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  • Ambient PM2.5 exposure and hospital cost and length of hospital stay for respiratory diseases in 11 cities in Shanxi Province, China

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Respiratory epidemiology
Original research
Ambient PM2.5 exposure and hospital cost and length of hospital stay for respiratory diseases in 11 cities in Shanxi Province, China
  1. Dawei Cao1,
  2. Dongyan Li1,
  3. Yinglin Wu2,
  4. Zhengmin (Min) Qian3,
  5. Yi Liu1,
  6. Qiyong Liu4,
  7. Jimin Sun5,
  8. Yuming Guo6,
  9. Shiyu Zhang2,
  10. Guangyuan Jiao7,
  11. Xiaoran Yang8,
  12. Chongjian Wang9,
  13. Stephen Edward McMillin10,
  14. Xinri Zhang1,
  15. Hualiang Lin2
  1. 1 Department of Respiration, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
  2. 2 Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
  3. 3 Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
  4. 4 Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
  5. 5 Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
  6. 6 School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  7. 7 Department of Ideological and Political Education, School of Marxism, Capital Medical University, Beijing, China
  8. 8 Department of Standards and Evaluation, Beijing Municipal Health Commission Policy Research Center, Beijing Municipal health Commission Information Center, Beijing, China
  9. 9 Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
  10. 10 School of Social Work, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
  1. Correspondence to Dr Hualiang Lin, Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China; linhualiang{at}mail.sysu.edu.cn; Dr Xinri Zhang, Department of Respiration, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; ykdzxr61{at}163.com

Abstract

Background Few studies have examined the effects of ambient particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (PM2.5) on hospital cost and length of hospital stay for respiratory diseases in China.

Methods We estimated ambient air pollution exposure for respiratory cases through inverse distance-weighted averages of air monitoring stations based on their residential address and averaged at the city level. We used generalised additive models to quantify city-specific associations in 11 cities in Shanxi and a meta-analysis to estimate the overall effects. We further estimated respiratory burden attributable to PM2.5 using the standards of WHO (25 µg/m3) and China (75 µg/m3) as reference.

Results Each 10 µg/m3 increase in lag03 PM2.5 corresponded to 0.53% (95% CI: 0.33% to 0.73%) increase in respiratory hospitalisation, an increment of 3.75 thousand RMB (95% CI: 1.84 to 5.670) in hospital cost and 4.13 days (95% CI: 2.51 to 5.75) in length of hospital stay. About 9.7 thousand respiratory hospitalisations, 132 million RMB in hospital cost and 145 thousand days of hospital stay could be attributable to PM2.5 exposures using WHO’s guideline as reference. We estimated that 193 RMB (95% CI: 95 to 292) in hospital cost and 0.21 days (95% CI: 0.13 to 0.30) in hospital stay could be potentially avoidable for an average respiratory case.

Conclusion Significant respiratory burden could be attributable to PM2.5 exposures in Shanxi Province, China. The results need to be factored into impact assessment of air pollution policies to provide a more complete indication of the burden addressed by the policies.

  • clinical epidemiology
  • respiratory measurement

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/thoraxjnl-2020-215838

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • DC and DL contributed equally.

    • Contributors DC and DL are joint first authors, contributed to the data collection, data cleaning and had primary responsibility for writing the manuscript. DC and DL contributed equally to this work. YW, ZQ, YL, QL and JS were involved in the writing and revision of the manuscript. YG, SZ, GJ, SM, CW and XY contributed to the revision of the manuscript and interpretation of the findings. XZ and HL contributed to the analysis and directed this study. All authors critically reviewed the manuscript for important intellectual content. The corresponding authors attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

    • Funding This study was funded by The Special Fund Project for Guiding Local Science and Technology Development by the Central Government (No.: YDZX20191400002737), the Natural Science Foundation of China (No.: 82041021) and the Bill & Melinda Gates Foundation (No.: INV-006371).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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