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      Short-term effects and economic burden of air pollutants on acute lower respiratory tract infections in children in Southwest China: a time-series study

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          Abstract

          Background

          There are few studies on the effects of air pollutants on acute lower respiratory tract infections (ALRI) in children. Here, we investigated the relationship of fine particulate matter (PM 2.5), inhalable particulate matter (PM 10), sulfur dioxide (SO 2), and nitrogen dioxide (NO 2) with the daily number of hospitalizations for ALRI in children in Sichuan Province, China, and to estimate the economic burden of disease due to exposure to air pollutants.

          Methods

          We collected records of 192,079 cases of childhood ALRI hospitalization between January 1, 2017 and December 31, 2018 from nine municipal/prefecture medical institutions as well as the simultaneous meteorological and air pollution data from 183 monitoring sites in Sichuan Province. A time series-generalized additive model was used to analyze exposure responses and lagged effects while assessing the economic burden caused by air pollutant exposure after controlling for long-term trends, seasonality, day of the week, and meteorological factors.

          Results

          Our single-pollutant model shows that for each 10 μg/m 3 increase in air pollutant concentration (1 μg/m 3 for SO 2), the effect estimates of PM 2.5, PM 10, SO 2, and NO 2 for pneumonia reached their maximum at lag4, lag010, lag010, and lag07, respectively, with relative risk (RR) values of 1.0064 (95% CI, 1.0004–1.0124), 1.0168(95% CI 1.0089–1.0248), 1.0278 (95% CI 1.0157–1.0400), and 1.0378 (95% CI, 1.0072–1.0692). By contrast, the effect estimates of PM 2.5, PM 10, SO 2, and NO 2 for bronchitis all reached their maximum at lag010, with RRs of 1.0133 (95% CI 1.0025–1.0242), 1.0161(95% CI 1.0085–1.0238), 1.0135 (95% CI 1.0025–1.0247), and 1.1133(95% CI 1.0739–1.1541). In addition, children aged 5–14 years were more vulnerable to air pollutants than those aged 0–4 years ( p < 0.05). According to the World Health Organization’s air quality guidelines, the number of ALRI hospitalizations attributed to PM 2.5, PM 10, and NO 2 pollution during the study period was 7551, 10,151, and 7575, respectively, while the incurring economic burden was CNY 2847.06, 3827.27, and 2855.91 million.

          Conclusion

          This study shows that in Sichuan Province, elevated daily average concentrations of four air pollutants lead to increases in numbers of childhood ALRI hospitalizations and cause a serious economic burden.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12940-023-00962-3.

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          Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

          Theo Vos, Stephen S Lim, Cristiana Abbafati … (2023)
          Summary Background In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding Bill & Melinda Gates Foundation.
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            Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis

            Harish Nair, D Nokes, Bradford Gessner … (2010)
            Summary Background The global burden of disease attributable to respiratory syncytial virus (RSV) remains unknown. We aimed to estimate the global incidence of and mortality from episodes of acute lower respiratory infection (ALRI) due to RSV in children younger than 5 years in 2005. Methods We estimated the incidence of RSV-associated ALRI in children younger than 5 years, stratified by age, using data from a systematic review of studies published between January, 1995, and June, 2009, and ten unpublished population-based studies. We estimated possible boundaries for RSV-associated ALRI mortality by combining case fatality ratios with incidence estimates from hospital-based reports from published and unpublished studies and identifying studies with population-based data for RSV seasonality and monthly ALRI mortality. Findings In 2005, an estimated 33·8 (95% CI 19·3–46·2) million new episodes of RSV-associated ALRI occurred worldwide in children younger than 5 years (22% of ALRI episodes), with at least 3·4 (2·8–4·3) million episodes representing severe RSV-associated ALRI necessitating hospital admission. We estimated that 66 000–199 000 children younger than 5 years died from RSV-associated ALRI in 2005, with 99% of these deaths occurring in developing countries. Incidence and mortality can vary substantially from year to year in any one setting. Interpretation Globally, RSV is the most common cause of childhood ALRI and a major cause of admission to hospital as a result of severe ALRI. Mortality data suggest that RSV is an important cause of death in childhood from ALRI, after pneumococcal pneumonia and Haemophilus influenzae type b. The development of novel prevention and treatment strategies should be accelerated as a priority. Funding WHO; Bill & Melinda Gates Foundation.
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              The impact of PM2.5 on the human respiratory system.

              Yu-Fei Xing, Yue-Hua Xu, Min-Hua Shi … (2016)
              Recently, many researchers paid more attentions to the association between air pollution and respiratory system disease. In the past few years, levels of smog have increased throughout China resulting in the deterioration of air quality, raising worldwide concerns. PM2.5 (particles less than 2.5 micrometers in diameter) can penetrate deeply into the lung, irritate and corrode the alveolar wall, and consequently impair lung function. Hence it is important to investigate the impact of PM2.5 on the respiratory system and then to help China combat the current air pollution problems. In this review, we will discuss PM2.5 damage on human respiratory system from epidemiological, experimental and mechanism studies. At last, we recommend to the population to limit exposure to air pollution and call to the authorities to create an index of pollution related to health.
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                Author and article information

                Contributors
                Yi He: 987670244@qq.com
                Wanyanhan Jiang: jiangwyh14@gmail.com
                Xi Gao: 1242002817@qq.com
                Chengwei Lin: 1421970720@qq.com
                Jia Li: 1825539066@qq.com
                Lian Yang: yyanglian@163.com
                Journal
                Journal ID (nlm-ta): Environ Health
                Journal ID (iso-abbrev): Environ Health
                Title: Environmental Health
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1476-069X
                Publication date (Electronic): 14 January 2023
                Publication date PMC-release: 14 January 2023
                Publication date Collection: 2023
                Volume: 22
                Electronic Location Identifier: 6
                Affiliations
                [1 ]GRID grid.411304.3, ISNI 0000 0001 0376 205X, HEOA Group, School of Public Health, , Chengdu University of Traditional Chinese Medicine, ; No. 1166 Liutai Road, Chengdu, China
                [2 ]GRID grid.411304.3, ISNI 0000 0001 0376 205X, HEOA Group, School of Management, , Chengdu University of Traditional Chinese Medicine, ; No. 1166 Liutai Road, Chengdu, China
                Article
                Publisher ID: 962
                DOI: 10.1186/s12940-023-00962-3
                PMC ID: 9840265
                PubMed ID: 36641448
                SO-VID: 79bc6e8c-56f6-4891-ab0b-76cfc8a99408
                Copyright © © The Author(s) 2023
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 8 October 2022
                Date accepted : 7 January 2023
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2023

                ScienceOpen disciplines: Public health
                Keywords: acute lower respiratory tract infections,children,economic cost,hospital admissions,air pollutants
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: acute lower respiratory tract infections, children, economic cost, hospital admissions, air pollutants

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