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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (2): 227-235. doi: 10.19723/j.issn.1671-167X.2022.02.005

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Short-term effects and seasonal variation of ozone on daily hospital outpatient visits for childhood asthma in Lanzhou

ZHANG Hong1,△(),DONG Ji-yuan2,WANG Jian-jun3,FAN Lin-xia3,QU Qiang3,LIU Yang1   

  1. 1. Asthma Center, Gansu Provincial Hospital, Lanzhou 730000, China
    2. Institute of Occupational and Environmental Health, School of Public Health, Lanzhou University, Lanzhou 730000, China
    3. Department of Pediatrics, Gansu Provincial Hospital, Lanzhou 730000, China
  • Received:2020-06-08 Online:2022-04-18 Published:2022-04-13
  • Contact: Hong ZHANG E-mail:zhanghong2020lz@163.com
  • Supported by:
    Research Fund Project of Gansu Provincial Hospital(18GSSY4-24)

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Abstract:

Objective: To analyze the effects of ozone (O3) concentrations measured with different approaches across different seasons on the total number of childhood asthma-related clinical visits, as well as the differentiation of such effects across different groups of patients. Methods: The outpatient data of three grade A tertiary hospitals in Lanzhou City spanning from 1 January 2014 to 31 December 2017, as well as air pollution and meteorological data during the same period were collected. Considering the nonlinear relationship between O3 concentrations and the total number of childhood asthma-related clinical visits and meteorological factors, a generalized additive temporal sequence model was employed to analyze the short-term association between changes in O3 concentrations and the total number of childhood asthma-related clinical visits. Taking into account of the variations in O3 concentrations within 1 day, this study adopted different measurement approaches to address the three types of O3 exposures, namely, the maximum 1 h daily concentration (O3max1h), the maximum 8 h daily concentration (O38h) and the mean 24 h daily concentration (O324h) as the short term exposure indicators to O3, followed by a model-based analysis. Results: The increase in short-term exposure levels to O3 in summer had a significant effect on the increase in the total number of childhood asthma-related clinical visits. With lag0 for the current day, every 10 μg/m3 increase in atmospheric concentration of O3max1h was associated with an increase in the total number of childhood asthma-related clinical visits by 3.351% (95%CI: 1.231%-5.516%); for every 10 μg/m3 increase in O38h concentration, the total number of childhood asthma-related clinical visits increased by 3.320% (95%CI: 0.197%-3.829%); for every 10 μg/m3increase in O324h concentration, the total number of childhood asthma-related clinical visits in summer increased by 6.600% (95%CI: 0.914%-12.607%); moreover, an increase in exposure to O3max1h also led to a significant rise in the total number of childhood asthma-related clinical visits among the males. Conclusion: The increase in short-term exposure levels to O3 in summer in Lanzhou City has a significant effect on the increase in the total number of childhood asthma-related clinical visits; O3max1h is more closely correlated with the increase in the total number of childhood asthma-related clinical visits.

Key words: Ozone, Air pollutants, Child, Asthma, Outpatients

CLC Number: 

  • R725.6

Table 1

Descriptive statistics on daily hospital outpatient visits for childhood asthma in Lanzhou during 2014 to 2017"

Category x -±s Minimum Percentile Maximum
P25 P50 P75
0-14 years 6±3 1 3 5 7 31
Male 4±2 1 2 3 5 20
Female 2±1 1 1 2 3 12
0-5 years 4±2 1 2 3 5 15
6-14 years 2±1 1 1 2 4 17
Spring 4±2 1 2 4 6 18
Summer 6±4 1 3 5 8 22
Autumn 5±3 1 3 5 8 31
Winter 3±1 1 2 4 6 14

Table 2

Descriptive statistics for meteorological variable and air pollutant levels in Lanzhou during 2014 to 2017"

Category x -±s Minimum Percentile Maximum
P25 P50 P75
Meteorological factors
Temperature/℃ 11.28±9.64 -12.30 2.45 12.90 19.80 29.90
Relative humidity/% 50.83±15.15 18.00 39.00 50.02 61.74 96.09
Air pollutants
PM2.5/(μg/m3) 53.30±27.19 12.73 35.40 45.69 63.59 269.43
PM10/(μg/m3) 122.90±78.25 18.98 81.00 107.94 145.25 1484.54
SO2/(μg/m3) 22.39±14.47 3.54 10.88 18.29 30.42 81.87
NO2/(μg/m3) 45.98±15.74 7.80 36.40 45.36 52.90 146.60
CO/(mg/m3) 1.34±0.73 0.34 0.83 1.09 1.62 4.65

Table 3

Descriptive statistics for different ozone metrics in Lanzhou during 2014 to 2017"

Category x -±s Minimum Percentile Maximum
P25 P25 P25
O3max1h/(μg/m3) 77.59±33.44 15.00 57.20 69.40 82.40 252.60
Spring 83.38±33.80 36.50 62.00 72.60 86.90 197.80
Summer 87.28±41.93 28.40 63.20 71.00 87.50 252.60
Autumn 73.15±28.77 15.00 54.40 68.00 82.80 195.20
Winter 66.29±21.59 15.80 52.20 62.00 77.20 158.60
O38h/(μg/m3) 84.03±36.53 8.00 56.00 78.00 106.00 221.00
Spring 99.23±32.82 20.00 78.00 98.00 118.00 221.00
Summer 104.43±39.93 10.00 76.00 103.00 134.00 197.00
Autumn 72.02±29.93 8.00 51.00 67.00 87.00 182.00
Winter 59.94±19.88 15.00 46.00 58.00 71.00 140.00
O324h/(μg/m3) 38.70±19.97 4.94 24.52 33.96 48.31 126.11
Spring 44.81±20.36 14.30 29.18 40.60 56.59 116.26
Summer 48.36±22.78 17.23 32.22 40.61 56.21 126.11
Autumn 31.42±14.5 8.03 20.75 28.51 38.01 84.56
Winter 29.91±13.74 4.94 19.17 26.96 38.25 78.58

Table 4

Excess risk of childhood asthma hospital outpatient visits associated with a 10 μg/m3increase in O3max1h concentrations with different lag days %"

Lag days ER (95%CI)
Spring Summer Autumn Winter
Lag0 1.358 (0.126 to 2.606)* 3.351 (1.231 to 5.516)* 2.359 (1.052 to 3.683)* 1.972 (0.484 to 3.482)*
Lag1 0.233 (-0.978 to 1.458) -1.312 (-3.078 to 0.486) -1.868 (-3.180 to 0.539) -0.878 (-2.268 to 0.531)
Lag2 -0.122 (-1.377 to 1.149) -0.450 (-1.961 to 1.084) -1.431 (-2.776 to 0.068) 0.229 (-1.152 to 1.630)
Lag3 -1.070 (-2.429 to 0.308) 0.136 (-1.504 to 1.803) -0.311 (-1.606 to 1.002) -1.055 (-2.613 to 0.529)
Lag4 -0.024 (-1.257 to 1.225) -0.662 (-2.318 to 1.022) 0.035 (-1.287 to 1.375) 0.626 (-0.837 to 2.110)
Lag5 0.542 (-0.744 to 1.844) 1.419 (-0.164 to 3.027) -0.191 (-1.537 to 1.175) -0.136 (-1.543 to 1.291)
Lag6 0.301 (-0.906 to 1.523) 0.491 (-1.216 to 2.227) -0.131 (-1.496 to 1.253) -0.932 (-2.349 to 0.506)
Lag7 0.474 (-0.832 to 1.797) -2.552 (-4.981 to 0.062) -0.740 (-2.037 to 0.575) 0.506 (-1.054 to 2.090)
Lag01 1.536 (-0.163 to 3.264) 0.929 (-1.510 to 3.428) -2.687 (-4.375 to 0.969) 0.814 (-1.030 to 2.694)
Lag02 1.961 (-0.216 to 4.186) 0.304 (-2.679 to 3.379) -2.884 (-4.943 to 0.779) 0.884 (-1.221 to 3.033)
Lag03 1.419 (-1.192 to 4.100) 0.528 (-3.179 to 4.377) -3.018 (-5.423 to 0.551) 0.270 (-2.221 to 2.824)
Lag04 1.347 (-1.671 to 4.457) -0.656 (-5.24 to 4.149) -1.678 (-4.610 to 1.344) 1.293 (-2.044 to 4.743)
Lag05 2.298 (-1.314 to 6.043) 1.651 (-4.132 to 7.782) -2.068 (-5.560 to 1.552) 1.399 (-2.970 to 5.964)
Lag06 1.769 (-2.055 to 5.743) 3.614 (-3.852 to 11.659) -2.254 (-6.414 to 2.092) -0.008 (-5.804 to 6.145)
Lag07 0.982 (-2.616 to 4.712) 1.127 (-7.630 to 10.714) -3.721 (-8.703 to 1.533) 0.765 (-6.056 to 8.082)

Table 5

Excess risk of childhood asthma hospital outpatient visits associated with a 10 μg/m3increase in O38h concentrations with different lag days %"

Lag days ER (95%CI)
Spring Summer Autumn Winter
Lag0 -0.383 (-1.579 to 0.828) 3.320 (0.197 to 3.829)* 0.552 (-1.149 to 2.283) -2.203 (-3.787 to -0.593)
Lag1 0.360 (-0.855 to 1.590) -1.689 (-3.761 to 0.428) 0.046 (-1.53 to 1.648) -0.232 (-1.869 to 1.432)
Lag2 -1.449 (-2.869 to -0.008) -1.106 (-3.083 to 0.912) 0.272 (-1.324 to 1.895) 1.171 (-0.359 to 2.724)
Lag3 0.590 (-0.805 to 2.005) 1.074 (-1.636 to 3.860) -0.511 (-2.148 to 1.154) 0.166 (-1.401 to 1.757)
Lag4 1.367 (-0.001 to 2.753) 2.747 (-1.046 to 6.685) 0.299 (-1.281 to 1.903) 0.762 (-0.767 to 2.315)
Lag5 -0.400 (-1.672 to 0.888) -3.538 (-7.437 to 0.525) 0.261 (-1.279 to 1.825) -0.841 (-2.353 to 0.695)
Lag6 0.313 (-0.91 to 1.552) -0.361 (-4.213 to 3.646) 0.273 (-1.242 to 1.811) -0.362 (-1.941 to 1.243)
Lag7 0.060 (-1.497 to 1.641) -0.597 (-4.584 to 3.557) 1.038 (-0.566 to 2.667) -0.895 (-2.404 to 0.637)
Lag01 0.251 (-1.248 to 1.772) 0.542 (-2.186 to 3.346) 0.550 (-1.652 to 2.801) -2.429 (-4.610 to 0.197)
Lag02 0.575 (-1.169 to 2.349) -0.559 (-4.371 to 3.406) 0.813 (-1.801 to 3.496) -1.481 (-4.234 to 1.35)
Lag03 0.052 (-2.056 to 2.206) 1.880 (-3.507 to 7.568) 0.822 (-2.172 to 3.907) -2.040 (-5.409 to 1.448)
Lag04 0.140 (-2.718 to 3.081) 2.916 (-2.582 to 8.724) 1.124 (-2.367 to 4.74) -2.219 (-6.268 to 2.004)
Lag05 0.864 (-2.969 to 4.848) 0.377 (-5.828 to 6.991) 1.251 (-2.773 to 5.441) -4.524 (-9.092 to 0.274)
Lag06 -2.218 (-6.916 to 2.716) -1.961 (-8.973 to 5.591) 1.300 (-3.317 to 6.137) -5.045 (-10.445 to 0.680)
Lag07 -2.271 (-7.518 to 3.273) -3.019 (-11.132 to 5.835) 2.307 (-3.077 to 7.990) -6.712 (-8.969 to 0.050)

Table 6

Excess risk of childhood asthma hospital outpatient visits associated with a 10 μg/m3increase in O324h concentrations with different lag days %"

Lag days ER (95%CI)
Spring Summer Autumn Winter
Lag0 -1.055 (-2.897 to 0.821) 6.600 (0.914 to 12.607)* 1.752 (-0.647 to 4.209) -2.261 (-6.110 to 1.745)
Lag1 -0.498 (-2.373 to 1.413) 3.552 (-0.338 to 7.593) -2.468 (-5.130 to 0.269) -4.455 (-8.325 to 0.421)
Lag2 -1.088 (-3.358 to 1.236) -2.162 (-5.842 to 1.662) -0.634 (-3.473 to 2.289) -0.220 (-3.861 to 3.559)
Lag3 -0.751 (-2.996 to 1.546) -0.539 (-4.299 to 3.369) 2.593 (-1.779 to 7.160) 1.874 (-1.838 to 5.726)
Lag4 -0.196 (-2.382 to 2.038) 1.187 (-2.568 to 5.087) 3.030 (-2.183 to8.520) 2.030 (-1.794 to 6.004)
Lag5 -0.033 (-2.051 to 2.027) -2.107 (-5.866 to 1.802) 3.273 (-2.055 to 8.891) -0.651 (-4.319 to 3.156)
Lag6 1.091 (-0.798 to 3.016) 0.511 (-3.342 to 4.518) 1.103 (-4.161 to 6.656) -2.145 (-5.963 to 1.829)
Lag7 1.067 (-1.232 to 3.418) 1.505 (-2.498 to 5.672) -1.963 (-6.748 to 3.067) -0.133 (-3.848 to 3.726)
Lag01 -0.509 (-2.745 to 1.779) 8.115 (-2.446 to 14.098) -0.117 (-3.645 to 3.542) -6.442 (-11.553 to 1.036)
Lag02 -0.801 (-3.425 to 1.895) 6.567 (-0.357 to 13.972) -2.218 (-7.136 to 2.960) -6.086 (-12.403 to 0.686)
Lag03 -1.475 (-4.674 to 1.831) 6.014 (-1.878 to 14.54) -1.225 (-7.883 to 5.915) -4.232 (-11.895 to 4.098)
Lag04 -1.773 (-5.757 to 2.38) 6.749 (-2.012 to 16.294) -0.938 (-9.439 to 8.360) -2.028 (-11.291 to 8.204)
Lag05 -2.023 (-6.667 to 2.851) 3.623 (-6.055 to 14.299) 0.186 (-10.06 to 11.600) -2.631 (-13.478 to 9.575)
Lag06 -1.232 (-6.561 to 4.400) 4.382 (-6.527 to 16.564) 2.964 (-10.017 to 17.817) -6.308 (-12.75 to 8.038)
Lag07 0.816 (-5.114 to 7.117) 4.637 (-7.882 to 18.858) -1.652 (-14.032 to 12.511) -6.538 (-11.281 to 9.966)

Table 7

Excess risk of childhood asthma hospital outpatient visits associated with a 10 μg/m3 increase in concentrations of O3max1h by gender and age %"

Variables ER(95%CI)
Spring Summer Autumn Winter
Male 0.382 (-1.478 to 2.277) 1.997 (0.197 to 3.829)* 4.877 (0.818 to 9.099)* 2.030 (1.794 to 6.004)*
Female 0.639 (-0.556 to 1.849) 1.752 (-0.647 to 4.209) 0.552 (-1.149 to 2.283) 0.762 (-0.767 to 2.315)
0-5 years 1.551 (-0.314 to 3.451) 3.351 (1.231 to 5.516)* 5.805 (0.686 to 11.185)* 2.162 (0.556 to 3.794)*
6-14 years -0.250 (-2.683 to 2.244) 2.945 (-0.033 to 6.012) 0.939 (-0.578 to 2.480) 1.367 (-3.392 to6.361)

Table 8

Excess risk of childhood asthma hospital outpatient visits associated with a 10 μg/m3 increase in concentrations of O38h by gender and age %"

Variables ER(95%CI)
Spring Summer Autumn Winter
Male 1.713 (-0.626 to 4.108) 1.973 (-1.581 to 5.656) 1.987 (-0.092 to 4.108) 1.215 (-0.825 to 3.297)
Female 0.486 (-2.410 to 3.468) -1.249 (-5.536 to 3.232) 1.713 (-4.501 to 8.331) -0.727 (-7.147 to 6.137)
0-5 years 0.226 (-1.662 to 2.150) 3.521 (0.806 to 6.309)* 2.926 (1.250 to 4.629)* 1.394 (-0.378 to 3.198)
6-14 years 1.669 (-0.135 to 3.506) -0.606 (-3.688 to 2.574) 0.331 (-2.276 to 3.007) 0.973 (-1.884 to 3.913)

Table 9

Excess risk of childhood asthma hospital outpatient visits associated with a 10 μg/m3 increase in concentrations of O324h by gender and age %"

Variables ER(95%CI)
Spring Summer Autumn Winter
Male 1.576 (-0.050 to 3.126) 5.805 (-0.686 to 11.185) 1.310 (-0.733 to 3.395) 1.603 (-2.120 to 5.469)
Female 1.948 (-0.588 to 4.549) 4.342 (-4.905 to 14.489) 0.579 (-1.416 to 2.613) 0.759 (-1.557 to 3.130)
0-5 years -0.595 (-4.263 to 3.213) 7.106 (-4.832 to 20.542) 0.379 (-5.174 to 6.257) 2.610 (-1.229 to 6.599)
6-14 years 0.262 (-1.938 to 2.512) 3.499 (-4.179 to 11.791) -0.280 (-2.530 to 2.023) -0.102 (-4.990 to 5.038)

Table 10

Excess risk of childhood asthma hospital outpatient visits associated with a 10 μg/m3 increase in O3 concentrations in two-pollutant models %"

Variables ER(95%CI)
O3max1h O38h O324h
Single model 3.351 (1.231 to 5.516) 3.320 (0.197 to 3.829) 6.600 (0.914 to 12.607)
O3+PM2.5 3.127 (1.513 to 5.195) 3.193 (0.124 to 3.768) 6.456 (0.637 to 11.208)
O3+PM10 3.191 (1.581 to 5.255) 3.055 (0.148 to 3.794) 6.573 (0.733 to 10.137)
O3+NO2 3.477 (1.501 to 5.310) 3.446 (0.136 to 3.789) 6.671 (0.724 to 12.428)
O3+ SO2 3.085 (1.239 to 4.985) 3.342 (0.092 to 3.609) 6.774 (1.028 to 12.834)
O3+ CO 3.338 (1.644 to 5.484) 3.415 (0.216 to 3.846) 6.929 (1.386 to 13.202)
O3+SO2+NO2 3.329 (1.167 to 5.321) 3.120 (0.169 to 3.629) 6.687 (1.014 to 11.307)
O3+SO2+PM10 3.253 (1.118 to 5.476) 3.097 (0.117 to 3.466) 6.471 (0.971 to 11.671)
O3+SO2+PM2.5 3.355 (1.138 to 5.383) 3.155 (0.127 to 3.491) 6.565 (0.833 to 10.782)
O3+SO2+CO 3.402 (1.136 to 5.289) 3.421 (0.135 to 3.742) 6.524 (0.901 to 11.763)
O3+NO2+PM10 3.338 (1.192 to 5.409) 3.351 (0.102 to 3.573) 6.684 (1.012 to 12.213)
O3+NO2+PM2.5 3.385 (1.216 to 5.446) 3.285 (0.187 to 3.446) 6.529 (1.206 to 12.102)
O3+NO2+CO 3.379 (1.197 to 5.229) 3.460 (0.201 to 3.733) 6.721 (1.314 to 12.786)
O3+PM10+PM2.5 3.293 (1.124 to 5.268) 3.172 (0.144 to 3.776) 6.456 (0.637 to 10.208)
O3+PM10+CO 3.275 (1.148 to 5.294) 3.155 (0.141 to 3.664) 6.473 (0.704 to 10.375)
O3+PM2.5+CO 3.401 (1.136 to 5.789) 3.246 (0.151 to 3.704) 6.571 (0.745 to 11.123)

Table 11

Sensitivity analysis of the effect of excess risk for every 10 μg/m3 increase in O3 concentration on outpatients with childhood asthma at different degrees of freedom %"

Items ER(95%CI)
O3max1h O38h O324h
df=6 3.330 (1.345 to 5.354) 3.463 (0.267 to 3.924) 6.676 (0.868 to 11.371)
df=7 3.351 (1.231 to 5.516) 3.320 (0.197 to 3.829) 6.600 (0.914 to 12.607)
df=8 3.502 (1.449 to 5.597) 3.464 (0.247 to 3.955) 6.562 (0.843 to 11.426)
df=9 3.238 (1.435 to 5.385) 3.249 (0.104 to 3.832) 6.452 (1.007 to 11.833)
df=10 3.279 (1.258 to 5.488) 3.399 (0.158 to 3.886) 6.712 (0.945 to 12.030)
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