Impacts of ambient PM_2.5 on hospitalizations for respiratory diseases and associated economic losses in Changchun, China

Objective To quantify the health impacts of short-term PM_2.5 exposure on hospitalizations for respiratory diseases and associated socioeconomic losses in Changchun, and to provide a scientific basis for formulating precise air pollution prevention and control strategies based on health benefits and economic feasibility.

Methods Data on hospitalizations from four general hospitals, ambient air quality (PM_2.5, PM₁₀, SO₂, NO₂, O₃, CO), meteorology, economy, and population in Changchun between 2019 and 2023 were collected. A case-crossover analysis was employed to assess the impacts of ambient PM_2.5 exposure on hospitalizations for respiratory diseases. Attributable fractions and attributable numbers were calculated to assess the attributable risk of PM_2.5 exposure on hospitalizations. The cost-of-illness method was used to estimate the economic burden of PM_2.5 pollution-induced hospitalizations.

Results From 2019 to 2023, 24 362 hospitalizations for respiratory diseases were recorded across the four hospitals, with a daily average admission of 12 cases and a mean PM_2.5 concentration of 35 μg/m³. Single-day lag effect peaked at lag1 day, where each 10 μg/m³ increase in PM_2.5 concentration was associated with a relative risk of 1.017 (1.013, 1.021), declining thereafter. The relative risk of moving average lag effect increased with the expansion of cumulative exposure window, peaking at 1.029 (1.022, 1.035) at lag07 day. The relative risks were generally higher for females than for males, and the ≥60 age group showed the highest risk effects. Under three reference concentrations (35, 15, 0 μg/m³), the attributable fractions for PM_2.5-attributable respiratory disease hospitalizations from 2019 to 2023 were 2.86%, 5.46%, and 9.05%, respectively, corresponding to attributable numbers of 19 500, 37 200, and 61 600 individuals, and economic losses of RMB 268 million, 512 million, and 848 million, respectively. Adjustments for O₃ and CO strengthened the association between PM_2.5 and respiratory disease hospitalizations.

Conclusion Ambient PM_2.5 may increase the risk of hospitalization for respiratory diseases in the population, particularly females and older adults. The hospitalizations and economic losses attributable to PM_2.5-induced respiratory diseases cannot be ignored, highlighting the importance of comprehensive management of PM_2.5 and other air pollutants.