The Association Analysis Between Chronic Obstructive Pulmonary Disease And Ambient Air Pollution

Part ⅠUsing Geographical Information System (GIS) to analyze the association between long-term ambient air pollution exposure and COPD prevalenceBackground:Chronic Obstructive Pulmonary Disease (COPD) is a common disease which is characterized by persistent and progressive airflow limitation. It is associated with a chronic inflammatory response in the airways and lungs to noxious particles or gases. COPD is a common disease which is a leading cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing.Neither the etiology nor the pathogenesis of COPD has been fully illustrated by far. Cigarette smoking is considered to be the most important cause for COPD. The BOLD project has conducted several relative research worldwide, and found that the prevalence of COPD is3-11%in non-smokers, which indicate cigarette smoking is not the sole risk factor for COPD development.Though growing evidence has demonstrated that exposure to outdoor air pollution is associated with development of COPD, the causal relationship has not fully established. Meanwhile, few studies have reported the relationship between ambient air pollution and spirometry-defined COPD, especially using Geological Information System (GIS) spatial analysis. There is no similar study in East China.Jinan is one of the most polluted cities in China. Our research group has conveyed a cross-sectional epidemiological survey in Jinan,2009. The results showed that the prevalence of COPD in Jinan urban residents older than40years-old is7.6%. Therefore, the investigation of the association between COPD prevalence and long-term exposure to ambient air pollution can provide new evidence and direction for COPD prevention.Objective:1. Using GIS to analyze the association between long-term exposure to ambient air pollution and COPD prevalence in JinanCity,2009.2. Using GIS to analyze the association between high-polluting industries relatedexposure and COPD prevalence in JinanCity,2009.Method:In the survey of the relationship between ambient air pollution and COPD prevalence, we enrolled660subjects (53COPD,607normal) with complete data from the cross-sectional epidemiological survey for COPD conducted in JinanCity,2009. Exposure levels to ambient air pollutants (nitrogen dioxide (NO2), ozone (O3), sulfur dioxide (SO2), particulate matter with aerodynamic diameter less than10mm (PM10), carbon monoxide (CO)) were assessed in Geographical Information System according to individual’s residence and workplace. The exposure assessment is based on the concentrations of air pollutants monitored by15monitoring stations interspersed in different sub districts of JinanCitywhich is provided by environmental Protection Agency of Shandong Province. Distances of residence and workplace from the high-polluting industries were calculated to assess high-polluting industries related exposure. We usedt test to compare the difference of pollutants exposure levels and high-polluting industries related exposure between COPD subjects and normal subjects. Multivariate logistic regression analysis was used to explore the association between COPD and related risk factors including air pollution exposure levels and high-polluting industries related exposure.Result:Compared to subjects without COPD, subjects with COPD exposed to higher long-term CO level in workplace (1447.3±196.5vs.1356.3±194.1μg/m3, P=0.006) and resided farer from high-polluting industries (2767.7±1800.4vs.2177.8±1527.8m, P=0.026), which showed no statistical significance after adjustment. The other ambient air pollutants in residence (SO2,PM10, NO2,O3, CO) and workplace (SO2,PM10,NO2,O3), and high-polluting industries related exposure showed no statistically significant difference between two groups.Conclusion:Long-term exposure to high CO level at workplace might be associated with increased COPD prevalence. Residing farer from high-polluting industries may be associated with COPD prevelance.Significance:This is the first study investigating the association between ambient air pollution and spirometry-defined COPD through Geographical Information System in East China. The conclusion that long-term exposure to high CO level at workplace might be associated with increased COPD prevalence can provide new direction for COPD prevention. Part IIUsing Geographical Information System (GIS) to analyze the association between short-term ambient air pollution exposure and AECOPD hospitalizationBackground:Chronic Obstructive Pulmonary Disease (COPD) is a common disease which is a leading cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing. COPD is a very important disease both in high-income countries and low-income countries. It is estimated that the disease burden of COPD will rank the fifth, the causes for death will rank the third till the year2020. The economic burden of COPD is enormous for the whole society. Therefore, it is of great significance to investigate the role of environmental factors in this particular disease with high burden.Acute exacerbations of COPD (AECOPD) are important events during disease procedure. AECOPD have negative effects on patients’quality of life, symptoms and lung function, and result in high socioeconomic costs.The acute exacerbations of COPD can be triggered by various factors. Though infection is the most common triggering factor, not all AECOPD patients have evidence for infection. This suggests the potential role of other factors in triggering acute exacerbations of COPD. Previous studies have demonstrated the significant association between outdoor air pollution and AECOPD hospitalizations, but few studies assessed individual exposure level through utilizing a spatial analyzing technique-Geographical Information System (GIS).Jinan is the capital of Shandong Province. It is one of the most polluted cities in China. Our research group have conveyed an epidemiological study of COPD in Jinan, which showed a COPD prevalence of7.6%in residents with40years old. COPD resulted a great direct and indirect economic burden, it is a common and prevalent disease in Jinan residents.Further investigation of the relationship between ambient air pollution and admissions for acute exacerbations of COPD will be helpful to define the triggering factors, prevent acute exacerbations of COPD and the subsequent negative events such as increased symptom, emergency department visits, hospitalization and even mortality.Objective:1. Using GIS to analyze the association between short-term ambient air pollution and AECOPD hospitalizations in Jinan City,2009.2. Using GIS to analyze the association between high-polluting industries relatedexposure and AECOPD hospitalizations in Jinan City,2009.Method:In the survey of the relationship between ambient air pollution and AECOPD hospitalizations, we enrolled414AECOPD hospitalization cases in Jinan,2009.598cholelithiasis hospitalization cases during the same period were selected as control group. Monthly concentrations of five monitored air pollutants (NO2, SO2, PM10, O3, CO) from January2009to December2009were provided by Environmental Protection Agency of Shandong Province. Each individual was geocoded in ArcGIS10.0software, and the temporal-spatial specific air pollutants exposure level for each individual was estimated using Kriging method. Buffer Analysis was employed to assess’ the relationship between AECOPD hospitalizations and high-polluting-industries related exposure level. Multivariate logistic regression analysis was used to explore the association between AECOPD hospitalizations and related risk factors including short-term air pollution exposure levels and high-polluting industries related exposure.Result:Compared to cholelithiasis hospitalization cases, patients who required hospitalization for AECOPD exposed to higher short-term PM10level(244.0±1.7vs.243.6±1.6μg/m3, P<0.001), lower SO2(189.3±7.1vs.191.7±8.0μg/m3, P<0.001) level in residence, lower short-term SO2(185.4±10.5vs.191.7±8.3μg/m3, P<0.001) level, lower short-term PM10(239.8±10.6vs.243.5±1.6μg/m3, P<0.001) level, lower short-term CO(1985.5±95.5vs.2023.1±33.7μg/m3, P<0.001) level and lower short-term NO2(79.2±3.6vs.80.6±0.7μg/m3, P<0.001) in workplace. SO2(OR=0.90,95%CI [0.84,0.97], P=0.004), O3(OR=0.82,95%CI [0.71,0.95], P=0.008) and NO2(OR=0.58,95%CI [0.36,0.94], P=0.027) at workplace remained statistically significant after adjustment.Conclusion:Short-term exposure to high PM10level at residence might be associated with increased AECOPD hospitalizations. Short-term exposure to low SO2, O3, NO2level at workplace was associated with increased AECOPD hospitalizations.Significance:This is the first study investigating the association between ambient air pollution and AECOPD hospitalizations through Geographical Information System. The conclusion that short-term exposure to high PM10level at residence might be associated with increased AECOPD hospitalizations can provide new direction for AECOPD triggering prevention.