Association between ambient air pollution and hospital admissions, length of hospital stay and hospital cost for patients with cardiovascular diseases and comorbid diabetes mellitus: Base on 1,969,755 cases in Beijing, China, 2014–2019

Zhiwei Li; Mengyang Liu; Zhiyuan Wu; Yue Liu; Weiming Li; Mengmeng Liu; Shiyun Lv; Siqi Yu; Yanshuang Jiang; Bo Gao; Xiaonan Wang; Xia Li; Wei Wang; Hualiang Lin; Xiuhua Guo; Xiangtong Liu

Environment International (Jul 2022)

Association between ambient air pollution and hospital admissions, length of hospital stay and hospital cost for patients with cardiovascular diseases and comorbid diabetes mellitus: Base on 1,969,755 cases in Beijing, China, 2014–2019

Zhiwei Li,
Mengyang Liu,
Zhiyuan Wu,
Yue Liu,
Weiming Li,
Mengmeng Liu,
Shiyun Lv,
Siqi Yu,
Yanshuang Jiang,
Bo Gao,
Xiaonan Wang,
Xia Li,
Wei Wang,
Hualiang Lin,
Xiuhua Guo,
Xiangtong Liu

Affiliations

Zhiwei Li: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
Mengyang Liu: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China; Department of Nutrition and Food Hygiene, School of Public Health, Hebei Medical University, Shijiazhuang, China;
Zhiyuan Wu: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
Yue Liu: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
Weiming Li: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
Mengmeng Liu: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
Shiyun Lv: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
Siqi Yu: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
Yanshuang Jiang: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
Bo Gao: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
Xiaonan Wang: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
Xia Li: Department of Mathematics and Statistics, La Trobe University, Melbourne 3086, Australia
Wei Wang: School of Medical Sciences and Health, Edith Cowan University, WA6027 Perth, Australia
Hualiang Lin: Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China; Corresponding authors at: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xi-Tou-Tiao, You-An-Men Street, Fengtai District, Beijing 100069, China (Xiangtong Liu). Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xi-Tou-Tiao, You-An-Men Street, Fengtai District, Beijing 100069, China (Xiuhua Guo). Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China (Hualiang Lin).
Xiuhua Guo: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China; School of Medical Sciences and Health, Edith Cowan University, WA6027 Perth, Australia; National Institute for Data Science in Health and Medicine, Capital Medical University, China; Corresponding authors at: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xi-Tou-Tiao, You-An-Men Street, Fengtai District, Beijing 100069, China (Xiangtong Liu). Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xi-Tou-Tiao, You-An-Men Street, Fengtai District, Beijing 100069, China (Xiuhua Guo). Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China (Hualiang Lin).
Xiangtong Liu: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China; Corresponding authors at: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xi-Tou-Tiao, You-An-Men Street, Fengtai District, Beijing 100069, China (Xiangtong Liu). Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xi-Tou-Tiao, You-An-Men Street, Fengtai District, Beijing 100069, China (Xiuhua Guo). Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China (Hualiang Lin).

Journal volume & issue: Vol. 165
p. 107301

Abstract

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Background: Evidence on the effects of the air pollutants on the hospital admissions, hospital cost and length of stay (LOS) among patients with comorbidities remains limited in China, particularly for patients with cardiovascular diseases and comorbid diabetes mellitus (CVD-DM). Methods: We collected daily data on CVD-DM patients from 242 hospitals in Beijing between 2014 and 2019. Generalized additive model was employed to quantify the associations between admissions, LOS, and hospital cost for CVD-DM patients and air pollutants. We further evaluated the attributable risk posed by air pollutants to CVD-DM patients, using both Chinese and WHO air quality guidelines as reference. Results: Per 10 ug/m3 increase of particles with an aerodynamic diameter < 2.5 μm (PM2.5), particles with an aerodynamic diameter < 10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbonic oxide (CO) and ozone (O3) corresponded to a 0.64% (95% CI: 0.57 to 0.71), 0.52% (95% CI: 0.46 to 0.57), 0.93% (95% CI: 0.67 to 1.20), 0.98% (95% CI: 0.81 to 1.16), 1.66% (95% CI: 1.18 to 2.14) and 0.53% (95% CI: 0.45 to 0.61) increment for CVD-DM patients’ admissions. Among the six pollutants, particulate pollutants (PM2.5 and PM10) in most lag days exhibited adverse effects on LOS and hospital cost. For every 10 ug/m3 increase in PM2.5 and PM10, the absolute increase with LOS will increase 62.08 days (95% CI: 28.93 to 95.23) and 51.77 days (95% CI:22.88 to 80.66), respectively. The absolute increase with hospital cost will increase 105.04 Chinese Yuan (CNY) (95% CI: 49.27 to 160.81) and 81.76 CNY (95% CI: 42.01 to 121.51) in PM2.5 and PM10, respectively. Given WHO 2021 air quality guideline as the reference, PM2.5 had the maximum attributable fraction of 3.34% (95% CI: 2.94% to 3.75%), corresponding to an avoidable of 65,845 (95% CI: 57,953 to 73,812) patients with CVD-DM. Conclusion: PM2.5 and PM10 are positively associated with hospital admissions, hospital cost and LOS for patients with CVD-DM. Policy changes to reduce air pollutants exposure may reduce CVD-DM admissions and substantial savings in health care spending and LOS.

Published in Environment International

ISSN: 0160-4120 (Print)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Geography. Anthropology. Recreation: Environmental sciences
Website: https://www.journals.elsevier.com/environment-international

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