Size-fractioned particulate air pollution and cardiovascular emergency room visits in Beijing, China
Highlights
► Our study was based on accurately size-segregated particles data in a highly polluted megacity (Beijing). ► The effects of particles within different size fractions had different lag patterns.► The lagged effects of ultrafine particles started late and lasted extremely long comparing with results from other studies.► Our study took non-linear exposure-response functions into account.
Section snippets
Background
Ambient particulate matter (PM) has increasingly been linked with cardiovascular diseases during the last decades (Brook et al., 2004). Observed effects of short-term fluctuations of ambient PM on the cardiovascular system include ischemia and arrhythmia in patients with coronary artery disease, altered heart rate and autonomic control, altered blood pressure, systemic inflammatory response, a pro-thrombotic state and endothelial dysfunction (Peters, 2005). The exposure-response functions
Study area and period
We conducted this study in Beijing, China, from 4 Mar 2004 to 31 Dec 2006 (1033 days). Beijing has an area of about 16,808 km2 consisting of eight urban and ten suburban districts (Fig. 1), with a population size of approximately 15,380,000 in 2005 (http://baike.baidu.com/view/2621.htm). It is located in the North China Plain surrounded by mountains of 1000–1500 m in altitude to the west, north, and northeast, and the Bohai Sea on the southeast side. Typical warm temperate semi-humid continental
Cardiovascular emergency room visits data and meteorological data
Table 1 presents the overall cardiovascular emergency room visits counts during the study period, as well as the descriptive statistics for daily total and severe cardiovascular emergency room visits, air temperature, relative humidity, and barometric pressure. Severe cardiovascular emergency room visits counts represented 67% of the total counts. As shown in Supplementary Fig. 1, daily air temperature, relative humidity and barometric pressure all followed seasonal patterns, but with different
Effects of ultrafine particles, sub-micrometer particles and their sub-size fractions
Using particle data from the same measurement station, Breitner et al. (2011) reported 2-days delayed associations between daily cardiovascular mortality in the Beijing urban area and number concentration of Aitken mode particles and particles smaller than 800 nm. In a study conducted in London by Atkinson et al. (2010), the association between particulate number concentration and cardiovascular deaths was observed at lag 1. In studies conducted in Erfurt, Germany, an increase in number
Conclusions
The results from our study add to the evidence that elevated concentration level of sub-micrometer particles are associated with increased cardiovascular morbidity. Ultrafine particles showed delayed effects, while the effects of accumulation mode particles were rather immediate. This might indicate that particles within different size ranges play their effects through different pathways. The different lags by which the effects of certain particle size fractions appear should be considered when
Author contributions
LL performed the statistical analyses and drafted the manuscript. SB and AS guided the statistical analyses and the interpretation of the results, and revised the manuscript critically. JC, AW and BW performed air pollution data collection and data processing, and revised the manuscript critically. IB was involved in the study design and revised the manuscript critically. UF, US, AML and OH were involved in the study design and in air pollution data processing, and revised the manuscript
Acknowledgments
This research was funded by the German Research Foundation (DFG) (grants PE 1156/1–2 and WI 621/16-1). Parts of this work were funded by a scholarship being awarded to Liqun Liu (File no. 2008601213) under the State Scholarship Fund by the China Scholarship Council (CSC). We would like to thank the Emergency Department of Peking University Third Hospital for providing the medical record forms, the Institute for Tropospheric Research (IfT) for providing the monitoring devices, and the State Key
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