Associations between short-term absolute increases in ambient air pollution and hospital admissions and outpatient visits for depression: A nationwide case-crossover study.
Aug 2026· Ecotoxicology and Environmental Safety· Vol 323, pp.
120707
· 0 citations· 25 references
Medicine
TL;DR
Novel evidence is provided that short-term absolute increases in air pollution levels are associated with elevated risks of depression, which is worth consideration in future disease prevention practices.
Abstract
Short-term absolute changes in ambient air pollution levels may result in disease events such as depression, whereas evidence from large-scale epidemiological studies has been insufficient. A time-stratified case-crossover study was performed to investigate the associations between air pollution increases between neighboring days (APINs, generated as the differences in absolute air pollution concentrations on the current days minus those on the previous days) and morbidity risks of depression based on hospital admission and outpatient visit data from 239 Chinese cities of prefecture-level or above during 2013-2017. Daily absolute concentrations of particulate matter with an aerodynamic diameter ≤ 2.5 μm (PM2.5), particulate matter with an aerodynamic diameter ≤ 10 μm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO) and ozone (8 h O3) were obtained, and conditional logistic regression models were used to evaluate the associations between absolute concentrations and APINs of major air pollutants with morbidity risks of depression. A total of 330,610 hospital admissions and 3,726,390 outpatient visits for depression were included. Per interquartile range (IQR) increase in APINs of major air pollutants at lag 0-3 were associated with increases ranging from 0.59% (0.06%, 1.13%) (8 h O3) to 1.66% (1.09%, 2.22%) (NO2) in hospital admissions for depression; and with increases ranging from 0.42% (0.15%, 0.68%) (8 h O3) to 0.85% (0.56%, 1.14%) (NO2) in outpatient visits for depression, which were robust to adjustments for absolute concentrations of major air pollutants (with the exception of 8 h O3). This study provides novel evidence that short-term absolute increases in air pollution levels are associated with elevated risks of depression, which is worth consideration in future disease prevention practices.
Background Acute myocardial infarction (AMI) imposes a substantial and growing burden globally. Short-term exposure to ambient fine particulate matter (PM2.5) has been linked to AMI mortality, yet most studies have focused on absolute pollutant concentrations. The association between daily changes in PM2.5 and AMI hospitalizations remains poorly understood. Methods We conducted an individual-level time-stratified case-crossover study in Zhongshan, China, from 2020 to 2024. A total of 1,795 AMI hospitalizations were identified from a tertiary hospital, with 5,877 control days matched by day of week within the same calendar month. Daily PM2.5 exposure was assigned based on residential address using the China High Air Pollutants (CHAP) dataset at 1 km resolution. Conditional logistic regression models were fitted to estimate the association between a 10 μg/m3 increase in PM2.5 (both absolute concentration and day-to-day change) and AMI hospitalization, adjusting for temperature, relative humidity, and public holidays. Subgroup analyses were performed by age, sex, season, AMI subtype, and comorbidities. Results A 10 μg/m3 increase in PM2.5 from the previous day to the admission day (lag0–lag1) was associated with a 7.89% (95% CI: 0.86%–15.40%) higher odds of AMI hospitalization. Associations were found among females (22.58%), adults aged >65 years (22.16%), cold-season admissions (10.85%), and patients with ST-segment elevation myocardial infarction (17.90%), with age identified as a significant effect modifier (P for interaction < 0.05). Results remained robust after adjustment for co-pollutants (except for nitrogen dioxide) and alternative degrees of freedom (df) for temperature and relative humidity. Conclusion Daily increments in ambient PM2.5 concentration were independently associated with an increased risk of AMI hospitalization, particularly among females, older adults, and patients with ST-segment elevation myocardial infarction. These findings suggested that day-to-day PM2.5 variability may warrant consideration in future cardiovascular prevention frameworks.
Huan-Li Zeng, Xin Li, Yu-Hua Zhao et al.· Frontiers in Public Health· 0 citations
Stroke is a leading cause of death and disability worldwide. Exposure to ambient air pollutants and the risk of stroke have been reported in many studies, but the results vary greatly among different regions. This study aims to investigate the association between short-term exposure to air pollution and the admission of total stroke and its subtypes in the Luohu District, Shenzhen. A time-stratified case-crossover study was conducted among 21,973 newly diagnosed stroke cases in Luohu, Shenzhen from 2014 to 2022. Residential exposure to air pollution was assessed using validated grid datasets. A distributed lag model (DLM) and conditional logistic regression model were implemented to evaluate the relationship between ambient air pollution and the admission of stroke and its subtypes. We found that a 10 µg/m3 increase in exposure to NO2 and SO2 was positively associated with a 2.73% increase (95% confidence interval [CI]: 2.21%, 3.25%) and a 24.89% increase (20.87%, 29.06%) in the odds of total stroke admission, respectively. Statistical significance has also been found in subtypes. Stronger associations were observed in females (SO2), the elderly (NO2 and SO2), and the cold season (NO2 and SO2). Our findings indicate that exposure to NO2 and SO2 exacerbates the risk of stroke admission, especially in the elderly, females, and the cold season.
With less decline and greater attributable impact than PM2.5, NO2 is increasingly important for measuring morbidity impacts from local sources (i.e., traffic and buildings) in New York City.
A. Spira-Cohen, Rebecca Goldberg, Sarah Johnson et al.· Environmental Epidemiology· 0 citations
A significant association between short-term exposure to air pollutants and CKD mortality in the population of Zhejiang Province is revealed and a need for governmental authorities to enhance the monitoring and control of air pollution to mitigate the health burden on the elderly is suggested.
Pin-Yuan Dai, Xiao-Yan Zhou, Wei-Wei Gong et al.· BMC Nephrology· 0 citations
PM2.5, PM10, NO2, and CO exposures were associated with COPD hospitalization in Kashi, precautionary measures should be taken with a focus on vulnerable subgroups, to control hospitalization for COPD associated with air pollutants.
Li Li, Ayiguli Alimu, Jing-Ran Xu et al.· International Journal of COP...· 0 citations
Osteoarthritis (OA) is a leading cause of disability, yet its acute environmental triggers remain poorly understood despite rising healthcare demand in aging societies. Short-term exposure may aggravate established OA, but claims-based visit dates reflect healthcare utilization rather than confirmed symptom onset. We linked the Korean National Health Insurance Service-National Sample Cohort (2002-2019) with nationwide air pollution data to examine short-term associations between six ambient pollutants (PM10, PM2.5, NO2, SO2, O3, and CO) and OA-related hospital visits (ICD-10 M15-M19). Using a time-stratified case-crossover design, we assessed subgroup-specific susceptibility across demographic, socioeconomic, lifestyle, and clinical characteristics using linked health-screening data. Among 3,697,314 OA-related visits, all six pollutants were positively associated with visits per interquartile range (IQR) increment: 5.28% (95% CI, 5.02-5.54) for NO2, 2.88% (2.59-3.16) for CO, 1.36% (1.10-1.63) for SO2, 0.90% (0.73-1.07) for PM10, 0.76% (0.44-1.08) for O3, and 0.73% (0.47-1.00) for PM2.5. After correction for multiple comparisons, pollutant-specific effect modification was observed for sex, age, residential area, insurance type, smoking, alcohol use, physical activity, body mass index, and comorbidity burden. In two-pollutant and principal-component analyses, the NO2 association remained robust and the mixture components were positively associated with visits. These findings extend the health burden of air pollution to acute musculoskeletal morbidity in a lower-exposure East Asian setting where these effects remain policy-relevant. By resolving susceptibility across multiple individual-level domains rarely available in prior studies, our study provides evidence to inform targeted environmental health protection in aging populations.
Sun-Woo Kang, Subin Jeong, Yeonji Nam et al.· Environmental Pollution· 0 citations
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