Impacts of ambient air quality on acute asthma hospital admissions during the COVID-19 pandemic in Oxford City, UK: a time-series study

Ajit Singh; Gabriella L Morley; Cécile Coignet; Felix Leach; Francis D Pope; Graham Neil Thomas; Brian Stacey; Tony Bush; Stuart Cole; George Economides; Ruth Anderson; Pedro Abreu; Suzanne E Bartington

doi:10.1136/bmjopen-2022-070704

Impacts of ambient air quality on acute asthma hospital admissions during the COVID-19 pandemic in Oxford City, UK: a time-series study

Ajit Singh, Gabriella L Morley, Cécile Coignet, Felix Leach, Francis D Pope, Graham Neil Thomas, Brian Stacey, Tony Bush, Stuart Cole, George Economides, Ruth Anderson, Pedro Abreu, Suzanne E Bartington^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

OBJECTIVES: The study aims to investigate the short-term associations between exposure to ambient air pollution (nitrogen dioxide (NO2), particulate matter pollution-particles with diameter<2.5 µm (PM2.5) and PM10) and incidence of asthma hospital admissions among adults, in Oxford, UK.

DESIGN: Retrospective time-series study.

SETTING: Oxford City (postcode areas OX1-OX4), UK.

PARTICIPANTS: Adult population living within the postcode areas OX1-OX4 in Oxford, UK from 1 January 2015 to 31 December 2021.

PRIMARY AND SECONDARY OUTCOME MEASURES: Hourly NO2, PM2.5 and PM10 concentrations and meteorological data for the period 1 January 2015 to 31 December 2020 were analysed and used as exposures. We used Poisson linear regression analysis to identify independent associations between air pollutant concentrations and asthma admissions rate among the adult study population, using both single (NO2, PM2.5, PM10) and multipollutant (NO2 and PM2.5, NO2 and PM10) models, where they adjustment for temperature and relative humidity.

RESULTS: The overall 5-year average asthma admissions rate was 78 per 100 000 population during the study period. The annual average rate decreased to 46 per 100 000 population during 2020 (incidence rate ratio 0.58, 95% CI 0.42 to 0.81, p<0.001) compared to the prepandemic years (2015-2019). In single-pollutant analysis, we observed a significantly increased risk of asthma admission associated with each 1 μg/m3 increase in monthly concentrations of NO2 4% (95% CI 1.009% to 1.072%), PM2.5 3% (95% CI 1.006% to 1.052%) and PM10 1.8% (95% CI 0.999% to 1.038%). However, in the multipollutant regression model, the effect of each individual pollutant was attenuated.

CONCLUSIONS: Ambient NO2 and PM2.5 air pollution exposure increased the risk of asthma admissions in this urban setting. Improvements in air quality during COVID-19 lockdown periods may have contributed to a substantially reduced acute asthma disease burden. Large-scale measures to improve air quality have potential to protect vulnerable people living with chronic asthma in urban areas.

Original language	English
Article number	e070704
Number of pages	8
Journal	BMJ open
Volume	14
Issue number	1
DOIs	https://doi.org/10.1136/bmjopen-2022-070704
Publication status	Published - 23 Jan 2024

Bibliographical note

Keywords

Adult
Humans
Nitrogen Dioxide
Pandemics
Retrospective Studies
COVID-19
Communicable Disease Control
Asthma
Air Pollution
Environmental Pollutants
Particulate Matter
Hospitals
United Kingdom

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/bmjopen-2022-070704Licence: Creative Commons: Attribution (CC BY)

SinghA2024ImpactsFinal published version, 789 KBLicence: Creative Commons: Attribution (CC BY)

Assessing the air quality impacts of COVID-19 public health measures in Oxford City
Bartington, S., Pope, F. & Thomas, N.
Natural Environment Research Council
1/07/20 → 31/12/21
Project: Research Councils
Assessing the impact of zero and low emissions control interventions upon air quality in Oxford City; baseline data collection and feasibility study
Thomas, N., Greenfield, S., Pope, F. & Bartington, S.
NIHR
1/11/19 → 31/07/20
Project: Other Government Departments

Cite this

Singh, A., Morley, G. L., Coignet, C., Leach, F., Pope, F. D., Neil Thomas, G., Stacey, B., Bush, T., Cole, S., Economides, G., Anderson, R., Abreu, P., & Bartington, S. E. (2024). Impacts of ambient air quality on acute asthma hospital admissions during the COVID-19 pandemic in Oxford City, UK: a time-series study. BMJ open, 14(1), Article e070704. https://doi.org/10.1136/bmjopen-2022-070704

@article{5a2117822bc04e3888b7b0e919a2c940,

title = "Impacts of ambient air quality on acute asthma hospital admissions during the COVID-19 pandemic in Oxford City, UK: a time-series study",

abstract = "OBJECTIVES: The study aims to investigate the short-term associations between exposure to ambient air pollution (nitrogen dioxide (NO2), particulate matter pollution-particles with diameter<2.5 µm (PM2.5) and PM10) and incidence of asthma hospital admissions among adults, in Oxford, UK.DESIGN: Retrospective time-series study.SETTING: Oxford City (postcode areas OX1-OX4), UK.PARTICIPANTS: Adult population living within the postcode areas OX1-OX4 in Oxford, UK from 1 January 2015 to 31 December 2021.PRIMARY AND SECONDARY OUTCOME MEASURES: Hourly NO2, PM2.5 and PM10 concentrations and meteorological data for the period 1 January 2015 to 31 December 2020 were analysed and used as exposures. We used Poisson linear regression analysis to identify independent associations between air pollutant concentrations and asthma admissions rate among the adult study population, using both single (NO2, PM2.5, PM10) and multipollutant (NO2 and PM2.5, NO2 and PM10) models, where they adjustment for temperature and relative humidity.RESULTS: The overall 5-year average asthma admissions rate was 78 per 100 000 population during the study period. The annual average rate decreased to 46 per 100 000 population during 2020 (incidence rate ratio 0.58, 95% CI 0.42 to 0.81, p<0.001) compared to the prepandemic years (2015-2019). In single-pollutant analysis, we observed a significantly increased risk of asthma admission associated with each 1 μg/m3 increase in monthly concentrations of NO2 4% (95% CI 1.009% to 1.072%), PM2.5 3% (95% CI 1.006% to 1.052%) and PM10 1.8% (95% CI 0.999% to 1.038%). However, in the multipollutant regression model, the effect of each individual pollutant was attenuated.CONCLUSIONS: Ambient NO2 and PM2.5 air pollution exposure increased the risk of asthma admissions in this urban setting. Improvements in air quality during COVID-19 lockdown periods may have contributed to a substantially reduced acute asthma disease burden. Large-scale measures to improve air quality have potential to protect vulnerable people living with chronic asthma in urban areas.",

keywords = "Adult, Humans, Nitrogen Dioxide, Pandemics, Retrospective Studies, COVID-19, Communicable Disease Control, Asthma, Air Pollution, Environmental Pollutants, Particulate Matter, Hospitals, United Kingdom",

author = "Ajit Singh and Morley, {Gabriella L} and C{\'e}cile Coignet and Felix Leach and Pope, {Francis D} and {Neil Thomas}, Graham and Brian Stacey and Tony Bush and Stuart Cole and George Economides and Ruth Anderson and Pedro Abreu and Bartington, {Suzanne E}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.",

year = "2024",

month = jan,

day = "23",

doi = "10.1136/bmjopen-2022-070704",

language = "English",

volume = "14",

journal = "BMJ open",

issn = "2044-6055",

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number = "1",

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Singh, A, Morley, GL, Coignet, C, Leach, F, Pope, FD , Neil Thomas, G, Stacey, B, Bush, T, Cole, S, Economides, G, Anderson, R, Abreu, P & Bartington, SE 2024, 'Impacts of ambient air quality on acute asthma hospital admissions during the COVID-19 pandemic in Oxford City, UK: a time-series study', BMJ open, vol. 14, no. 1, e070704. https://doi.org/10.1136/bmjopen-2022-070704

TY - JOUR

T1 - Impacts of ambient air quality on acute asthma hospital admissions during the COVID-19 pandemic in Oxford City, UK

T2 - a time-series study

AU - Singh, Ajit

AU - Morley, Gabriella L

AU - Coignet, Cécile

AU - Leach, Felix

AU - Pope, Francis D

AU - Neil Thomas, Graham

AU - Stacey, Brian

AU - Bush, Tony

AU - Cole, Stuart

AU - Economides, George

AU - Anderson, Ruth

AU - Abreu, Pedro

AU - Bartington, Suzanne E

N1 - © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.

PY - 2024/1/23

Y1 - 2024/1/23

N2 - OBJECTIVES: The study aims to investigate the short-term associations between exposure to ambient air pollution (nitrogen dioxide (NO2), particulate matter pollution-particles with diameter<2.5 µm (PM2.5) and PM10) and incidence of asthma hospital admissions among adults, in Oxford, UK.DESIGN: Retrospective time-series study.SETTING: Oxford City (postcode areas OX1-OX4), UK.PARTICIPANTS: Adult population living within the postcode areas OX1-OX4 in Oxford, UK from 1 January 2015 to 31 December 2021.PRIMARY AND SECONDARY OUTCOME MEASURES: Hourly NO2, PM2.5 and PM10 concentrations and meteorological data for the period 1 January 2015 to 31 December 2020 were analysed and used as exposures. We used Poisson linear regression analysis to identify independent associations between air pollutant concentrations and asthma admissions rate among the adult study population, using both single (NO2, PM2.5, PM10) and multipollutant (NO2 and PM2.5, NO2 and PM10) models, where they adjustment for temperature and relative humidity.RESULTS: The overall 5-year average asthma admissions rate was 78 per 100 000 population during the study period. The annual average rate decreased to 46 per 100 000 population during 2020 (incidence rate ratio 0.58, 95% CI 0.42 to 0.81, p<0.001) compared to the prepandemic years (2015-2019). In single-pollutant analysis, we observed a significantly increased risk of asthma admission associated with each 1 μg/m3 increase in monthly concentrations of NO2 4% (95% CI 1.009% to 1.072%), PM2.5 3% (95% CI 1.006% to 1.052%) and PM10 1.8% (95% CI 0.999% to 1.038%). However, in the multipollutant regression model, the effect of each individual pollutant was attenuated.CONCLUSIONS: Ambient NO2 and PM2.5 air pollution exposure increased the risk of asthma admissions in this urban setting. Improvements in air quality during COVID-19 lockdown periods may have contributed to a substantially reduced acute asthma disease burden. Large-scale measures to improve air quality have potential to protect vulnerable people living with chronic asthma in urban areas.

AB - OBJECTIVES: The study aims to investigate the short-term associations between exposure to ambient air pollution (nitrogen dioxide (NO2), particulate matter pollution-particles with diameter<2.5 µm (PM2.5) and PM10) and incidence of asthma hospital admissions among adults, in Oxford, UK.DESIGN: Retrospective time-series study.SETTING: Oxford City (postcode areas OX1-OX4), UK.PARTICIPANTS: Adult population living within the postcode areas OX1-OX4 in Oxford, UK from 1 January 2015 to 31 December 2021.PRIMARY AND SECONDARY OUTCOME MEASURES: Hourly NO2, PM2.5 and PM10 concentrations and meteorological data for the period 1 January 2015 to 31 December 2020 were analysed and used as exposures. We used Poisson linear regression analysis to identify independent associations between air pollutant concentrations and asthma admissions rate among the adult study population, using both single (NO2, PM2.5, PM10) and multipollutant (NO2 and PM2.5, NO2 and PM10) models, where they adjustment for temperature and relative humidity.RESULTS: The overall 5-year average asthma admissions rate was 78 per 100 000 population during the study period. The annual average rate decreased to 46 per 100 000 population during 2020 (incidence rate ratio 0.58, 95% CI 0.42 to 0.81, p<0.001) compared to the prepandemic years (2015-2019). In single-pollutant analysis, we observed a significantly increased risk of asthma admission associated with each 1 μg/m3 increase in monthly concentrations of NO2 4% (95% CI 1.009% to 1.072%), PM2.5 3% (95% CI 1.006% to 1.052%) and PM10 1.8% (95% CI 0.999% to 1.038%). However, in the multipollutant regression model, the effect of each individual pollutant was attenuated.CONCLUSIONS: Ambient NO2 and PM2.5 air pollution exposure increased the risk of asthma admissions in this urban setting. Improvements in air quality during COVID-19 lockdown periods may have contributed to a substantially reduced acute asthma disease burden. Large-scale measures to improve air quality have potential to protect vulnerable people living with chronic asthma in urban areas.

KW - Adult

KW - Humans

KW - Nitrogen Dioxide

KW - Pandemics

KW - Retrospective Studies

KW - COVID-19

KW - Communicable Disease Control

KW - Asthma

KW - Air Pollution

KW - Environmental Pollutants

KW - Particulate Matter

KW - Hospitals

KW - United Kingdom

U2 - 10.1136/bmjopen-2022-070704

DO - 10.1136/bmjopen-2022-070704

M3 - Article

C2 - 38262660

SN - 2044-6055

VL - 14

JO - BMJ open

JF - BMJ open

IS - 1

M1 - e070704

ER -

Impacts of ambient air quality on acute asthma hospital admissions during the COVID-19 pandemic in Oxford City, UK: a time-series study

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

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Projects

Assessing the air quality impacts of COVID-19 public health measures in Oxford City

Assessing the impact of zero and low emissions control interventions upon air quality in Oxford City; baseline data collection and feasibility study

Cite this