Using five exposure metrics to explore the association between ambient PM and the hospital admissions for COPD in Tianshui city, China.

Numerous studies have identified air pollutant as a primary risk factor for chronic obstructive pulmonary disease (COPD), particularly for fine particulate matter (PM). However, the daily average levels of PM may not accurately reflect the actual exposure level due to the fluctuating air pollutant levels throughout the day and different human activity patterns. Few studies have comparatively analyzed the association between different exposure metrics of PM and COPD hospitalization. We aimed to explore the association between PM and COPD admission in Tianshui city using five different exposure metrics (a) Daily mean concentration (DailyPMmean), (b) Daily hourly peak concentration (DailyPMmax), (c) Daily morning concentration (DailyPMmor), (d) Daily evening concentration (DailyPMeve) and (e) Daily excessive concentration hours (PMDECH). The PMDECH was defined as daily total concentration hours > 25 µg/m. We collected daily records of COPD admission and hourly data on air pollutants and meteorological factors from Tianshui, China, 2018-2019. DailyPMmean, DailyPMmax, DailyPMmor, DailyPMeve and PMDECH were used as the exposure variables. A generalized additive model (GAM) based Poisson-distribution combined with a distributed lag non-linear model (DLNM) was applied to quantify the association between five different exposure metrics of PM and COPD admission. Stratified analyses were conducted to examine the effect modifications of gender, age, and season. The analysis revealed significant associations between five different exposure metrics of PM and COPD admission. PM-related risks of COPD admission differed by five exposure metrics. An interquartile range (IQR) increment in DailyPMmean at lag06, DailyPMmax at lag06, DailyPMmor at lag04, DailyPMeve at lag06 and PMDECH at lag07 was associated with a 21.64%(95%CI: 7.46%, 36.68%), 12.84%(95%CI: 1.47%, 24.58%), 16.47%(95%CI: 0.96%, 33.01%), 31.54%(95%CI: 16.49%, 47.58%), and 30.37%(95%CI: 13.91%, 46.88%) increase in Tianshui's COPD admissions, respectively. Associations of COPD admission with five different exposure metrics of PM appeared to be stronger in the cold season and among the females, while we found significantly higher effects in the population < 65 years old. The five metrics of PM exposure and COPD hospitalization show an exposure-response relationship that resembles a function curve that increases monotonically. This study added evidence for increased risk of admissions associated with exposure to the five metrics of ambient PM in Tianshui City, China, and DailyPMeve or PMDECH may be a significant risk factor for the increased risk of COPD admission, indicating that we should focus more on the relationship between air pollution and related diseases during the evening peak hours.