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Attributable Risk and Economic Cost of Cardiovascular Hospital Admissions Due to Ambient Particulate Matter in Wuhan, China.

ABSTRACT: Although the adverse effects of ambient particulate matter (PM) on cardiovascular disease (CVD) have been previously documented, information about their economic consequence was insufficient. This study aimed to evaluate the attributable risk and economic cost of cardiovascular hospitalizations due to ambient PM. Data of CVD hospitalizations and PM concentrations from 1 January 2015 to 31 December 2017 were collected in Wuhan, China. A generalized additive model was applied to quantify the PM-attributable CVD hospitalizations, and total attributable hospitalization costs were calculated via multiplying the total attributable cases by the case-average hospitalization costs. A total of 45,714 CVD hospitalizations were included in this study. The results showed that a 10 µg/m3 increase in PM2.5 and PM10 concentrations at lag7 day, respectively, contributed to a 1.01% (95% confidence interval: 0.67-1.34) and 0.48% (0.26-0.70) increase in CVD hospitalizations. During the study period, 1487 and 983 CVD hospitalizations were attributable to PM2.5 and PM10, equaling an economic cost of 29.27 and 19.34 million RMB (1 RMB = 0.1424 USD), respectively, and significant differences in PM-attributable hospitalizations and economic burden were found between gender and age groups. Our study added evidence in heavily polluted megacities regarding the increased health risk and economic cost of CVD hospitalizations associated with ambient particulate pollution.

SUBMITTER: Wang X

PROVIDER: S-EPMC7432018 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Attributable Risk and Economic Cost of Cardiovascular Hospital Admissions Due to Ambient Particulate Matter in Wuhan, China.

Wang Xuyan X Yu Chuanhua C Zhang Yunquan Y Shi Fang F Meng Runtang R Yu Yong Y

International journal of environmental research and public health 20200729 15

Although the adverse effects of ambient particulate matter (PM) on cardiovascular disease (CVD) have been previously documented, information about their economic consequence was insufficient. This study aimed to evaluate the attributable risk and economic cost of cardiovascular hospitalizations due to ambient PM. Data of CVD hospitalizations and PM concentrations from 1 January 2015 to 31 December 2017 were collected in Wuhan, China. A generalized additive model was applied to quantify the PM-at ...[more]

PMID: 32751102

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Project description:BACKGROUND:The effects of ambient particulate matter (PM) pollution on pneumonia in adults are inconclusive, and few scientific data on a national scale have been generated in low- or middle-income countries, despite their much higher PM concentrations. We aimed to examine the association between PM levels and hospital admissions for pneumonia in Chinese adults. METHODS AND FINDINGS:A nationwide time series study was conducted in China between 2014 and 2017. Information on daily hospital admissions for pneumonia for 2014-2017 was collected from the database of Urban Employee Basic Medical Insurance (UEBMI), which covers 282.93 million adults. Associations of PM concentrations and hospital admissions for pneumonia were estimated for each city using a quasi-Poisson regression model controlling for time trend, temperature, relative humidity, day of the week, and public holiday and then pooled by random-effects meta-analysis. Meta-regression models were used to investigate potential effect modifiers, including cities' annual-average air pollutants concentrations, temperature, relative humidity, gross domestic product (GDP) per capita, and coverage rates by the UEBMI. More than 4.2 million pneumonia admissions were identified in 184 Chinese cities during the study period. Short-term elevations in PM concentrations were associated with increased pneumonia admissions. At the national level, a 10-?g/m3 increase in 3-day moving average (lag 0-2) concentrations of PM2.5 (PM ?2.5 ?m in aerodynamic diameter) and PM10 (PM ?10 ?m in aerodynamic diameter) was associated with 0.31% (95% confidence interval [CI] 0.15%-0.46%, P < 0.001) and 0.19% (0.11%-0.30%, P < 0.001) increases in hospital admissions for pneumonia, respectively. The effects of PM10 were stronger in cities with higher temperatures (percentage increase, 0.031%; 95% CI 0.003%-0.058%; P = 0.026) and relative humidity (percentage increase, 0.011%; 95% CI 0%-0.022%; P = 0.045), as well as in the elderly (percentage increase, 0.10% [95% CI 0.02%-0.19%] for people aged 18-64 years versus 0.32% [95% CI 0.22%-0.39%] for people aged ?75 years; P < 0.001). The main limitation of the present study was the unavailability of data on individual exposure to PM pollution. CONCLUSIONS:Our findings suggest that there are significant short-term associations between ambient PM levels and increased hospital admissions for pneumonia in Chinese adults. These findings support the rationale that further limiting PM concentrations in China may be an effective strategy to reduce pneumonia-related hospital admissions.

Project description:BackgroundEnteric infections cause significant deaths, and global projection studies suggest that mortality from enteric infections will increase in the future with warmer climate. However, a major limitation of these projection studies is the use of risk estimates derived from nonmortality data to project excess enteric infection mortality associated with temperature because of the lack of studies that used actual deaths.ObjectiveWe quantified the associations of daily temperature with both mortality and hospital admissions due to enteric infections in the Philippines. These associations were applied to projections under various climate and population change scenarios.MethodsWe modeled nonlinear temperature associations of mortality and hospital admissions due to enteric infections in 17 administrative regions of the Philippines using a two-stage time-series approach. First, we quantified nonlinear temperature associations of enteric infections by fitting generalized linear models with distributed lag nonlinear models. Second, we combined regional estimates using a meta-regression model. We projected the excess future enteric infections due to nonoptimal temperatures using regional temperature-enteric infection associations under various combinations of climate change scenarios according to representative concentration pathways (RCPs) and population change scenarios according to shared socioeconomic pathways (SSPs) for 2010-2099.ResultsRegional estimates for mortality and hospital admissions were significantly heterogeneous and had varying shapes in association with temperature. Generally, mortality risks were greater in high temperatures, whereas hospital admission risks were greater in low temperatures. Temperature-attributable excess deaths in 2090-2099 were projected to increase over 2010-2019 by as little as 1.3% [95% empirical confidence intervals (eCI): -3.1%, 6.5%] under a low greenhouse gas emission scenario (RCP 2.6) or as much as 25.5% (95% eCI: -3.5%, 48.2%) under a high greenhouse gas emission scenario (RCP 8.5). A moderate increase was projected for temperature-attributable excess hospital admissions, from 0.02% (95% eCI: -2.0%, 1.9%) under RCP 2.6 to 5.2% (95% eCI: -12.7%, 21.8%) under RCP 8.5 in the same period. High temperature-attributable deaths and hospital admissions due to enteric infections may occur under scenarios with high population growth in 2090-2099.DiscussionIn the Philippines, futures with hotter temperatures and high population growth may lead to a greater increase in temperature-related excess deaths than hospital admissions due to enteric infections. Our results highlight the need to strengthen existing primary health care interventions for diarrhea and support health adaptation policies to help reduce future enteric infections. https://doi.org/10.1289/EHP9324.

Project description:Murine Pulmonary Responses to Ambient Baltimore Particulate Matter: Genomic Analysis and Contribution to Airway Hyperresponsiveness Asthma is a complex disease characterized by airway hyperresponsiveness (AHR) and chronic airway inflammation. Environmental factors such as ambient particulate matter (PM), a major air pollutant, has been demonstrated in epidemiological studies to contribute to asthma exacerbation and increased asthma prevalence. OBJECTIVE: We investigated the genomic and pathophysiological effects of Baltimore PM (median diameter 1.78 µm) in a murine model of asthma to identify potential biomarkers. METHODS: A/J mice with ovalbumin (OVA) –induced AHR were exposed to PM (20 mg/kg, intratracheal), and both AHR and bronchoalveolar lavage (BAL) were assayed on days 1, 4, and 7 post exposure. Lung gene expression profiling (Affymetrix Mouse430_ 2.0) by PM (20 mg/kg, intratracheal) were assayed on OVA- and / or PM--challenged mice. RESULTS: Significant increases of airway responsiveness in OVA-treated mice were observed, indicating an asthmatic phenotype. Ambient PM exposure induced significant changes in AHR in both naive mice and OVA-induced asthmatic mice. In both naive and OVA challenged asthmatic mice, PM induced eosinophil and neutrophil infiltration into airways, elevated BAL protein content, and stimulated secretion of TH1 cytokines (IFN-g, IL-6, and TNF-a) and TH2 cytokines (IL-4, IL-5, and eotaxin) into BAL. Consistent with these results, PM induced expression of genes of innate immune response, chemotaxis and complementary system. CONCLUSION: These studies, consistent with epidemiological data, indicate that PM increases AHR and lung inflammation in naïve mice and exacerbates the asthma phenotype of increased AHR and gene expression pattern changes correlated with acute lung inflammation and airway damage. We used microarrays to detail the global programme of gene expression induced by rhPBEF treatment and VALI. Keywords: gene expression

Project description:ObjectiveTo quantitate the 2016 global and national burden of chronic kidney disease (CKD) attributable to ambient fine particulate matter air pollution ≤ 2.5 μm in aerodynamic diameter (PM2.5).DesignWe used the Global Burden of Disease (GBD) study data and methodologies to estimate the 2016 burden of CKD attributable to PM2.5 in 194 countries and territories. Population-weighted PM2.5 levels and incident rates of CKD for each country were curated from the GBD study publicly available data sources.SettingGBD global and national data on PM2.5 and CKD.Participants194 countries and territories.Main outcome measuresWe estimated the attributable burden of disease (ABD), years living with disability (YLD), years of life lost (YLL) and disability-adjusted life-years (DALYs).ResultsThe 2016 global burden of incident CKD attributable to PM2.5 was 6 950 514 (95% uncertainty interval: 5 061 533-8 914 745). Global YLD, YLL and DALYs of CKD attributable to PM2.5 were 2 849 311 (1 875 219-3 983 941), 8 587 735 (6 355 784-10 772 239) and 11 445 397 (8 380 246-14 554 091), respectively. Age-standardised ABD, YLL, YLD and DALY rates varied substantially among geographies. Populations in Mesoamerica, Northern Africa, several countries in the Eastern Mediterranean region, Afghanistan, Pakistan, India and several countries in Southeast Asia were among those with highest age-standardised DALY rates. For example, age-standardised DALYs per 100 000 were 543.35 (391.16-707.96) in El Salvador, 455.29 (332.51-577.97) in Mexico, 408.41 (283.82-551.84) in Guatemala, 238.25 (173.90-303.98) in India and 178.26 (125.31-238.47) in Sri Lanka, compared with 5.52 (0.82-11.48) in Sweden, 6.46 (0.00-14.49) in Australia and 12.13 (4.95-21.82) in Canada. Frontier analyses showed that Mesoamerican countries had significantly higher CKD DALY rates relative to other countries with comparable sociodemographic development.ConclusionsOur results demonstrate that the global toll of CKD attributable to ambient air pollution is significant and identify several endemic geographies where air pollution may be a significant driver of CKD burden. Air pollution may need to be considered in the discussion of the global epidemiology of CKD.

Project description:BackgroundPositive associations between ambient PM2.5 and cardiorespiratory disease have been well demonstrated during the past decade. However, few studies have examined the adverse effects of PM2.5 based on an entire population of a megalopolis. In addition, most studies in China have used averaged data, which results in variations between monitoring and personal exposure values, creating an inherent and unavoidable type of measurement error.MethodsThis study was conducted in Wuhan, a megacity in central China with about 10.9 million people. Daily hospital admission records, from October 2016 to December 2018, were obtained from the Wuhan Information center of Health and Family Planning, which administrates all hospitals in Wuhan. Daily air pollution concentrations and weather variables in Wuhan during the study period were collected. We developed a land use regression model (LUR) to assess individual PM2.5 exposure. Time-stratified case-crossover design and conditional logistic regression models were adopted to estimate cardiorespiratory hospitalization risks associated with short-term exposure to PM2.5. We also conducted stratification analyses by age, sex, and season.ResultsA total of 2,806,115 hospital admissions records were collected during the study period, from which we identified 332,090 cardiovascular disease admissions and 159,365 respiratory disease admissions. Short-term exposure to PM2.5 was associated with an increased risk of a cardiorespiratory hospital admission. A 10 μg/m3 increase in PM2.5 (lag0-2 days) was associated with an increase in hospital admissions of 1.23% (95% CI 1.01-1.45%) and 1.95% (95% CI 1.63-2.27%) for cardiovascular and respiratory diseases, respectively. The elderly were at higher PM-induced risk. The associations appeared to be more evident in the cold season than in the warm season.ConclusionsThis study contributes evidence of short-term effects of PM2.5 on cardiorespiratory hospital admissions, which may be helpful for air pollution control and disease prevention in Wuhan.

Project description:Background: Exposure to ambient particulate matter pollution (APMP) is a global health issue that directly affects the human respiratory system. Thus, we estimated the spatiotemporal trends in the burden of APMP-related respiratory diseases from 1990 to 2019. Methods: Based on the Global Burden of Disease Study 2019, data on the burden of APMP-related respiratory diseases were analyzed by age, sex, cause, and location. Joinpoint regression analysis was used to analyze the temporal trends in the burden of different respiratory diseases over the 30 years. Results: Globally, in 2019, APMP contributed the most to chronic obstructive pulmonary disease (COPD), with 695.1 thousand deaths and 15.4 million disability-adjusted life years (DALYs); however, the corresponding age-standardized death and DALY rates declined from 1990 to 2019. Similarly, although age-standardized death and DALY rates since 1990 decreased by 24% and 40%, respectively, lower respiratory infections (LRIs) still had the second highest number of deaths and DALYs attributable to APMP. This was followed by tracheal, bronchus, and lung (TBL) cancer, which showed increased age-standardized death and DALY rates during the past 30 years and reached 3.78 deaths per 100,000 persons and 84.22 DALYs per 100,000 persons in 2019. Among children aged < 5 years, LRIs had a huge burden attributable to APMP, whereas for older people, COPD was the leading cause of death and DALYs attributable to APMP. The APMP-related burdens of LRIs and COPD were relatively higher among countries with low and low-middle socio-demographic index (SDI), while countries with high-middle SDI showed the highest burden of TBL cancer attributable to APMP. Conclusions: APMP contributed substantially to the global burden of respiratory diseases, posing a significant threat to human health. Effective actions aimed at air pollution can potentially avoid an increase in the PM2.5-associated disease burden, especially in highly polluted areas.

Dataset Information

Attributable Risk and Economic Cost of Cardiovascular Hospital Admissions Due to Ambient Particulate Matter in Wuhan, China.

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Attributable Risk and Economic Cost of Cardiovascular Hospital Admissions Due to Ambient Particulate Matter in Wuhan, China.

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