Differential effects of size-specific particulate matter on lower respiratory infections in children: A multi-city time-series analysis in Sichuan, China.

Evidence on the short-term effects of size-specific particulate matter with aerodynamic diameter ≤2.5 μm (PM), ≤10 μm (PM), and their difference (PM) on children's Lower Respiratory Infections (LRI) is scare. This study aimed to estimate the differential effects of three size-specific PM on hospitalizations of children aged <18 years for pneumonia and bronchitis in 18 cities of southwestern China. The city-specific association was firstly estimated using the over-dispersed generalized additive model and then combined to obtain the regional average association. Further, to evaluate the robustness of the key findings, subgroup analyses and co-pollutant models were constructed. PM-related risks of LRI differed by PM fractions and cause-specific LRI. A 10 μg/m increment in PM_lag03, PM_lag06, and PM_lag06 was associated with a 0.79% (95% CI: 0.29%, 1.29%), 0.77% (95% CI: 0.13%, 1.41%), and 2.33% (95% CI: 1.23%, 3.44%) increase in children's LRI hospitalizations, respectively. After adjustment for gaseous pollutants, adverse effects of the three types of size-specific PM on pneumonia hospitalizations were stable, ranging from 0.29% (95% CI: 0.05%, 0.54%) for PM-2.50% (95% CI: 1.38%, 3.64%) for PM. Additionally, PM-related risk of bronchitis hospitalizations remained stable after adjustment for gaseous pollutants. Associations of pneumonia with PM and PM in infants, bronchitis with PM in children aged 6-17 years, pneumonia and bronchitis with PM, PM, and PM in children aged 1-5 years were all statistical significant. Specifically, the effects of PM on LRI hospitalizations increased by age, with the highest effect of 1.72% (95%CI: 1.01%, 2.43%) in children aged 6-17 years. Our study provided evidence for short-term effects of different PM fractions on children LRI hospitalizations in Southwestern China, which will be useful for making and promoting policies on air quality standards in order to protect children's health.