A time-series analysis of the effect of atmospheric ozone on hospitalization of residents with respiratory diseases in four Chinese cities
Background,aim,and scope In recent years,ozone has emerged as a significant pollutant impacting air quality in China.Variations in the effects of short-term ozone exposure on respiratory disease incidence may exist regionally.Nevertheless,there is a noticeable lack of studies encompassing multiple cities in this area.The primary goal of this research was to examine the influence of atmospheric ozone on the incidence of hospital admissions for respiratory diseases in several Chinese cities.Materials and methods Data on daily maximum 8-h average concentrations of ozone(O3-8h),meteorological conditions,and hospital admissions for respiratory diseases were gathered from January 1,2019,to December 31,2022,in four Chinese cities:Baoding,Yancheng,Zigong,and Guangzhou.The relationship between daily hospital admissions for respiratory diseases and atmospheric O3-8h concentrations was examined at the city level using a generalized additive model.This analysis adjusted for long-term and seasonal trends,meteorological conditions,the"day-of-the-week effect",and the"holiday effect".A random-effects meta-analysis was employed to synthesize the findings at the city level.Results The impact of ozone on hospital admissions for respiratory diseases was found to be delayed,with the severity of the impact varying significantly across cities.For each 10 µg·mr-3 increase in atmospheric O3-8h concentration,the percentage of daily hospitalizations for all respiratory diseases,chronic obstructive pulmonary disease(COPD),and pneumonia increased by 0.35％(Guangzhou)—1.11％(Zigong),0.54％(Baoding)—1.42％(Yancheng),and 0.42％(Guangzhou)—1.37％(Zigong),respectively in different cities,with most effects being statistically significant(P＜0.05).At the multi-city level,for each 10 μg·m-3 increase in O3-8h concentration,daily hospital admissions for respiratory diseases increased by 0.49％(95％CI:0.30％—0.68％,lag3),0.86％(95％CI:0.54％—1.18％,lag2),and 0.74％(95％CI:0.31％—1.17％,lag4).Stratification analysis revealed that children and the elderly aged 60 years or older were especially susceptible,with no notable differences in susceptibility between genders.The significance of the ozone effect was maintained in a dual-pollutant model that controlled for the presence of other pollutants.Discussion An increase in atmospheric ozone concentration has consistently led to an uptick in hospital admissions for respiratory ailments,with more pronounced effects generally observed in southern cities compared to northern ones.This difference may be partly due to regional variations in ozone infiltration rates.The lagged effect of ozone was also observed,which can be attributed to ozone's chemical and toxicological properties,along with the time lapse between residents falling ill and hospital admission.Vulnerability to ozone's health effects was heightened among elderly populations with diminished respiratory and immune functions,as well as children with underdeveloped respiratory and immune functions and increased pollutant exposure per unit of body weight.Conclusions Short-term ozone exposure has been linked to increased hospitalizations for respiratory diseases,showing both delayed effects and regional discrepancies.Recommendations and perspectives Considering the substantial link between atmospheric ozone and respiratory diseases,more rigorous actions should be implemented to curb the further worsening of ozone pollution.Additionally,the establishment of an early warning system for ozone-polluted weather could aid in advising vulnerable populations,particularly the elderly and children,on effective measures to mitigate health risks associated with ozone exposure.
air pollutionozonerespiratory diseasestime series analysisgeneralized additive models
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