Interactions between ambient air pollutants and temperature on emergency department visits: Analysis of varying-coefficient model in Guangzhou, China

Background: At present, there are few studies on the effect of short-term interactions between ambient air pollutants and temperature on cause-specific emergency department visits in China. This study aimed to explore their short-term interactions on cause-specific emergency department visits using data collected from a total of 65 public hospitals in Guangzhou city, south China. Material and methods: We included a total of 226,443 emergency department visits which were diagnosed as neurological, respiratory and circulatory disease in Guangzhou from January 1, 2014 to December 31, 2017. Average daily concentrations of air pollutants including carbon monoxide (CO), particulate matter having a median diameter of 2.5 mu m or less (PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O-3) were collected from the Guangzhou Environmental Protection Bureau. We employed quasi-Poisson varying coefficient regression models to assess the interaction effects between air pollutants and daily temperature levels (DTIs) on emergency department visits for neurological, respiratory and circulatory diseases, respectively. Results: Average number of emergency department visits for neurological, respiratory and circulatory diseases were 92, 26 and 38, respectively. After controlling for other pollutants, meteorological factors and other time-varying confounders, we found the interactions between NO2 and the 1st DTL (3.4-17.1 degrees C), NO2 and the 2nd DTL (17.1-23.5 degrees C) for neurological emergency department visits were statistically significant, displaying a nonlinear relationship. Additionally, we found that the interactions between SO2 and the 4th DTL (27.4-31.1 degrees C) also had a significantly adverse effect on respiratory emergency department visits. Conclusions: Our findings provide novel evidence on SO2-by-temperature interactions, and NO2-by-temperature interactions for emergency department visits of cause-specific diseases. (C) 2019 Published by Elsevier B.V.