Article Text

Download PDFPDF
Environmental factors and hospitalisation for chronic obstructive pulmonary disease in a rural county of England
  1. V Sauerzapf1,
  2. A P Jones1,
  3. J Cross2
  1. 1
    School of Environmental Sciences, University of East Anglia, Norwich, UK
  2. 2
    School of Allied Health Professions, University of East Anglia, Norwich, UK
  1. Dr A Jones, School of Environmental Sciences, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK; a.p.jones{at}


Background: Chronic obstructive pulmonary disease (COPD) is a major global cause of morbidity and mortality. Studies in urban areas have shown associations between air pollutants and hospital admissions for COPD. Whether temporal variations in air quality are associated with hospital admissions for COPD in a rural region with lower concentrations of air pollutants than previously studied was investigated.

Methods: Daily COPD admissions were recorded for patients attending three hospitals in the county of Norfolk, UK, between January 2006 and February 2007. Records were combined with daily information on concentrations of six air pollutants (carbon monoxide, nitric oxide, nitrogen dioxide, oxides of nitrogen, ozone and fine particulates), airborne pollens, temperature and influenza incidence. A case–crossover analysis was used to examine the association between air pollution and daily admissions.

Results: There were 1050 admissions for COPD over the study period. After adjustment for temperature, pollen and respiratory infections, each 10 μg/m3 increase in CO was associated with a 2% increase in the odds of admission. V3alues of 17%, 22% and 9% were observed for NO, NO2 and oxides of nitrogen respectively. No associations were observed with O3 or particulates.

Conclusion: Among a population of a less urbanised area than previously investigated, this study found evidence that ambient pollutant concentrations were still associated with the risks of hospital admission for COPD.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests: None.

  • Funding: The MATREX study is funded by NCCHTA programme and received full ethical approval. It is a registered randomised controlled trial, ISRCTN No. 13825248.

  • Ethics approval: Ethics committee approval from Norfolk 1 Research Ethics Committee.