Short-term effect of ambient air pollution on COPD mortality in four Chinese cities

Ambient air pollution has been associated with increased mortality and morbidity; however, few studies have examined the short-term effect of air pollution specifically on chronic obstructive pulmonary disease (COPD), which is an important cause of mortality and morbidity world wide. In this analysis, we examined the associations between daily air pollution levels [particulate matter less than 10 microns in aerodynamic diameter (PM10), sulfur dioxide (SO2) and nitrogen dioxide (NO2)] and COPD mortality in four Chinese cities. We used Poisson regression models with natural spline smoothing functions to adjust for long-term and seasonal trends of COPD mortality, as well as other time-varying covariates. We did a meta-analysis to obtain the 4-city average estimates. Air pollution (PM10, SO2, and NO2) was found to be associated with increased risk of COPD mortality in these four cities. Using the random-effects model, an increase of 10 μg m−3 of 2-day moving average concentrations of PM10, SO2 and NO2 corresponded to a 0.78% (95% CI, 0.13–1.42), 1.30% (95% CI, 0.61–1.99), and 1.78% (95% CI, 1.10–2.46) increase of COPD mortality, respectively. The concentration–response curves indicated linear associations without threshold. Only NO2 remained significant in the multi-pollutant models. To our knowledge, this is the first multi-city study in Asian developing region to report the short-term effect of air pollution on COPD mortality. Our results contribute to very limited data on the effects of air pollution on COPD mortality for high exposure settings typical in developing countries.