The impact of ambient particulate matter on hospital outpatient visits for respiratory and circulatory system disease in an urban Chinese population

Highlights: • PM was associated with overall outpatient visits of cardiopulmonary health. • The health impact of PM was sensitive to adjustment of gaseous pollutants. • The relationship curve presented non-linear across the full range of exposures. • Estimated risks in warm season were higher than those in cold season. -- Abstract: There are limited evidence on the association between short-term exposure to ambient particulate matter (PM) and overall hospital outpatient visits for respiratory system disease (RESD) and cardio-cerebrovascular system disease (CCD) in high-polluted countries like China. Though previous epidemiological studies of RESD and CCD generally applied a linear relationship of the acute PM effects, it is unclear whether this linear exposure-response relationship holds in high pollution area. In this study, a time-series study during 2013 through 2016 was conducted to investigate 245,442 and 430,486 hospital visits for RESD and CCD respectively from Nanjing city, China. A combination of logistic generalized additive model (GAM) was used to evaluate the exposure-response associations. The results disclosed that a 10 μg/m³ increase in PM_2.5 and PM₁₀ concentration on the current day of exposure (lag 0) was associated with 0.36% (95% CI: −0.02%–0.73%) and 0.33% (0.07%–0.60%) increase in RESD; and 0.42% (0.00%–0.85%) and 0.37% (0.08%–0.67%) increase in CCD. The exposure-response association was approximately linear within 0–150 μg/m³ of PM concentration and non-linear across the full range of exposures. The effects of PM on RESD and CCD were sensitive to additional adjustment for co-pollutants, indicating the health effects of air pollution mixture in Nanjing city. There was no evidence of potential effect modification of RESD and CCD by season (cold and warm), age (5–64, 65–74, ≧75 years) and sex (male and female) groups. Though not statistically significant, the estimated risks in warm season were higher than those in cold season, suggesting potential synergistic effects of ambient PM pollution and temperature on triggering RESD and CCD.