Abstract
OBJECTIVE: To investigate short term effects of concentrations of pollutants in ambient air on hospital admissions for cardiovascular and respiratory diseases in Hong Kong. METHODS: Retrospective ecological study. A Poisson regression was performed of concentrations of daily air pollutant on daily counts of emergency hospital admissions in 12 major hospitals. The effects of time trend, season, and other cyclical factors, temperature, and humidity were accounted for. Autocorrelation and overdispersion were corrected. Daily concentrations of nitrogen dioxide (NO2), sulphur dioxide (SO2), ozone (O3), and particulate matter < 10 microns in aerodynamic diameter (PM10) were obtained from seven air monitoring stations in Hong Kong in 1994 and 1995. Relative risks (RR) of respiratory and cardiovascular disease admissions (for an increase of 10 micrograms/m3 in concentration of air pollutant) were calculated. RESULTS: Significant associations were found between hospital admissions for all respiratory diseases, all cardiovascular diseases, chronic obstructive pulmonary diseases, and heart failure and the concentrations of all four pollutants. Admissions for asthma, pneumonia, and influenza were significantly associated with NO2, O3, and PM10. Relative risk (RR) for admissions for respiratory disease for the four pollutants ranged from 1.013 (for SO2) to 1.022 (for O3), and for admissions for cardiovascular disease, from 1.006 (for PM10) to 1.016 (for SO2). Those aged > or = 65 years were at higher risk. Significant positive interactions were detected between NO2, O3, and PM10, and between O3 and winter months. CONCLUSIONS: Adverse health effects are evident at current ambient concentrations of air pollutants. Further reduction in air pollution is necessary to protect the health of the community, especially that of the high risk group.
Full Text
The Full Text of this article is available as a PDF (187.7 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bachárová L., Fandáková K., Bratinka J., Budinská M., Bachár J., Gud-aba M. The association between air pollution and the daily number of deaths: findings from the Slovak Republic contribution to the APHEA project. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):s19–s21. doi: 10.1136/jech.50.suppl_1.s19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Borja-Aburto V. H., Loomis D. P., Bangdiwala S. I., Shy C. M., Rascon-Pacheco R. A. Ozone, suspended particulates, and daily mortality in Mexico City. Am J Epidemiol. 1997 Feb 1;145(3):258–268. doi: 10.1093/oxfordjournals.aje.a009099. [DOI] [PubMed] [Google Scholar]
- Brunekreef B., Dockery D. W., Krzyzanowski M. Epidemiologic studies on short-term effects of low levels of major ambient air pollution components. Environ Health Perspect. 1995 Mar;103 (Suppl 2):3–13. doi: 10.1289/ehp.95103s23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dab W., Medina S., Quénel P., Le Moullec Y., Le Tertre A., Thelot B., Monteil C., Lameloise P., Pirard P., Momas I. Short term respiratory health effects of ambient air pollution: results of the APHEA project in Paris. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):s42–s46. doi: 10.1136/jech.50.suppl_1.s42. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dockery D. W., Pope C. A., 3rd Acute respiratory effects of particulate air pollution. Annu Rev Public Health. 1994;15:107–132. doi: 10.1146/annurev.pu.15.050194.000543. [DOI] [PubMed] [Google Scholar]
- Dockery D. W., Pope C. A., 3rd, Xu X., Spengler J. D., Ware J. H., Fay M. E., Ferris B. G., Jr, Speizer F. E. An association between air pollution and mortality in six U.S. cities. N Engl J Med. 1993 Dec 9;329(24):1753–1759. doi: 10.1056/NEJM199312093292401. [DOI] [PubMed] [Google Scholar]
- Gilmour P. S., Brown D. M., Lindsay T. G., Beswick P. H., MacNee W., Donaldson K. Adverse health effects of PM10 particles: involvement of iron in generation of hydroxyl radical. Occup Environ Med. 1996 Dec;53(12):817–822. doi: 10.1136/oem.53.12.817. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Katsouyanni K., Schwartz J., Spix C., Touloumi G., Zmirou D., Zanobetti A., Wojtyniak B., Vonk J. M., Tobias A., Pönkä A. Short term effects of air pollution on health: a European approach using epidemiologic time series data: the APHEA protocol. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):S12–S18. doi: 10.1136/jech.50.suppl_1.s12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Katsouyanni K., Touloumi G., Spix C., Schwartz J., Balducci F., Medina S., Rossi G., Wojtyniak B., Sunyer J., Bacharova L. Short-term effects of ambient sulphur dioxide and particulate matter on mortality in 12 European cities: results from time series data from the APHEA project. Air Pollution and Health: a European Approach. BMJ. 1997 Jun 7;314(7095):1658–1663. doi: 10.1136/bmj.314.7095.1658. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kelsall J. E., Samet J. M., Zeger S. L., Xu J. Air pollution and mortality in Philadelphia, 1974-1988. Am J Epidemiol. 1997 Nov 1;146(9):750–762. doi: 10.1093/oxfordjournals.aje.a009351. [DOI] [PubMed] [Google Scholar]
- Morris R. D., Naumova E. N., Munasinghe R. L. Ambient air pollution and hospitalization for congestive heart failure among elderly people in seven large US cities. Am J Public Health. 1995 Oct;85(10):1361–1365. doi: 10.2105/ajph.85.10.1361. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ponce de Leon A., Anderson H. R., Bland J. M., Strachan D. P., Bower J. Effects of air pollution on daily hospital admissions for respiratory disease in London between 1987-88 and 1991-92. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):s63–s70. doi: 10.1136/jech.50.suppl_1.s63. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pönkä A., Virtanen M. Asthma and ambient air pollution in Helsinki. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):s59–s62. doi: 10.1136/jech.50.suppl_1.s59. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pönkä A., Virtanen M. Low-level air pollution and hospital admissions for cardiac and cerebrovascular diseases in Helsinki. Am J Public Health. 1996 Sep;86(9):1273–1280. doi: 10.2105/ajph.86.9.1273. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Raizenne M. E., Burnett R. T., Stern B., Franklin C. A., Spengler J. D. Acute lung function responses to ambient acid aerosol exposures in children. Environ Health Perspect. 1989 Feb;79:179–185. doi: 10.1289/ehp.8979179. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Saldiva P. H., Pope C. A., 3rd, Schwartz J., Dockery D. W., Lichtenfels A. J., Salge J. M., Barone I., Bohm G. M. Air pollution and mortality in elderly people: a time-series study in Sao Paulo, Brazil. Arch Environ Health. 1995 Mar-Apr;50(2):159–163. doi: 10.1080/00039896.1995.9940893. [DOI] [PubMed] [Google Scholar]
- Schouten J. P., Vonk J. M., de Graaf A. Short term effects of air pollution on emergency hospital admissions for respiratory disease: results of the APHEA project in two major cities in The Netherlands, 1977-89. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):s22–s29. doi: 10.1136/jech.50.suppl_1.s22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schwartz J. Air pollution and hospital admissions for respiratory disease. Epidemiology. 1996 Jan;7(1):20–28. doi: 10.1097/00001648-199601000-00005. [DOI] [PubMed] [Google Scholar]
- Schwartz J., Spix C., Touloumi G., Bachárová L., Barumamdzadeh T., le Tertre A., Piekarksi T., Ponce de Leon A., Pönkä A., Rossi G. Methodological issues in studies of air pollution and daily counts of deaths or hospital admissions. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):S3–11. doi: 10.1136/jech.50.suppl_1.s3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Spix C., Wichmann H. E. Daily mortality and air pollutants: findings from Köln, Germany. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):s52–s58. doi: 10.1136/jech.50.suppl_1.s52. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sunyer J., Castellsagué J., Sáez M., Tobias A., Antó J. M. Air pollution and mortality in Barcelona. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):s76–s80. doi: 10.1136/jech.50.suppl_1.s76. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Touloumi G., Samoli E., Katsouyanni K. Daily mortality and "winter type" air pollution in Athens, Greece--a time series analysis within the APHEA project. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):s47–s51. doi: 10.1136/jech.50.suppl_1.s47. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Utell M. J., Morrow P. E., Speers D. M., Darling J., Hyde R. W. Airway responses to sulfate and sulfuric acid aerosols in asthmatics. An exposure-response relationship. Am Rev Respir Dis. 1983 Sep;128(3):444–450. doi: 10.1164/arrd.1983.128.3.444. [DOI] [PubMed] [Google Scholar]
- Vigotti M. A., Rossi G., Bisanti L., Zanobetti A., Schwartz J. Short term effects of urban air pollution on respiratory health in Milan, Italy, 1980-89. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):s71–s75. doi: 10.1136/jech.50.suppl_1.s71. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Walters S., Griffiths R. K., Ayres J. G. Temporal association between hospital admissions for asthma in Birmingham and ambient levels of sulphur dioxide and smoke. Thorax. 1994 Feb;49(2):133–140. doi: 10.1136/thx.49.2.133. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wordley J., Walters S., Ayres J. G. Short term variations in hospital admissions and mortality and particulate air pollution. Occup Environ Med. 1997 Feb;54(2):108–116. doi: 10.1136/oem.54.2.108. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Xu X., Gao J., Dockery D. W., Chen Y. Air pollution and daily mortality in residential areas of Beijing, China. Arch Environ Health. 1994 Jul-Aug;49(4):216–222. doi: 10.1080/00039896.1994.9937470. [DOI] [PubMed] [Google Scholar]
- Zmirou D., Barumandzadeh T., Balducci F., Ritter P., Laham G., Ghilardi J. P. Short term effects of air pollution on mortality in the city of Lyon, France, 1985-90. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):S30–S35. doi: 10.1136/jech.50.suppl_1.s30. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Zmirou D., Schwartz J., Saez M., Zanobetti A., Wojtyniak B., Touloumi G., Spix C., Ponce de León A., Le Moullec Y., Bacharova L. Time-series analysis of air pollution and cause-specific mortality. Epidemiology. 1998 Sep;9(5):495–503. [PubMed] [Google Scholar]