this work

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

39 Citations (Scopus)

Abstract

Background: Short-term exposure to PM_2.5 has been widely associated with human morbidity and mortality. However, most up-to-date research was conducted at a daily timescale, neglecting the intra-day variations in both exposure and outcome. As an important fraction in PM_2.5, PM₁ has not been investigated about the very acute effects within a few hours.
Methods: Hourly data for size-specific PMs (i.e., PM₁, PM_2.5, and PM₁₀), all-cause emergency department (ED) visits and meteorological factors were collected from Guangzhou, China, 2015–2016. A time-stratified case-crossover design with conditional logistic regression analysis was performed to evaluate the hourly association between size-specific PMs and ED visits, adjusting for hourly mean temperature and relative humidity. Subgroup analyses stratified by age, sex and season were conducted to identify potential effect modifiers.
Results: A total of 292,743 cases of ED visits were included. The effects of size-specific PMs exhibited highly similar lag patterns, wherein estimated odds ratio (OR) experienced a slight rise from lag 0–3 to 4–6 h and subsequently attenuated to null along with the extension of lag periods. In comparison with PM_2.5 and PM₁₀, PM₁ induced slightly larger effects on ED visits. At lag 0–3 h, for instance, ED visits increased by 1.49% (95% confidence interval: 1.18–1.79%), 1.39% (1.12–1.66%) and 1.18% (0.97–1.40%) associated with a 10-μg/m³ rise, respectively, in PM₁, PM_2.5 and PM₁₀. We have detected a significant effect modification by season, with larger PM₁-associated OR during the cold months (1.017, 1.013 to 1.021) compared with the warm months (1.010, 1.005 to 1.015).
Conclusions: Our study provided brand-new evidence regarding the adverse impact of PM₁ exposure on human health within several hours. PM-associated effects were significantly more potent during the cold months. These findings may aid health policy-makers in establishing hourly air quality standards and optimizing the allocation of emergency medical resources.

© 2018 Elsevier B.V.

Original language	English
Article number	142347
Journal	Science of the Total Environment
Volume	750
Online published	15 Sept 2020
DOIs	https://doi.org/10.1016/j.scitotenv.2020.142347
Publication status	Published - 1 Jan 2021
Externally published	Yes

Funding

Yunquan Zhang was supported by the Key Research Center for Humanities and Social Sciences in Hubei Province (Hubei University of Medicine) (Grant No. 2020ZD001 ). Jiaying Fang was supported by the Health Science and Technology Project of Guangzhou (Grant No. 20191A011114 ). We acknowledge the China National Environmental Monitoring Center for providing air pollution data and United States' National Centers for Environmental Information for providing hourly meteorological data. We appreciated the anonymous reviewers very much, whose insightful comments and suggestions contributed a lot to improving the quality of our manuscript. Yunquan Zhang was supported by the Key Research Center for Humanities and Social Sciences in Hubei Province (Hubei University of Medicine) (Grant No. 2020ZD001). Jiaying Fang was supported by the Health Science and Technology Project of Guangzhou (Grant No. 20191A011114). We acknowledge the China National Environmental Monitoring Center for providing air pollution data and United States' National Centers for Environmental Information for providing hourly meteorological data. We appreciated the anonymous reviewers very much, whose insightful comments and suggestions contributed a lot to improving the quality of our manuscript.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Keywords

Case-crossover design
China
Emergency department visits
Hourly effects
PM1

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@article{ce0bc01d643a44d0ad5c63b91ed42d04,

title = "Intraday effects of ambient PM1 on emergency department visits in Guangzhou, China: A case-crossover study",

abstract = "Background: Short-term exposure to PM2.5 has been widely associated with human morbidity and mortality. However, most up-to-date research was conducted at a daily timescale, neglecting the intra-day variations in both exposure and outcome. As an important fraction in PM2.5, PM1 has not been investigated about the very acute effects within a few hours. Methods: Hourly data for size-specific PMs (i.e., PM1, PM2.5, and PM10), all-cause emergency department (ED) visits and meteorological factors were collected from Guangzhou, China, 2015–2016. A time-stratified case-crossover design with conditional logistic regression analysis was performed to evaluate the hourly association between size-specific PMs and ED visits, adjusting for hourly mean temperature and relative humidity. Subgroup analyses stratified by age, sex and season were conducted to identify potential effect modifiers. Results: A total of 292,743 cases of ED visits were included. The effects of size-specific PMs exhibited highly similar lag patterns, wherein estimated odds ratio (OR) experienced a slight rise from lag 0–3 to 4–6 h and subsequently attenuated to null along with the extension of lag periods. In comparison with PM2.5 and PM10, PM1 induced slightly larger effects on ED visits. At lag 0–3 h, for instance, ED visits increased by 1.49\% (95\% confidence interval: 1.18–1.79\%), 1.39\% (1.12–1.66\%) and 1.18\% (0.97–1.40\%) associated with a 10-μg/m3 rise, respectively, in PM1, PM2.5 and PM10. We have detected a significant effect modification by season, with larger PM1-associated OR during the cold months (1.017, 1.013 to 1.021) compared with the warm months (1.010, 1.005 to 1.015). Conclusions: Our study provided brand-new evidence regarding the adverse impact of PM1 exposure on human health within several hours. PM-associated effects were significantly more potent during the cold months. These findings may aid health policy-makers in establishing hourly air quality standards and optimizing the allocation of emergency medical resources. {\textcopyright} 2018 Elsevier B.V.",

keywords = "Case-crossover design, China, Emergency department visits, Hourly effects, PM1",

author = "Linjiong Liu and Fujian Song and Jiaying Fang and Jing Wei and Ho, \{Hung Chak\} and Yimeng Song and Yuanyuan Zhang and Lu Wang and Zhiming Yang and Chengyang Hu and Yunquan Zhang",

year = "2021",

month = jan,

day = "1",

doi = "10.1016/j.scitotenv.2020.142347",

language = "English",

volume = "750",

journal = "Science of the Total Environment",

issn = "0048-9697",

publisher = "Elsevier B.V.",

}

TY - JOUR

T1 - Intraday effects of ambient PM1 on emergency department visits in Guangzhou, China

T2 - A case-crossover study

AU - Liu, Linjiong

AU - Song, Fujian

AU - Fang, Jiaying

AU - Wei, Jing

AU - Ho, Hung Chak

AU - Song, Yimeng

AU - Zhang, Yuanyuan

AU - Wang, Lu

AU - Yang, Zhiming

AU - Hu, Chengyang

AU - Zhang, Yunquan

PY - 2021/1/1

Y1 - 2021/1/1

N2 - Background: Short-term exposure to PM2.5 has been widely associated with human morbidity and mortality. However, most up-to-date research was conducted at a daily timescale, neglecting the intra-day variations in both exposure and outcome. As an important fraction in PM2.5, PM1 has not been investigated about the very acute effects within a few hours. Methods: Hourly data for size-specific PMs (i.e., PM1, PM2.5, and PM10), all-cause emergency department (ED) visits and meteorological factors were collected from Guangzhou, China, 2015–2016. A time-stratified case-crossover design with conditional logistic regression analysis was performed to evaluate the hourly association between size-specific PMs and ED visits, adjusting for hourly mean temperature and relative humidity. Subgroup analyses stratified by age, sex and season were conducted to identify potential effect modifiers. Results: A total of 292,743 cases of ED visits were included. The effects of size-specific PMs exhibited highly similar lag patterns, wherein estimated odds ratio (OR) experienced a slight rise from lag 0–3 to 4–6 h and subsequently attenuated to null along with the extension of lag periods. In comparison with PM2.5 and PM10, PM1 induced slightly larger effects on ED visits. At lag 0–3 h, for instance, ED visits increased by 1.49% (95% confidence interval: 1.18–1.79%), 1.39% (1.12–1.66%) and 1.18% (0.97–1.40%) associated with a 10-μg/m3 rise, respectively, in PM1, PM2.5 and PM10. We have detected a significant effect modification by season, with larger PM1-associated OR during the cold months (1.017, 1.013 to 1.021) compared with the warm months (1.010, 1.005 to 1.015). Conclusions: Our study provided brand-new evidence regarding the adverse impact of PM1 exposure on human health within several hours. PM-associated effects were significantly more potent during the cold months. These findings may aid health policy-makers in establishing hourly air quality standards and optimizing the allocation of emergency medical resources. © 2018 Elsevier B.V.

AB - Background: Short-term exposure to PM2.5 has been widely associated with human morbidity and mortality. However, most up-to-date research was conducted at a daily timescale, neglecting the intra-day variations in both exposure and outcome. As an important fraction in PM2.5, PM1 has not been investigated about the very acute effects within a few hours. Methods: Hourly data for size-specific PMs (i.e., PM1, PM2.5, and PM10), all-cause emergency department (ED) visits and meteorological factors were collected from Guangzhou, China, 2015–2016. A time-stratified case-crossover design with conditional logistic regression analysis was performed to evaluate the hourly association between size-specific PMs and ED visits, adjusting for hourly mean temperature and relative humidity. Subgroup analyses stratified by age, sex and season were conducted to identify potential effect modifiers. Results: A total of 292,743 cases of ED visits were included. The effects of size-specific PMs exhibited highly similar lag patterns, wherein estimated odds ratio (OR) experienced a slight rise from lag 0–3 to 4–6 h and subsequently attenuated to null along with the extension of lag periods. In comparison with PM2.5 and PM10, PM1 induced slightly larger effects on ED visits. At lag 0–3 h, for instance, ED visits increased by 1.49% (95% confidence interval: 1.18–1.79%), 1.39% (1.12–1.66%) and 1.18% (0.97–1.40%) associated with a 10-μg/m3 rise, respectively, in PM1, PM2.5 and PM10. We have detected a significant effect modification by season, with larger PM1-associated OR during the cold months (1.017, 1.013 to 1.021) compared with the warm months (1.010, 1.005 to 1.015). Conclusions: Our study provided brand-new evidence regarding the adverse impact of PM1 exposure on human health within several hours. PM-associated effects were significantly more potent during the cold months. These findings may aid health policy-makers in establishing hourly air quality standards and optimizing the allocation of emergency medical resources. © 2018 Elsevier B.V.

KW - Case-crossover design

KW - China

KW - Emergency department visits

KW - Hourly effects

KW - PM1

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U2 - 10.1016/j.scitotenv.2020.142347

DO - 10.1016/j.scitotenv.2020.142347

M3 - RGC 21 - Publication in refereed journal

C2 - 33182206

AN - SCOPUS:85091557925

SN - 0048-9697

VL - 750

JO - Science of the Total Environment

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