Construction of AQHI based on joint effects of multi-pollutants in 5 provinces of China / 环境与职业医学

Background Air pollution is a major public health concern. Air Quality Health Index (AQHI) is a very important air quality risk communication tool. However, AQHI is usually constructed by single-pollutant model, which has obvious disadvantages. Objective To construct an AQHI based on the joint effects of multiple air pollutants (J-AQHI), and to provide a scientific tool for health risk warning and risk communication of air pollution. Methods Data on non-accidental deaths in Yunnan, Guangdong, Hunan, Zhejiang, and Jilin provinces from January 1, 2013 to December 31, 2018 were obtained from the corresponding provincial disease surveillance points systems (DSPS), including date of death, age, gender, and cause of death. Daily meteorological (temperature and relative humidity) and air pollution data (SO2, NO2, CO, PM2.5, PM10, and maximum 8 h O3 concentrations) at the same period were respectively derived from China Meteorological Data Sharing Service System and National Urban Air Quality Real-time Publishing Platform. Lasso regression was first applied to select air pollutants, then a time-stratified case-crossover design was applied. Each case was matched to 3 or 4 control days which were selected on the same days of the week in the same calendar month. Then a distributed lag nonlinear model (DLNM) was used to estimate the exposure-response relationship between selected air pollutants and mortality, which was used to construct the AQHI. Finally, AQHI was classified into four levels according to the air pollutant guidance limit values from World Health Organization Global Air Quality Guidelines (AQG 2021), and the excess risks (ERs) were calculated to compare the AQHI based on single-pollutant model and the J-AQHI based on multi-pollutant model. Results PM2.5, NO2, SO2, and O3 were selected by Lasso regression to establish DLNM model. The ERs for an interquartile range (IQR) increase and 95% confidence intervals (CI) for PM2.5, NO2, SO2 and O3 were 0.71% (0.34%–1.09%), 2.46% (1.78%–3.15%), 1.25% (0.9%–1.6%), and 0.27% (−0.11%–0.65%) respectively. The distribution of J-AQHI was right-skewed, and it was divided into four levels, with ranges of 0-1 for low risk, 2-3 for moderate risk, 4-5 for high health risk, and ≥6 for severe risk, and the corresponding proportions were 11.25%, 64.61%, 19.33%, and 4.81%, respectively. The ER (95%CI) of mortality risk increased by 3.61% (2.93–4.29) for each IQR increase of the multi-pollutant based J-AQHI , while it was 3.39% (2.68–4.11) for the single-pollutant based AQHI . Conclusion The J-AQHI generated by multi-pollutant model demonstrates the actual exposure health risk of air pollution in the population and provides new ideas for further improvement of AQHI calculation methods.

Estimation of the National Burden of Disease and Vulnerable Population Associated with Natural Disasters in Korea: Heavy Precipitation and Typhoon

BACKGROUND: Despite its growing significance, studies on the burden of disease associated with natural disasters from the perspective of public health were few. This study aimed at estimating the national burden of disease associated with typhoons and torrential rains in Korea. METHODS: During the period of 2002–2012, 11 typhoons and five torrential rains were selected. Mortality and morbidities were defined as accentual death, injury and injury-related infection, and mental health. Their incidences were estimated from National Health Insurance Service. Case-crossover design was used to define the disaster-related excess mortality and morbidity. Disability-adjusted life years (DALYs) were directly assessed from excess mortality and morbidity. RESULTS: The burden of disease from typhoons increased with the intensity, with 107.7, 30.6, and 36.6 DALYs per 100,000 per event for strong, moderate, and weak typhoons, respectively. Burden of disease from torrential rains were 56.9, 52.8, and 26.4 DALYs per 100,000 per event for strong, moderate, and weak episodes, respectively. Mental disorders contributed more years lived with disability (YLDs) than did injuries in most cases, but the injury-induced YLDs associated with strong typhoon and torrential rain were higher than those of lower-intensity. The elderly was the most vulnerable to most types of disaster and storm intensities, and males younger than 65 years were more vulnerable to a strong torrential rain event. CONCLUSION: The intensity of torrential rain or typhoon was the strongest determinant of the burden of disease from natural disasters in Korea. Population vulnerable may vary depending on the nature and strength of the disasters.

Atmospheric particulate matter and hospital admission due to lower respiratory tract infection: A case-cross study in Shijiazhuang, China / 解放军医学杂志

Objective To explore the association between atmospheric particulate matter (PM10/PM2.5) levels and hospital admissions due to lower respiratory tract infection in Shijiazhuang. Methods Data of air pollution, meteorologic data, and the data of patients admitted to hospital due to lower respiratory tract infection were retrospectively analyzed. Pearson's correlation coefficients were calculated to analyze correlations between atmospheric particulate matter and meteorologic factors. Data of hospital admission due to lower respiratory tract infection and of atmospheric air pollution levels in Shijiazhuang were obtained, a bidirectional case-crossover design was used to investigate the association between hospital admissions due to lower respiratory tract infection and levels of atmospheric particles. Stratified analyses of exposure based on age, gender, complications and season were performed to evaluate the effect. Results Pearson's correlation analysis showed positive correlations among PM2.5, PM10, SO2, NO2 and CO. The concentration of all these five pollutants were negatively correlated with O3 and daily mean temperature, while a positive correlation was found between concentrations of the 5 pollutants and daily average temperature and O3. In single-pollutant model, every 10μg/m3 increase in PM2.5 and PM10 at lag5 brought the corresponding OR values (95%CI) up to 1.010(1.005-1.015) and 1.006(1.003-1.009) respectively. In the multi-pollutant models, the observed effects of PM2.5 remained significant. Stratified analysis based on gender, age, season and comorbidities showed that the effect of PM2.5 exposure on lower respiratory tract infection admissions was stronger in males, persons younger than 60 years of age and persons without comorbidities, and even more stronger in cold season. The effect of PM10 exposure on lower respiratory tract infection admissions was stronger in females, persons older than 60 years of age and persons with comorbidities, and even more stronger in cold season. Conclusion Our study demonstrates that higher levels of atmospheric particulate matter (PM10/PM2.5) may increase the risk of hospital admissions due to lower respiratory tract infection.

Zolpidem Use and Risk of Fracture in Elderly Insomnia Patients / 예방의학회지

OBJECTIVES: To evaluate the risk of fractures related with zolpidem in elderly insomnia patients. METHODS: Health claims data on the entire South Korean elderly population from January 2005 to June 2006 were extracted from the Health Insurance Review and Assessment Service database. We applied a case-crossover design. Cases were defined as insomnia patients who had a fracture diagnosis. We set the hazard period of 1 day length prior to the fracture date and four control periods of the same length at 5, 10, 15, and 20 weeks prior to the fracture date. Time independent confounding factors such as age, gender, lifestyle, cognitive function level, mobility, socioeconomic status, residential environment, and comorbidity could be controlled using the casecrossover design. Time dependent confounding factors, especially co-medication of patients during the study period, were adjusted by conditional logistic regression analysis. The odds ratios and their 95% confidence intervals (CIs) were estimated for the risk of fracture related to zolpidem. RESULTS: One thousand five hundred and eight cases of fracture were detected in insomnia patients during the study period. In our data, the use of zolpidem increased the risk of fracture significantly (adjusted odds ratio [aOR], 1.72; 95% CI, 1.37 to 2.16). However, the association between benzodiazepine hypnotics and the risk of fracture was not statistically significant (aOR, 1.00; 95% CI, 0.83 to 1.21). Likewise, the results were not statistically significant in stratified analysis with each benzodiazepine generic subgroup. CONCLUSIONS: Zolpidem could increase the risk of fracture in elderly insomnia patients. Therefore zolpidem should be prescribed carefully and the elderly should be provided with sufficient patient education.

Acute Effects of Ambient Air CO Pollution on Cerebrocardiovascular Diseases Mortality in People Aged 65 Years and over in Taiyuan City / 环境与健康杂志

Objective To understand the acute effect of ambient air CO pollution on daily mortality of cerebrocardiovascular diseases among highly and long-term exposed residents of 65 years and over in Taiyuan,Shanxi,China.Methods The relationship of CO concentration and daily mortality of cerebrocardiovascular diseases among residents over 65 years old in Taiyuan(2003-2004) was analyzed by case-crossover design and conditional Logistic regression in SAS 9.0 Results The 48 h accumulated CO concentration had the most significant effect.As increment of CO average was 100 ?g/m~3,the corresponding OR of the effect on the total deaths of the cerebrocardiovascular diseases,the cardiac disease,the ischemic heart disease,myocardial infarction,cardiac failure,arrhythmia and stroke was 1.006,1.010,1.007,1.005,1.005,1.006 and 1.012 respectively.Under different air pollution conditions,the pollutant presented different effects on deaths of eerebrocardiovascular diseases.Conclusion The current CO pollution has caused a certain adverse effect on the cerebrocardiovascular mortality among residents of 65 years and over in Taiyuan city.More stringent measures should be taken to control the air pollution and decrease CO level,thus reduce the mortality of cerebrocardiovascular diseases.

Short-term Effect of Air Pollution on Respiratory Disease in Seoul : A Case-Crossover Study / 예방의학회지

OBJECTIVES: To evaluate the hypothesis that air pollution could increase emergency room visits for respiratory diseases, and if so, to quantify the strength of association between those. METHODS: We compiled daily records of hospital emergency room visits for respiratory diseases in Seoul, from November 1. 1995 to October 31. 1996, by using medical utilization data of unscheduled visits. In addition, air quality and weather data for the same period was collected. And a case-crossover design was applied by adopting conditional logistic regression analysis to determine the relationship between air pollutants and emergency room visits for respiratory diseases. In particular, the control periods were chosen by a bidirectional paired matching technique 7, 14, and 21days before and after the case periods. RESULTS: Only ozone was associated with the increased number of emergency room visits for respiratory diseases. The relative risk according to a 30ppb increase of ozone concentration (24hr mean, lagged 1day) was 1.91 (95% confidence interval = 1.78-2.05). CONCLUSION: There was a statistically significant association between the ambient ozone and daily emergency room visits for respiratory diseases.

Transient Effects on the Risk of Occupational Injuries as an Acute Events: a Case-crossover Study / 예방의학회지

OBJECTIVES: To elucidate the transient effects on the risk of occupational injuries as acute events and establish an alternative proposal. METHODS: The study population comprised a total of 302 workers randomly selected from applications for occupational injury compensation reported to the Inchon local labor office from January 1, 1999 to December 31. A case-crossover design, where each case serves its own control, was applied to this study. Through a telephone interview, workers provided useful data concerning five job related stressful events such as company transfer, work load change, overtime work, exchange duty, and work-part transfer. They were asked whether there were stressful events within a week of the occurrence of injury and the degree of stress. Exposure status from one year prior was used as control information. In the end, the data provided by 158 of selected persons was used for the analysis based on the quality of the data provided by the participants. A conditional logistic regression was used to discover the transient effects on the risk of occupational injuries as acute events. RESULTS: The effect of a company transfer and work load change on occupational injury was statistically significant on the risk of occupational injuries as an acute event(RR=5.5, 95% CI=2.501-12.428; RR=3.1, 95% CI=1.963-5.017, respectively). Other stressful events were found to elevate the risk factor for the occurrence of occupational injury, but were not significant. CONCLUSIONS: Our results suggested that transient stressful events elevated the risk factor for the occurrence of occupational injury.

A case-crossover study between air pollution and hospital emergency room visits by asthma attack / 대한산업의학회지

OBJECTIVES: This study, using case-crossover design, search a relationship between changing levels of air pollutants and asthma attack in asthma patients. METHODS: We searched the daily total number of asthmatic patients at hospital' s emergency room in Seoul, Korea by investigating total 49 general hospitals emergency room records. Otherwise, We investigated medical records of asthmatic patients at one of the 49 hospitals we have searched. We investigated addresses that they are living, diagnosis, smoking history, whether respiratory infection or not, medications. We analyzed the data by 1:m conditional logistic regression used when matched case-control study is analyzed. Control periods were chosen by bidirectional paired matching technique 7, 14 days before and after case periods. RESULTS: the relative risk of asthmatic attack by 100 ppm ozone increase between June and September were 1.348(95 % CI = 1.010~1.619). Between November and February, the relative risk by 100 /m TSP increase, 100ppb sulfur dioxide and nitrogen dioxide were respectively 1.278(1.010~1.619), 1.237(1.019~1.502), 1.285(1.006~1.640). In stratified analysis, the relative risk were significant when the asthmatic patients were children aged 15 years or below, when there were respiratory infection, and when the patients took medications irregularly CONCLUSIONS: There was statistically significant association between ambient levels of air pollutants and asthmatic attack. So, we have to exert our efforts to minimize the air pollution effectively, to protect public health from air pollution.

Relationship between Air Pollution and Acute Respiratory Symptoms in Children in Taiyuan / 环境与健康杂志

Objective To investigate the relationship between air pollution and the acute respiratory symptoms in children in Taiyuan,China.Methods A case-crossover design was used to study the association between air pollution and the acute respiratory symptoms of 254 children aged 7-11 in a school in 2005.Results The acute respiratory symptoms(cough,nose running,stuffy nose and angina)increased as the air concentration of PM10 increased.Conclusion There seems to be a positive association between air pollution of PM10 and the acute respiratory symptoms in children in Taiyuan.

Impact of Cold Wave on Mortality of Cerebra-cardiovascular Diseases in Beijing:a Case-crossover Study / 环境与健康杂志

Objective To estimate the impact of cold wave on daily death of cerebra-cardiovascular diseases in Beijing by using case-crossover design. Methods The data of death counts was provided by Beijing Center for Disease Control and Prevention while the meteorological data was provided by Institute of Urban Meteorology,China Meteorological Administration (CMA),Beijing. The impact of six cold waves from Jan 1,1998 to Jun 30,2000 on daily death of cerebra-cardiovascular diseases were analyzed by using 1∶1 one-directional retrospective design and 1∶2 bi-directional symmetry control design. The cases were the people who dead during winter. Controls were the seventh day before or after the date of cases (or the fourteenth day). Results There were six cold waves in the investigation duration. The third cold wave in which minimum temperature declined obviously with decreasing humidity and increasing air pressure had significantly statistical significance in OR and the lag time of this cold wave was 0 day,the OR values were 1.500 (95%CI:1.032-2.181) for cardiovascular disease (CVD),respectively 1.913 (95%CI:1.066-3.432) for acute myocardial infarction,1.679 (95%CI:1.139-2.474) for cerebra-vascular disease(CBD) respectively. The other five cold waves do not have significant impact on cerebra-cardiovascular diseases. Conclusion Most cold waves studied in Beijing do not impact the daily death counts caused by cerebra-cardiovascular diseases. The cold wave with significant increased air pressure may increase the risk of death of cerebra-cardiovascular diseases without any lag time in Beijing.

Acute Effect of Air Pollution on Cardiovascular Disease Mortality in Old People in Taiyuan City / 环境与健康杂志

Objective To understand the acute effect of the air pollution on daily mortality of cardiovascular diseases in the old people aged over 65 years in Taiyuan, Shanxi, China. Methods Case-crossover design was used to assess the association between air pollution and daily cardiovascular disease mortality. Pollutants considered were nitrogen dioxide (NO2), carbon monoxide (CO), inhalable particles (PM10) and sulfur dioxide (SO2). Results CO exposure was significantly associated with the mortality of five kinds of cardiovascular diseases. No association was found for arrhythmia. As CO concentration increased by 100 ?g/m3, the corresponding OR of cardiovascular disease mortality were as follows, total cardiovascular disease mortality were1.000-1.013, cardiac mortality were1.000-1.024, ischemic heart disease were 1.005-1.032, cardiac failure were 1.006-1.112, myocardial infarction were 1.009-1.050 respectively. The higher OR value was found in unidirectional control design than that in the bidirectional design. Considering the lag effect of air pollution, the 24 hr and 48 hr average of air pollution levels were analyzed in the present study respectively. Conclusion The current air pollution level (PM10, CO) in Taiyuan City has a acute effect on the cardiovascular disease mortality in the local old people aged over 65 years.