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BACKGROUND: Ambient air pollution is leading risk factor for health burden in China. Few studies in China have investigated the economic loss related to short-term exposure to ambient PM2.5, which could trigger acute onset of cardiorespiratory diseases within a few days. METHODS: Daily ambient air pollutants data are obtained for each city from the National Air Quality Monitoring System and daily hospitalization data are obtained from the urban employee-based basic medical insurance scheme database in 74 Chinese cities with an average coverage of 88.5 million urban employees during 2016-2017. A three-stage time-series analytic approach is used in this study to investigate the impact of short-term exposure to ambient fine particulate (PM2.5) air pollution on hospital admissions, expenses and hospital stays of three cause-specific cardiorespiratory diseases, including lower respiratory infections (LRI), coronary heart disease (CHD) and stroke in the included cities. FINDINGS: Based on the time-series analysis using daily hospitalization data, 28,560 LRI cases, 54,600 CHD cases, and 23,989 stroke cases are attributable to ambient PM2.5 in the 74 cities during the study period, and the related attributable expenses are 220 million CNY (US$ 32.9 million) for LRI, 458 million CNY (US$ 68.5 million) for CHD, and 410 million CNY (US$ 65.8 million) for stroke, respectively. These attributable numbers account for 1.45% to 2.05% of total hospital admissions and 1.10% to 1.51% of total expenses for the three diseases during 2016-2017, respectively. The attributable numbers for the three cause-specific cardiorespiratory diseases would increase to 362,007 hospital admission cases and 3.68 billion CNY expenses ($US550 million) in the entire urban employee population (299 million) in China during 2016-2017, and the related direct economic loss of absence from work would be 798 million CNY (US$ 119.3 million). INTERPRETATION: Our results support that short-term exposure to ambient PM2.5 pollution could lead to significant health and economic impacts in China. Reducing levels of ambient PM2.5 can avoid substantial health damage and expenditures, and generate appreciable economic benefits from decreasing absence from work. FUNDING: Natural Science Foundation of China (82073509, 71903010, 71903011), and the National Key Research and Development Program of China (2017YFC0211600, 2017YFC0211601).
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OBJECTIVE: Although the association between ambient air pollution and risk of depression has been investigated in several epidemiological studies, the evidence is still lacking for hospital admissions for depression, which indicates a more severe form of depressive episode. The authors used national morbidity data to investigate the association between short-term exposure to ambient air pollution and daily hospital admissions for depression. METHODS: Using data from the Chinese national medical insurance databases for urban populations, the authors conducted a two-stage time-series analysis to investigate the associations of short-term exposure to major ambient air pollutants-fine particles (PM2.5), inhalable particles (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO)-and daily hospital admission risk for depression in 75 Chinese cities during the period 2013-2017. RESULTS: The authors identified 111,620 hospital admissions for depression in 75 cities. In the single-pollutant models, the effect estimates of all included air pollutants, with the exception of O3, were significant at several lags within 7 days. For example, 10 µg/m3 increases in PM2.5, PM10, and NO2 at lag01 were associated with increases of 0.52% (95% CI=0.03, 1.01), 0.41% (95% CI=0.05, 0.78), and 1.78% (95% CI=0.73, 2.83), respectively, in daily hospital admissions for depression. Subgroup, sensitivity, and two-pollutant model analyses highlighted the robustness of the effect estimates for NO2. CONCLUSIONS: The study results suggest that short-term exposure to ambient air pollution is associated with an increased risk of daily hospital admission for depression in the general urban population in China, which may have important implications for improving mental wellness among the public.