Particulate matter pollution and hospital outpatient visits for endocrine, digestive, urological, and dermatological diseases in Nanjing, China

Clinical or pathological evidence demonstrated that air pollution could undermine other organ systems of human body besides respiratory and circulation systems. Investigations that directly relate hospital outpatient visits for endocrine (ENDO), digestive (DIGE), urological (UROL), and dermatological (DERM) diseases categories with ambient particulate matter (PM) are still lacking, particularly in heavily polluted cities. Here, we conducted a time-series analysis using 812,624, 1,111,342, 539,803, and 741,662 hospital visits for ENDO, DIGE, UROL, and DERM, respectively, in Nanjing, China from 2013 to 2019. A generalized additive model was applied to estimate the exposure-response associations. Results showed that a 10 μg/m3 increase in PM2.5 concentration on lag 0 day was significantly associated with 0.59% (95% CI: 0.30%, 0.88%), 0.43% (0.15%, 0.70%), 0.36% (0.06%, 0.66%), and 0.65% (0.42%, 0.87%) increase for ENDO, DIGE, UROL, and DERM hospital visits, respectively. The estimated effects of PM10 were slightly smaller but still statistically significant. The magnitude and significance of the associations between PM and four health outcomes were sensitive to additional adjustment for co-pollutants. Exposure-response relationships were linear for PM concentrations lower than 100 μg/m3 but the curves became nonlinear across the full range of exposures due to a flatten slope at higher concentrations. We also explored the effect modifications by season (cold or warm), age (5–18, 18–64, 65–74, or 75+ years), and sex (male or female). Results showed that the DERM-related population aged 65 years or older was more vulnerable to PM exposure, compared with the 5 to 17-year age group; the DERM-related population aged 75 years or older and 65 years or older was more vulnerable to PM2.5 and PM10 exposure, respectively, compared with the 18 to 64-year age group. Our study provided suggestive evidence that ambient PM pollution was associated with ENDO, DIGE, UROL, and DERM outpatient hospital visits in Nanjing, China.