Mortality and morbidity of asthma and chronic obstructive pulmonary disease associated with ambient environment in metropolitans in Taiwan

PLoS One. 2021 Jul 6;16(7):e0253814. doi: 10.1371/journal.pone.0253814. eCollection 2021.


Background: This study investigated risks of mortality from and morbidity (emergency room visits (ERVs) and outpatient visits) of asthma and chronic obstructive pulmonary disease (COPD) associated with extreme temperatures, fine particulate matter (PM2.5), and ozone (O3) by sex, and age, from 2005 to 2016 in 6 metropolitan cities in Taiwan.

Methods: The distributed lag non-linear model was employed to assess age (0-18, 19-39, 40-64, and 65 years and above), sex-cause-specific deaths, ERVs, and outpatient visits associated with extreme high (99th percentile) and low (5th percentile) temperatures and PM2.5 and O3 concentrations at 90th percentile. Random-effects meta-analysis was adopted to investigate cause-specific pooled relative risk (RR) and 95% confidence intervals (CI) for the whole studied areas.

Results: Only the mortality risk of COPD in the elderly men was significantly associated with the extreme low temperatures. Exposure to the 90th percentile PM2.5 was associated with outpatient visits for asthma in 0-18 years old boys [RR = 1.15 (95% CI: 1.09-1.22)]. Meanwhile, significant elevation of ERVs of asthma for females aged 40-64 years was associated with exposure to ozone, with the highest RR of 1.21 (95% CI: 1.05-1.39).

Conclusions: This study identified vulnerable subpopulations who were at risk to extreme events associated with ambient environments deserving further evaluation for adaptation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Air Pollution / adverse effects*
  • Air Pollution / statistics & numerical data
  • Asthma / epidemiology*
  • Asthma / etiology
  • Child
  • Child, Preschool
  • Cities / epidemiology
  • Cities / statistics & numerical data
  • Cold Temperature / adverse effects
  • Ecological Parameter Monitoring / statistics & numerical data
  • Environmental Exposure / adverse effects*
  • Environmental Exposure / statistics & numerical data
  • Female
  • Hot Temperature / adverse effects
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Morbidity
  • Mortality
  • Particulate Matter / adverse effects
  • Pulmonary Disease, Chronic Obstructive / epidemiology*
  • Pulmonary Disease, Chronic Obstructive / etiology
  • Risk Assessment / statistics & numerical data
  • Risk Factors
  • Sex Factors
  • Taiwan / epidemiology
  • Young Adult


  • Particulate Matter

Grants and funding

This study was also supported by grants from the Ministry of Science and Technology (MOST 109-2625-M-033-002-, MOST 108-2625-M-033-002- and MOST 106-2221-E-033-006-MY2) - Yu-Chun Wang The National Health Research Institutes (NHRI-107A1-EMCO-3617191 and NHRI-106A1-PDCO-3617191) - Yu-Chun Wang Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW109-TDU-B-212-114004)- Fung-Chang Sung Taiwan Environmental Protection Administration - Yu-Chun Wang MOST Clinical Trial Consortium for Stroke (MOST 109-2321-B-039-002) - Fung-Chang Sung Tseng-Lien Lin Foundation, Taichung, Taiwan - Fung-Chang Sung The National Health Research Institutes (MOHW105-TDU-M-212-113003) - Fung-Chang Sung.