Burden of chronic obstructive pulmonary disease attributed to short-term exposure to ambient air pollutants: a time-stratified case-crossover study in Gansu Province, northwestern China
Abstract
BackgroundChronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and imposes a substantial clinical and medical burden. Short-term exposure to ambient air pollutants can trigger exacerbations and increase healthcare use and costs. However, the avoidable COPD burden attributable to short-term air pollution exposure remains poorly quantified, especially in northwestern China. Comprehensive quantification of this burden is essential to inform targeted air quality and public health policies.MethodsThis time-stratified case-crossover study analyzed 37,868 COPD-related hospital admissions and 26,473 outpatient visits in Gansu Province during 2019, using data from Gansu Healthcare Security Administration and the ChinaHighAirPollutants dataset. Conditional logistic regression models were used to assess the link between ambient air pollutants and COPD admissions/visits, with measurements of excess fractions, medical fees, and length of stay calculated.ResultsShort-term exposure to PM2.5, NO2, CO, and O3 was associated with increased risks of COPD hospitalization and outpatient visits. In counterfactual modeling analyses assuming pollutant concentrations were reduced to WHO guideline levels, the modeled avoidable COPD burden was 9.19% [95% empirical confidence interval (eCI): 6.45%−11.94%] of hospital admissions, 3,481 (2,442–4,521) admissions, 25,899 (18,168–33,629) in-hospital days, 12.07 (8.46–15.67) million Chinese Yuan (CNY) in hospitalization costs, 8.40% (5.77%−11.03%) of outpatient visits, 2,224 (1,529–2,919) outpatient visits, and 0.25 (0.17–0.33) million CNY in outpatient costs. With WHO air quality guideline levels as the counterfactual reference, PM2.5 accounted for the largest proportion of the modeled avoidable inpatient COPD burden, whereas O3 accounted for the largest proportion of the modeled avoidable outpatient COPD burden. Under the theoretical minimum exposure scenario, O3 was the dominant contributor to outpatient burden, while PM2.5 and O3 contributed comparably to inpatient burden.ConclusionsUnder WHO guideline scenario, PM2.5 and O3 mainly contributed to avoidable inpatient and outpatient COPD burden, respectively; under theoretical minimum exposure scenario, PM2.5 and O3 contributed comparably to inpatient burden, whereas O3 was the dominant contributor to outpatient burden.
Related
- Age- and sex-stratified prevalence of obstructive sleep apnea and stroke risk comorbidities: A large cross-sectional EHR study
- Non-Coding RNA Regulates Pyroptosis in Chronic Obstructive Pulmonary Disease
- Pulmonary Dysfunction Contributes to Nocturnal Hypoxemia Beyond Obstructive Sleep Apnea Severity in Primary Sjögren Syndrome
- Sleep Quality and Daytime Sleepiness in Patients with Chronic Obstructive Pulmonary Disease in a Tertiary Care Hospital: An Observational Study
- Comparison of chronic obstructive pulmonary disease awareness across two cross-sectional surveys in Southeastern China from 2019 to 2025
BibTeX
@article{wu2026burden,
title = {{Burden of chronic obstructive pulmonary disease attributed to short-term exposure to ambient air pollutants: a time-stratified case-crossover study in Gansu Province, northwestern China}},
author = {DeAn Wu and YouHong Liu and SiJing Ding and ZheHeng Liu and ZiYi Cheng and Long Wang and XiaoJu Liu},
journal = {Frontiers in Public Health},
year = {2026},
month = nov,
doi = {10.3389/fpubh.2026.1836036},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1836036},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Burden of chronic obstructive pulmonary disease attributed to short-term exposure to ambient air pollutants: a time-stratified case-crossover study in Gansu Province, northwestern China
AU - DeAn Wu
AU - YouHong Liu
AU - SiJing Ding
AU - ZheHeng Liu
AU - ZiYi Cheng
AU - Long Wang
AU - XiaoJu Liu
PY - 2026
DA - 2026/11/09
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1836036
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1836036
AB - BackgroundChronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and imposes a substantial clinical and medical burden. Short-term exposure to ambient air pollutants can trigger exacerbations and increase healthcare use and costs. However, the avoidable COPD burden attributable to short-term air pollution exposure remains poorly quantified, especially in northwestern China. Comprehensive quantification of this burden is essential to inform targeted air quality and public health policies.MethodsThis time-stratified case-crossover study analyzed 37,868 COPD-related hospital admissions and 26,473 outpatient visits in Gansu Province during 2019, using data from Gansu Healthcare Security Administration and the ChinaHighAirPollutants dataset. Conditional logistic regression models were used to assess the link between ambient air pollutants and COPD admissions/visits, with measurements of excess fractions, medical fees, and length of stay calculated.ResultsShort-term exposure to PM2.5, NO2, CO, and O3 was associated with increased risks of COPD hospitalization and outpatient visits. In counterfactual modeling analyses assuming pollutant concentrations were reduced to WHO guideline levels, the modeled avoidable COPD burden was 9.19% [95% empirical confidence interval (eCI): 6.45%−11.94%] of hospital admissions, 3,481 (2,442–4,521) admissions, 25,899 (18,168–33,629) in-hospital days, 12.07 (8.46–15.67) million Chinese Yuan (CNY) in hospitalization costs, 8.40% (5.77%−11.03%) of outpatient visits, 2,224 (1,529–2,919) outpatient visits, and 0.25 (0.17–0.33) million CNY in outpatient costs. With WHO air quality guideline levels as the counterfactual reference, PM2.5 accounted for the largest proportion of the modeled avoidable inpatient COPD burden, whereas O3 accounted for the largest proportion of the modeled avoidable outpatient COPD burden. Under the theoretical minimum exposure scenario, O3 was the dominant contributor to outpatient burden, while PM2.5 and O3 contributed comparably to inpatient burden.ConclusionsUnder WHO guideline scenario, PM2.5 and O3 mainly contributed to avoidable inpatient and outpatient COPD burden, respectively; under theoretical minimum exposure scenario, PM2.5 and O3 contributed comparably to inpatient burden, whereas O3 was the dominant contributor to outpatient burden.
SN - 2296-2565
ER -