Assessing PM 2.5 -associated risk of hospitalization for COPD: an application of daily excessive concentration hours

Existing PM 2.5 -morbidity studies using daily mean concentration as exposure metric may fail to capture intra-day variations of PM 2.5 concentrations, resulting in underestimated health impacts to some extent. This study introduced a novel indicator, daily excessive concentration hours (DECH), defined as sums of per-hourly excessive concentrations of PM 2.5 against a specific threshold within a day. PM 2.5 DECHs were separately calculated as daily concentration-hours >8, 10, 15, 20, and 25 μg/m 3 (abbreviations: DECH-8, DECH-10, DECH-15, DECH-20, and DECH-25). We adopted a time-stratified case-crossover design with conditional logistic regression models to compare risks of hospitalizations for chronic obstructive pulmonary disease (COPD) associated with PM 2.5 mean and DECHs in Shenzhen, China. We observed highly comparable PM 2.5 -COPD associations using exposure metrics of daily mean and DECHs with above-defined thresholds. For instance, PM 2.5 mean and DECHs showed similar increases in risks of COPD hospitalization for an interquartile range rise in exposure, with odds ratio estimates of 1.26 (95% confidence interval: 1.06–1.50) for PM 2.5 mean, 1.24 (1.05–1.46) for DECH-10 and 1.21 (1.06–1.39) for DECH-25, respectively. Findings remained robust after further adjusting for gaseous pollutants (e.g., SO 2 , NO 2 , CO, and O 3 ) and meteorologic factors (e.g., wind speed and air pressure). Our study strengthened the evidence that DECHs could come be as a novel exposure metric in health risk assessments associated with short-term exposure to ambient PM 2.5 .