| Objective:In order to clarify the general information and variation trends of the number of respiratory hospitalizations,corresponding hospitalization costs and length of stay,and the concentrations of air pollutants in Wuhan city.And to quantitatively evaluate the impacts of air pollution on respiratory disease hospitalizations and its related economic losses.Our study would provide a reference to assess the health effect of air pollution and the cost-benefit of environmental policy.Methods:Daily counts of respiratory disease hospitalizations were collected from two Grade-A Tertiary Hospital in Wuhan city from January 1,2015 to December 31,2019.The daily air pollutant concentration data were collected from the Department of Ecology and Environment of Hubei Province（http://sthjt.hubei.gov.cn）,including Fine Particulate Matter(PM2.5),Inhalable Particulate Matter(PM10),Sulfur Dioxide（SO2）,Nitrogen Dioxide（NO2）,Ozone（O3）and Carbon Monoxide（CO）,meteorological data（including average temperature and relative humidity）were obtained from the China Meteorological Data Network（http://data.cma.cn）.Firstly,descriptive analysis was used to detected the characteristic of the number of hospital admissions,hospitalization costs and length of stay of respiratory diseases,and to explore the trend of daily concentration of each air pollutant.Secondly,Generalized Additive Model was conducted to assess the impacts of PM2.5,PM10,SO2,NO2,O3 and CO exposure on respiratory disease hospitalizations,and the underlying effect modification of respiratory diseases risk by sex,age,season and subtype disease were further investigated.Lastly,Cost of Illness Approach was applied to evaluated the related economic losses caused by air pollution.Results:The results of the study showed that:（1）A total of 45699 inpatients with respiratory diseases were included in the study,among which 60.67%were males and 39.33%were females,and nearly half of cases were aged 65 years and above,accounting for 44.42%.Besides,majority of the patient hospitalized due to pneumonia and Chronic Obstructive Pulmonary Disease（COPD）,total accounting for 48.67%.（2）During the study period,the number of inpatients with respiratory diseases showed an increasing trend from 2015 to 2019,and had a distinct seasonal nature that more hospitalizations in winter and spring,less in summer and autumn.The daily average number of respiratory hospitalizations was 25.05,of which the average number of daily hospitalizations for pneumonia and COPD were 5.87 and 6.31,respectively.The average number of daily hospitalizations in males（15.18）was more than that in females（9.84）.According to age stratification,the highest number of daily hospitalizations was observed for the 65+years group（11.11）.（3）The hospitalization cost of respiratory diseases showed an increasing trend during the study period,with a median of 8842.49 yuan,while the length of stay for patients with respiratory diseases doesn’t change evidently with a median of 9 days.In addition,males and the group age 65+years cost more and stay longer in hospital due to respiratory diseases were observed.（4）During the study period,the concentration of PM2.5,PM10,SO2,O3showed a declining trend,while the concentration of NO2 and CO changed of a fluctuating.The daily average concentrations of PM2.5,PM10,SO2,NO2,O3 and CO were 54.07μg/m3,87.32μg/m3,11.24μg/m3,44.97μg/m3,92.83μg/m3 and 1.020 mg/m3,respectively.Daily concentrations of PM2.5,PM10,SO2,NO2 and CO had similar characteristics of seasonal fluctuation,which showed a low concentration in summer and autumn while a high concentration in winter and spring.However,the seasonal trend of daily concentration of O3 was going in the other direction.（5）Increased hospitalizations for respiratory diseases were significantly related to the exposure of air pollution.With a 10μg/m3 increase in PM2.5,PM10,SO2,NO2 and CO concentrations in the best lag day,the percent change of hospitalizations for respiratory diseases were 1.71%（95%CI:1.29,2.12）,0.71%（0.45,0.97）,8.28%（5.77,10.84）,0.76%（0.13,1.40）and 0.13%（0.08,0.19）,respectively.（6）There were differences in the relationship between hospitalization risk and air pollution in respiratory diseases subgroup,pneumonia was more sensitive to PM2.5,PM10,SO2,NO2 and O3,while COPD was more sensitive to CO.（7）There were gender differences in the risk of hospitalization for respiratory diseases associated with air pollution,that the percent change of hospitalizations for respiratory diseases caused by PM2.5,PM10,SO2,NO2,O3 and CO were higher in males than that in females.（8）The hospitalization risk of respiratory diseases caused by air pollution varied by age groups,PM2.5,PM10,SO2 and NO2 had greater impacts on the group aged 0-14years,while O3 and CO had greater impacts on the group aged 65+years.（9）The hospitalization risk of respiratory diseases due to air pollution was also observed varying by season.The effect values of PM2.5,PM10,O3 and CO in cold season（April to October）were higher than that in warm season（November to March）,while the effects of SO2 and NO2 were stronger in warm season than in cold season.（10）A certain economic losses were caused by the respiratory hospitalization related to air pollution exposure,which approximately accounting for 0.20%of GDP for Wuhan city in 2019.Our study also found that the economic losses of respiratory hospitalization caused by PM2.5,SO2 and CO was higher than those of PM10,NO2and O3.Conclusions:The number of inpatients with respiratory diseases showed an increasing trend,and the exposure of air pollutants were associated with increased number of respiratory hospitalization admissions,which has caused a certain economic loss.Therefore,strengthening the air pollution control would yield considerable health and economic benefits to some extent. |
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