ABSTRACT
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 30 days) (p < 0.001). In addition, outpatient visits of cerebrovascular and respiratory disease were extremely significant correlated with PM2.5 (exposures within 0-360 days) (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 15 days) increased by 1 mg/m3, the cardiovascular outpatient visits increased most dramatically (by about 440 people). For nonlinear relationships, when the average PM2.5 concentration (exposure with over 30 days or more) increased by 1 mg/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 1 mg/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 15 days) 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 30 days) and outpatient visits, with cardiovascular and cerebrovascular outpatient visits showed a nonlinear but overall upward trend when the atmosphere is moderately polluted.
