title: Urban air pollution and meteorological factors affect emergency department visits of elderly patients with chronic obstructive pulmonary disease in Taiwan.
abstract: Both air pollution and meteorological factors in metropolitan areas increased emergency department (ED) visits from people with chronic obstructive pulmonary disease (COPD). Few studies investigated the associations between air pollution, meteorological factors, and COPD-related health disorders in Asian countries. This study aimed to investigate the relationship between the environmental factors and COPD-associated ED visits of susceptible elderly population in the largest Taiwanese metropolitan area (Taipei area, including Taipei city and New Taipei city) between 2000 and 2013. Data of air pollutant concentrations (PM10, PM2.5, O3, SO2, NO2and CO), meteorological factors (daily temperature, relative humidity and air pressure), and daily COPD-associated ED visits were collected from Taiwan Environmental Protection Administration air monitoring stations, Central Weather Bureau stations, and the Taiwan National Health Insurance database in Taipei area. We used a case-crossover study design and conditional logistic regression models with odds ratios (ORs), and 95% confidence intervals (CIs) for evaluating the associations between the environmental factors and COPD-associated ED visits. Analyses showed that PM2.5, O3, and SO2had significantly greater lag effects (the lag was 4 days for PM2.5, and 5 days for O3and SO2) on COPD-associated ED visits of the elderly population (65-79 years old). In warmer days, a significantly greater effect on elderly COPD-associated ED visits was estimated for PM2.5with coexistence of O3. Additionally, either O3or SO2combined with other air pollutants increased the risk of elderly COPD-associated ED visits in the days of high relative humidity and air pressure difference, respectively. This study showed that joint effect of urban air pollution and meteorological factors contributed to the COPD-associated ED visits of the susceptible elderly population in the largest metropolitan area in Taiwan. Government authorities should review existing air pollution policies, and strengthen health education propaganda to ensure the health of the susceptible elderly population.
authors.affiliation: Institute of Environmental Health, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Air Quality Protection and Noise Control, Environmental Protection Administration, Taipei, Taiwan.
authors.forename: Pei-Hsiou
authors.initials: PH
authors.lastname: Ding
authors.affiliation: Institute of Environmental Health, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Gen-Shuh
authors.initials: GS
authors.lastname: Wang
authors.affiliation: National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan; Department of Environmental and Occupational Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Yue-Leon
authors.initials: YL
authors.lastname: Guo
authors.affiliation: Department of Environmental Monitoring, Environmental Protection Administration, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Shuenn-Chin
authors.initials: SC
authors.lastname: Chang
authors.affiliation: Department of Respiratory Therapy, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan. Electronic address: ghwan@mail.cgu.edu.tw.
authors.forename: Gwo-Hwa
authors.initials: GH
authors.lastname: Wan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000633:toxicity*; D001208:Asia; D002947:Cities; D018592:Cross-Over Studies; D004630:Emergencies / Q000453:epidemiology; D004636:Emergency Service, Hospital; D004784:Environmental Monitoring; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008685:Meteorological Concepts; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology*; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000393:Air Pollutants
keywords: Air pollution; COPD; Emergency department visits; Meteorological factor; Urbanization