Department of Respiration, Key Laboratory of Respiratory Disease Prevention and Control of Shanxi Department of Pulmonary and Critical Care Medicine, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China.
Ecotoxicol Environ Saf. 2022 Jan 1;229:113082. doi: 10.1016/j.ecoenv.2021.113082. Epub 2021 Dec 18.
Ambient sulfur dioxide (SO) has been associated with morbidity and mortality of respiratory diseases, however, its effect on length of hospital stays (LOS) and cost for these diagnoses remain unclear.
We collected hospital admission information for respiratory diseases from all 11 cities in the Shanxi Province of China during 2017-2019. We assessed individual-level exposure by using an inverse distance weighting approach based on geocoded residential addresses. A generalized additive model was built to delineate city-specific effects of SO on hospitalization, hospital expenditure, and length of hospital stay for respiratory diseases. The overall effects were obtained by random-effects meta-analysis. We further estimated the respiratory burden attributable to SO by comparing different reference concentrations.
We observed significant effects of SO exposure on respiratory diseases. At the provincial level, each 10 μg/m increase in SO on lag was associated with a 0.63% (95% CI: 0.14-0.11) increase in hospital admission, an increase of 4.56 days (95% CI: 1.16-7.95) of hospital stay, and 3647.97 renminbi (RMB, Chinese money) (95% CI: 1091.05-6204.90) in hospital cost. We estimated about 6.13 (95% CI: 1.33-11.10) thousand hospital admissions, 65.77 million RMB (95% CI: 19.67-111.87) in hospital expenditure, and 82.13 (95% CI: 20.87-143.40) thousand days of hospital stay could have potentially been avoided had the daily SO concentrations been reduced to WHO's reference concentration (40 µg/m). Variable values in correspondence with this reference concentration could reduce the hospital cost and LOS of each case by 52.67 RMB (95% CI: 15.75-89.59) and 0.07 days (95% CI: 0.02-0.117).
This study provides evidence that short-term ambient SO exposure is an important risk factor of respiratory diseases, indicating that continually tightening policies to reduce SO levels could effectively reduce respiratory disease burden in Shanxi Province.
环境二氧化硫（SO）与呼吸系统疾病的发病率和死亡率有关，但它对住院时间（LOS）和这些诊断的费用的影响尚不清楚。
我们收集了 2017 年至 2019 年期间山西省 11 个城市所有呼吸系统疾病的住院信息。我们使用基于地理编码的居住地址的逆距离加权方法评估个体水平的暴露。建立了广义加性模型来描绘 SO 对呼吸系统疾病住院、医院支出和住院时间的城市特异性影响。通过随机效应荟萃分析获得总体影响。我们通过比较不同的参考浓度进一步估计了 SO 造成的呼吸系统负担。
我们观察到 SO 暴露对呼吸系统疾病有显著影响。在省级水平上，SO 滞后 10μg/m 的每增加 0.63%（95%CI：0.14-0.11）与住院人数增加 0.63%相关，住院时间增加 4.56 天（95%CI：1.16-7.95），医院费用增加 3647.97 元（95%CI：1091.05-6204.90）。我们估计，如果每日 SO 浓度降低到世界卫生组织的参考浓度（40μg/m），可能会避免 6.13 千例（95%CI：1.33-11.10）住院、6577 万元（95%CI：19.67-111.87）的医院支出和 82.13 千天（95%CI：20.87-143.40）的住院时间。与该参考浓度对应的变量值可以使每例患者的住院费用和 LOS 分别降低 52.67 元（95%CI：15.75-89.59）和 0.07 天（95%CI：0.02-0.117）。
本研究提供了短期环境 SO 暴露是呼吸系统疾病的一个重要危险因素的证据，表明持续收紧降低 SO 水平的政策可以有效降低山西省的呼吸系统疾病负担。
