Influence of air pollution on influenza-like illness in China: A nationwide time-series analysisResearch in context
Jun Yang,
Zhou Yang,
Li Qi,
Mengmeng Li,
Di Liu,
Xiaobo Liu,
Shilu Tong,
Qinghua Sun,
Luzhao Feng,
Chun-Quan Ou,
Qiyong Liu
Affiliations
Jun Yang
School of Public Health, Guangzhou Medical University, Guangzhou, 511436, China; Corresponding author.
Zhou Yang
State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
Li Qi
Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, China
Mengmeng Li
Department of Cancer Prevention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
Di Liu
School of Public Health, Guangzhou Medical University, Guangzhou, 511436, China
Xiaobo Liu
State 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, 102206, China
Shilu Tong
Shanghai Children's Medical Center, Shanghai Jiao Tong University, Shanghai, 200127, China
Qinghua Sun
School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
Luzhao Feng
School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China; Corresponding author.
Chun-Quan Ou
State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
Qiyong Liu
State 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, 102206, China; Corresponding author.
Summary: Background: Evidence concerning effects of air pollution on influenza-like illness (ILI) from multi-center is limited and little is known about how regional factors might modify this relationship. Methods: In this ecological study, ILI cases defined as outpatients with temperature ≥38 °C, accompanied by cough or sore throat, were collected from National Influenza Surveillance Network in China. We adopted generalized additive model with quasi-Poisson to estimate province-specific association between air pollution and ILI in 30 Chinese provinces during 2015–2019, after adjusting for time trend and meteorological factors. We then pooled province-specific association by using random-effect meta-analysis. Potential effect modifications of season and regional characteristics were explored. Findings: A total of 26, 004, 853 ILI cases and 777, 223, 877 hospital outpatients were collected. In general, effects of air pollutants were acute. An inter-quartile range increase of PM2.5, SO2, PM10, NO2 and CO at lag0, and O3 at lag0-2 was associated with 3.08% (95% CI: 1.91%, 4.27%), 3.00% (1.86%, 4.16%), 6.46% (4.71%, 8.25%), 7.21% (5.73%, 8.71%), 4.37% (3.05%, 5.70%), and −9.26% (−11.32%, −7.14%) change of ILI at national level, respectively. Associations between air pollutants and ILI varied by season and regions, with higher effect estimates in cold season, eastern and central regions and provinces with more humid condition and larger population. Interpretation: This study indicated that most air pollutants increased the risk of ILI in China. Our findings might provide implications for the development of policies to protect public health from air pollution and influenza. Funding: National Natural Science Foundation of China and Chongqing Health Commission Program.
