Emergency room (ER) visits for accidental casualties, according to the International Classification of Deceases 10th Revision Chapters 19 and 20, include injury, poisoning, and external causes (IPEC). Annual distribution of 187,008 ER visits that took place between 2009 and 2011 in Beijing, China displayed regularity rather than random characteristics. The annual cycle from the Fourier series fitting of the number of ER visits was found to explain 63.2% of its total variance. In this study, the possible effect and regulation of meteorological conditions on these ER visits are investigated through the use of correlation analysis, as well as statistical modeling by using the Distributed Lag Non-linear Model and Generalized Additive Model. Correlation analysis indicated that meteorological variables that positively correlated with temperature have a positive relationship with the number of ER visits, and vice versa. The temperature metrics of maximum, minimum, and mean temperatures were found to have similar overall impacts, including both the direct impact on human mental/physical conditions and indirect impact on human behavior. The lag analysis indicated that the overall impacts of temperatures higher than the 50th percentile on ER visits occur immediately, whereas low temperatures show protective effects in the first few days. Accidental casualties happen more frequently on warm days when the mean temperature is higher than 14 °C than on cold days. Mean temperatures of around 26 °C result in the greatest possibility of ER visits for accidental casualties. In addition, males were found to face a higher risk of accidental casualties than females at high temperatures. Therefore, the IPEC-classified ER visits are not pure accidents; instead, they are associated closely with meteorological conditions, especially temperature. Full article

The objective was to assess the transient association between air pollution and cardiac arrhythmia. Five databases were searched for studies investigating the association between daily increases in air pollutants (PM_2.5, PM₁₀, carbon monoxide, nitrogen dioxide, sulfur dioxide and ozone) and arrhythmia hospitalization or arrhythmia mortality. Two reviewers independently selected studies, extracted data, and assessed risk of bias. Outcomes were analyzed via a random-effects model and reported as relative risk and 95% confidence interval. 25 studies satisfied our inclusion criteria and 23 contributed to the meta-analysis. Arrhythmia hospitalization or mortality were associated with increases in PM_2.5 (RR = 1.015 per 10 μg/m³, 95% CI: 1.006–1.024), PM₁₀ (RR = 1.009 per 10 μg/m³, 95% CI: 1.004–1.014), carbon monoxide (RR = 1.041 per 1 ppm, 95% CI: 1.017–1.065), nitrogen dioxide (RR = 1.036 per 10 ppb, 95% CI: 1.020–1.053), and sulfur dioxide (RR = 1.021 per 10 ppb, 95% CI: 1.003–1.039), but not ozone (RR = 1.012 per 10 ppb, 95% CI: 0.997–1.027). Both particulate and gaseous components, with the exception of ozone, have a temporal association with arrhythmia hospitalization or mortality. Compared with Europe and North America, a stronger association was noted in Asia. Full article

Background: Diurnal temperature range (DTR) is an important index of climate change and variability. It is also a risk factor affecting human health. However, limited evidence is available to illustrate the effect of DTR modification on cause-specific cardiovascular disease among the elderly. Methods: A semi-parametric generalized additive model (GAM) was used to analyze the exposure-effect relationship between DTR and daily emergency room (ER) admissions for cause-specific cardiovascular diseases among the elderly from 2009 to 2011 in Beijing. We examined the effects of DTR for stratified groups by gender and age, and examined the effects of DTR in the warm season and cold season for cause-specific cardiovascular diseases. Results: Significant associations were found between DTR and ER admissions for all cardiovascular and cerebrovascular disease among elderly males, while DTR was significantly associated with ER admissions for all cardiovascular disease, ischemic heart disease and cerebrovascular disease among elderly females. People aged 75 years and older were more vulnerable to DTR. DTR caused greater adverse effects on both genders in the warm season, whereas the effect estimates on females were higher in cold season than in warm season. Conclusions: A short-term increase of DTR was significantly associated with ER admissions for cause-specific cardiovascular disease among the elderly in Beijing. Gender, age and season may modify the acute health effect of DTR. Some prevention programs that target the high risk subgroups in the elderly for impending large temperature changes may reduce the impact of DTR on people’s health. Full article

Continuous measurements of surface ozone (O₃) and nitrogen oxides (NO_X) at an urban site (39°37′N, 118°09′E) in Tangshan, the largest heavy industry city of North China during summertime from 2008 to 2011 are presented. The pollution of O₃ was serious in the city. The daily maximum 1 h means (O_{3_1-hr max}) reached 157 ± 55, 161 ± 54, 120 ± 50, and 178 ± 75 μg/m³ corresponding to an excess over the standard rates of 21%, 27%, 10%, and 40% in 2008–2011, respectively. The total oxidant level (O_X = O₃ + NO₂) was high, with seasonal average concentrations up to 100 μg/m³ in summer. The level of O_X at a given location was made up of NO_X-independent and NO_X-dependent contributions. The independent part can be considered as a regional contribution and was about 100 μg/m³ in Tangshan. Statistical early warning analysis revealed that the O₃ levels would exceed the standard rate by 50% on the day following a day when the daily average ozone concentration (O_{3_mean}) exceeded 87 μg/m³ and the daily maximum temperature (T_{_max}) exceeded 29 °C. The exceed-standard rate would reach 80% when O_{3_mean} and T_{_max} exceeded 113 μg/m³ and 31 °C. Similarly, the exceed-standard rate would reach 100% when O_{3_mean} and T_{_max} exceeded 127 μg/m³ and 33 °C, respectively. Full article

Panel studies show a consistent association between increase in the cardiovascular hospitalizations with air pollutants in economically developed regions, but little evidence in less developed inland areas. In this study, a time-series analysis was used to examine the specific effects of major air pollutants [particulate matter less than 10 microns in diameter (PM₁₀), sulfur dioxide (SO₂), and nitrogen dioxides (NO₂)] on daily hospital admissions for cardio-cerebrovascular diseases in Lanzhou, a heavily polluted city in China. We examined the effects of air pollutants for stratified groups by age and gender, and conducted the modifying effect of seasons on air pollutants to test the possible interaction. The significant associations were found between PM₁₀, SO₂ and NO₂ and cardiac disease admissions, SO₂ and NO₂ were found to be associated with the cerebrovascular disease admissions. The elderly was associated more strongly with gaseous pollutants than younger. The modifying effect of seasons on air pollutants also existed. The significant effect of gaseous pollutants (SO₂ and NO₂) was found on daily hospital admissions even after adjustment for other pollutants except for SO₂ on cardiac diseases. In a word, this study provides the evidence for the detrimental short-term health effects of urban gaseous pollutants on cardio-cerebrovascular diseases in Lanzhou. Full article