Ambient air pollution and daily hospital admissions: A nationwide study in 218 Chinese cities

Environ Pollut. 2018 Nov;242(Pt B):1042-1049. doi: 10.1016/j.envpol.2018.07.116. Epub 2018 Aug 1.


There have been few large multicity studies to evaluate the acute health effects of ambient air pollution on morbidity risk in developing counties. In this study, we examined the short-term associations of air pollution with daily hospital admissions in China. We conducted a nationwide time-series study in 218 Chinese cities between 2014 and 2016. Data on daily hospital admissions counts were obtained from the National Health Insurance Database for Urban Employees covering 0.28 billion enrollees. We used generalized additive model with Poisson regression to estimate the associations in each city, and we performed random-effects meta-analysis to pool the city-specific estimates. More than 60 million hospital admissions were analyzed in this study. At the national-average level, each 10 μg/m3 increase in PM10, SO2, and NO2, and 1 mg/m3 increase in CO at lag 0 day was associated with a 0.29% (95% CI, 0.23%-0.36%), 1.16% (95% CI, 0.92%-1.40%), 1.68% (95% CI, 1.40%-1.95%), and 2.59% (95% CI, 1.69%-3.50%) higher daily hospital admissions, respectively. The associations of air pollution with hospital admissions remained statistically significant at levels below the current Chinese Ambient Air Quality Standards. The effect estimates were larger in cities with lower air pollutants levels or higher air temperatures and relative humidity, as well as in the elderly. In conclusion, our findings provide robust evidence of increased hospital admissions in association with short-term exposure to ambient air pollution in China.

Keywords: Air pollution; China; Hospital admission; Time-series.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Air Pollutants / analysis
  • Air Pollution / analysis*
  • Carbon Monoxide / analysis
  • China / epidemiology
  • Cities / epidemiology
  • Environmental Monitoring
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Nitrogen Dioxide / analysis
  • Particulate Matter / analysis
  • Risk
  • Sulfur Dioxide / analysis
  • Temperature
  • Young Adult


  • Air Pollutants
  • Particulate Matter
  • Sulfur Dioxide
  • Carbon Monoxide
  • Nitrogen Dioxide