Association Between Ambient Air Pollution and Mortality From Chronic Obstructive Pulmonary Disease in Wuhan, China: a Population-based Time-series Study

Abstract Background: Previous studies have mainly focused on the associations between air pollution and total respiratory disease mortality. However, evidence on the short-term effects of air pollution on chronic obstructive pulmonary disease (COPD) mortality is still not conclusive to date. The aim of this study was to investigate the short-term effects of ambient air pollution on COPD mortality in Wuhan China.Methods: Daily death numbers, concentrations of air pollutants (PM2.5, PM10, SO2, NO2, and O3) and meteorological characteristics in Wuhan between January 1, 2014 to December 31, 2019 were collected. Time-series analysis using generalized additive model was applied to evaluated the association between ambient air pollution and daily COPD mortality. Subgroup analysis by age (<65 and ≥65 year) and sex (male and female) were also conducted. Results: During the study period, we observed a total of 16150 deaths(7.37 deaths per day) from COPD. The daily average concentrations of PM2.5, PM10, SO2, NO2 and O3 were 59.03, 90.48, 12.91, 48.84 and 91.77 µg/m3, respectively. In single pollutant model, for every increase of 10 µg/m3 in PM10, SO2, NO2 levels, COPD mortality increased by 0.581%(95CI:0.054%-1.111%), 4.316%(95CI:1.002%-7.738%) and 1.815%(95CI:0.523%-3.125%) at lag03, respectively. No significant associations were found for PM2.5 and O3. Subgroup analysis demonstrated that females were more susceptible to PM2.5, PM10, SO2 and NO2, in addition the concentrations of PM10, SO2 and NO2 were significantly associated with COPD mortality for older adults. In two-pollutant models, the significantly positive associations between SO2 as well as NO2 and COPD mortality remained after adjusting for PM2.5 or O3.Conclusions: Short-term exposure to PM10, SO2, and NO2 are significantly associated with a higher risk of COPD mortality. Female or elderly are more susceptible to air pollution. Further research is required to reveal the underlying mechanisms. The implementation of the environmental protection policy has become urgent.