Ambient air pollution and hospital admissions for acute aortic dissection in Shantou, China: A time-series analysis

Acute aortic dissection (AAD) is an extremely serious cardiovascular emergency. This study aimed to explore the acute association between short-term exposure to air pollution and hospitalization for AAD and to quantify the burden of disease due to air pollution exposure in the coastal city of Shantou in southeast China. Data on daily AAD hospitalizations and air pollutants were collected from January 1, 2015, to December 31, 2019. The overdispersed generalized additive model was adopted to estimate the relationship between air pollution and AAD hospitalizations. Stratified analysis was then conducted by age and sex. The burden of disease was expressed in terms of attributable fractions and numbers. A total of 2111 AAD hospitalizations were identified. For a 10 mu g/m(3) increase in the concentration of fine particulate matter (PM2.5), inhalable particulate matter (PM10), carbon monoxide (CO), sulfur dioxide (SO2) and ozone (O-3) at lag 01, the corresponding relative risks (RRs) and 95% confidence intervals (CIs) were 1.0917 (1.0449-1.1407), 1.0595 (1.0275-1.0925), 1.0043 (1.0013-1.0073), 1.1994 (1.0369-1.3872) and 1.0257 (1.0050-1.0468), respectively. However, no significant effects of nitrogen dioxide (NO2) on AAD hospitalizations were found. Elderly individuals (>= 60 years) and males were more susceptible to pollutants than their corresponding groups. In the two-pollutant model, the estimates of PM2.5 and PM10 were relatively robust. Taking the World Health Organization (WHO) air quality standard as a reference, 13.0% of AAD hospitalizations were attributable to PM2.5 exposure, followed by PM10 (6.1%) and O-3 (3.3%) exposure. Our results showed that short-term exposure to air pollutants, especially PM2.5 and PM10, was significantly associated with AAD and contributed to a significant disease burden. This study provides a reference for the future implementation of targeted air pollution control interventions.