Study On The Association Among Meteorological Factors,Atmospheric Pollutants And Acute Exacerbation Of Chronic Obstructive Pulmonary Disease In Haikou

ObjectiveTo examine the epidemiological characteristics of acute exacerbation of chronic obstructive pulmonary disease（AECOPD）in Haikou City from 2017 to 2021.To explore the relationship between meteorological factors（temperature,pressure）,air pollutants(PM_2.5,PM₁₀,SO₂,O₃and NO₂)and AECOPD,and analyse the exposure effect and lag effect of each factor on different populations,identify the susceptible population,and provide reference for the prevention and treatment of AECOPD in tropical areas of China.MethodsThis study collected case data of local resident daily AECOPD hospitalization,meteorological factors and atmospheric pollutants data of Haikou city from January 1,2017 to December 31,2021 in three tertiary level A general hospitals（Hainan Provincial People’s Hospital,the First Affiliated Hospital of Hainan Medical College,and the Second Affiliated Hospital of Hainan Medical College）.Spearman correlation analysis was used to explore the correlation between meteorological factors and pollutants,and a distributed lag non-linear model（DLNM）was constructed to explore the effect of meteorological factors and air pollutants on the risk of AECOPD hospitalization.The Akaike information criterion was used as the criterion for selecting the degrees of freedom to fit the optimal model.The relationship between meteorology and pollutants and the number of AECOPD hospitalizations was plotted and the exposure-response relationship was determined.Three-dimensional graphs and contour maps were used to visually show the effect of weather and pollutant indicators on the risk of AECOPD hospitalization at different lag times,and stratified analysis by sex and age was performed to identify the susceptible population.At the same time,a quantitative analysis was performed to determine whether the interaction between meteorological factors and air pollutants on the number of AECOPD hospitalizations was statistically significant.Results1.The total number of AECOPD hospitalizations of local residents in the three grade A hospitals in Haikou City from 1 January 2017 to 31 December 2021 was10,287,of which a total of 7,872（76.5%）were males and a total of 2,415（23.5%）were females.The number of AECOPD hospitalizations was higher in the elderly group（age≥65 years,N=8827）than in the non-elderly group（age<65 years,N=1460）.2.The exposure-response relationship between mean daily temperature and AECOPD admissions showed an S-shape.In Haikou,both low temperature（13℃）and high temperature（32℃）had a lag effect on the number of AECOPD hospitalizations.The cumulative effect of high temperature on hospitalization was more significant than that of low temperature,with the lowest RR of 0.684（95%CI:0.506-0.926）when the lag was at lag0-14 days.Subgroup analysis showed that low temperature increased the number of hospitalizations in females,with the highest RR of 1.830（95%CI:1.094-3.059）for lag0-8 days,whereas high temperatures decreased the number of hospitalizations in males and elderly population（≥65 years）,with the lowest RR values at lag 0-14 days of 0.659（95%CI:0.463-0.936）and 0.644（95%CI:0.465-0.891）,respectively.3.The exposure-response relationship between daily mean air pressure and AECOPD hospitalizations was U-shaped.The effect of low pressure（992 h Pa）on AECOPD hospitalizations was not significant,and there was a lag in the effect of high pressure（1017 h Pa）,with an effect on AECOPD hospitalizations at lag 8 day（lag8d）with an RR of 1.083（95%CI:1.013-1.158）.Subgroup analysis showed that the effect of low atmospheric pressure on male was only significant at lag0-1 days,with an RR of 1.212（95%CI:1.014-1.450）.4.The exposure-response relationship between particulate pollutants(PM_2.5and PM₁₀)and AECOPD hospitalizations was S-shaped.Compared with the median value,higher concentrations of PM_2.5and PM₁₀significantly increased the risk of hospital admission for AECOPD,with maximum RR values of 1.562（95%CI:1.139-2.140）and 1.355（95%CI:1.052-1.746）,respectively,with a long-term delayed effect and with males and older populations being more susceptible to their effects.In contrast,the effect of both low PM_2.5and PM₁₀on hospitalizations for this disease was not statistically significant over the lag period.5.The exposure-response curves for gaseous pollutants（NO₂,O₃and SO₂）and AECOPD hospitalizations were all non-linear,with lower NO₂concentrations increasing the risk of hospital admission for AECOPD patients compared with the median value,with the highest RR value of 1.164（95%CI:1.001-1.354）at lag 0-5days.Higher concentrations of O₃and SO₂significantly increased the risk of hospital hospitalization for this disease,with maximum RR values of 1.625（95%CI:1.255-2.140）and 1.321（95%CI:1.009-1.728）,respectively,and a long lag effect duration.Males and older populations（≥65 years）were sensitive to NO₂and O₃,whereas females were more sensitive to SO₂.6.In the two-pollutant model,the introduction of PM_2.5,PM₁₀and O₃into the NO₂model would increase the risk of AECOPD hospitalization and the introduction of SO₂would reduce the risk.The separate introduction of other pollutants into the PM_2.5,PM₁₀,SO₂and O₃models would reduce the risk of AECOPD hospitalization.7.The results of the interaction of meteorological factors and air pollutants on AECOPD hospitalizations showed that for each 10μg/m³increase in PM_2.5,PM₁₀and NO₂concentrations at high pressure（≥1017h Pa）,the risk of hospitalization increased by 1.005（95 CI%:1.0012-1.0093）,1.003（95 CI%:1.0003-1.0059）and 1.005（95CI%:1.0004-1.0104）,respectively.ConclusionsThis study found that patients with AECOPD in Haikou city were mainly male and elderly.Low temperature and high pressure environment will increase the number of AECOPD hospitalizations,and the effect has a lag effect,while high temperature has a protective effect on the hospitalization of the disease.High levels of the pollutants PM_2.5,PM₁₀,SO₂and O₃increased the number of AECOPD admissions,and chronic exposure to low levels of pollutants also had a negative delayed effect on AECOPD admissions,with PM_2.5and O₃having greater health effects than other pollutants,and their effects varied by gender and age.The effects of meteorological factors and pollutants on human health may interact,attention should be paid to the joint prevention and control of various air pollutants.At the same time,the health monitoring of the population susceptible to AECOPD should be strengthened in order to provide a theoretical basis for the establishment of the prevention and treatment system of“Weather-Atmospheric pollutants”sensitive diseases in the next stage.