Regional differences in acute hospitalization risk associated with NO2 by cause, season, age, sex, and trend: an ecological time series study in Canada
Abstract Background Nitrogen dioxide (NO2) is a highly reactive gas produced mainly from burning fossil fuels. Exposure to NO2 has been shown to impact public health worldwide. However, spatial and temporal variations in its effects by season, age, and sex have been underexamined. Methods We conduct...
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2025-03-01
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| Online Access: | https://doi.org/10.1186/s12889-025-22339-6 |
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| author | Hwashin Hyun Shin James G. Owen Kimberly Megan Mitchell Marc Smith-Doiron Parvin Dehghani |
| author_facet | Hwashin Hyun Shin James G. Owen Kimberly Megan Mitchell Marc Smith-Doiron Parvin Dehghani |
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| description | Abstract Background Nitrogen dioxide (NO2) is a highly reactive gas produced mainly from burning fossil fuels. Exposure to NO2 has been shown to impact public health worldwide. However, spatial and temporal variations in its effects by season, age, and sex have been underexamined. Methods We conducted an ecological time-series study based on about 20 million people (52% of Canadians in 2012) in three regions (Western, Central and Eastern Canada) over 17 years (1996–2012). We collected hourly NO2 concentrations and temperatures, and daily counts of non-accidental all-cause, circulatory-, and respiratory-related hospitalizations, including more specific causes: ischemic heart disease, other heart disease, cerebrovascular disease, influenza/pneumonia, and chronic lower respiratory disease. We first estimated city-specific risks, applying over-dispersed generalized Poisson models, and then regional and national risks for each season, age-group, and sex using Bayesian hierarchical models. We also applied Sen’s test to detect linear trends in annual regional and national risks. Results We found significant NO2 effects by cause, season, age, sex, and linear trend. For circulatory hospitalization, only Western Canada showed significant adverse effects for non-seniors (≤ 65) (1.7% with 95% credible interval of 0.3–3.2% per 10 ppb increase in NO2), and for males for more specific cause, ischemic heart disease (2.3%, 0.1–4.5%). Regional differences were observed for circulatory but not respiratory hospitalizations. For example, the Western and Eastern regions were at significantly higher risk of circulatory hospitalization but not the Central region: 1.6% (0.2–3.0%) for the Western region; 2.0% (0.6–3.4%) for the Eastern region; and 0.8% (-0.3–2.0%) for the Central region. In particular, the Western region had a much higher risk of cerebrovascular disease hospitalization: 2.8% (1.1–4.6%) for the Western region; 0.1% (-3.0–3.1%) for the Central region; and 0.0% (-3.4–3.5%) for the Eastern region. However, no other regional differences were observed for other causes. Overall, there were noticeable increases in regional differences over time, particularly in the later years. Conclusions This study indicates harmful NO2 effects on acute hospitalizations year-round: circulatory causes (cold season) and respiratory causes (warm season). Future work is warranted to investigate potential causes of observed regional differences using more community-related information such as socioeconomic status, health-care accessibility, and others. |
| format | Article |
| id | doaj-art-52bbbc7bccc7442dabbc8bdd50bd70bd |
| institution | DOAJ |
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| language | English |
| publishDate | 2025-03-01 |
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| spelling | doaj-art-52bbbc7bccc7442dabbc8bdd50bd70bd2025-08-20T03:08:09ZengBMCBMC Public Health1471-24582025-03-0125111610.1186/s12889-025-22339-6Regional differences in acute hospitalization risk associated with NO2 by cause, season, age, sex, and trend: an ecological time series study in CanadaHwashin Hyun Shin0James G. Owen1Kimberly Megan Mitchell2Marc Smith-Doiron3Parvin Dehghani4Environmental Health Science and Research Bureau, Health CanadaEnvironmental Health Science and Research Bureau, Health CanadaEnvironmental Health Science and Research Bureau, Health CanadaEnvironmental Health Science and Research Bureau, Health CanadaEnvironmental Health Science and Research Bureau, Health CanadaAbstract Background Nitrogen dioxide (NO2) is a highly reactive gas produced mainly from burning fossil fuels. Exposure to NO2 has been shown to impact public health worldwide. However, spatial and temporal variations in its effects by season, age, and sex have been underexamined. Methods We conducted an ecological time-series study based on about 20 million people (52% of Canadians in 2012) in three regions (Western, Central and Eastern Canada) over 17 years (1996–2012). We collected hourly NO2 concentrations and temperatures, and daily counts of non-accidental all-cause, circulatory-, and respiratory-related hospitalizations, including more specific causes: ischemic heart disease, other heart disease, cerebrovascular disease, influenza/pneumonia, and chronic lower respiratory disease. We first estimated city-specific risks, applying over-dispersed generalized Poisson models, and then regional and national risks for each season, age-group, and sex using Bayesian hierarchical models. We also applied Sen’s test to detect linear trends in annual regional and national risks. Results We found significant NO2 effects by cause, season, age, sex, and linear trend. For circulatory hospitalization, only Western Canada showed significant adverse effects for non-seniors (≤ 65) (1.7% with 95% credible interval of 0.3–3.2% per 10 ppb increase in NO2), and for males for more specific cause, ischemic heart disease (2.3%, 0.1–4.5%). Regional differences were observed for circulatory but not respiratory hospitalizations. For example, the Western and Eastern regions were at significantly higher risk of circulatory hospitalization but not the Central region: 1.6% (0.2–3.0%) for the Western region; 2.0% (0.6–3.4%) for the Eastern region; and 0.8% (-0.3–2.0%) for the Central region. In particular, the Western region had a much higher risk of cerebrovascular disease hospitalization: 2.8% (1.1–4.6%) for the Western region; 0.1% (-3.0–3.1%) for the Central region; and 0.0% (-3.4–3.5%) for the Eastern region. However, no other regional differences were observed for other causes. Overall, there were noticeable increases in regional differences over time, particularly in the later years. Conclusions This study indicates harmful NO2 effects on acute hospitalizations year-round: circulatory causes (cold season) and respiratory causes (warm season). Future work is warranted to investigate potential causes of observed regional differences using more community-related information such as socioeconomic status, health-care accessibility, and others.https://doi.org/10.1186/s12889-025-22339-6Acute hospitalizationAir pollutionBayesian hierarchical modelNitrogen dioxideOver-dispersed generalized Poisson modelsRegional risk |
| spellingShingle | Hwashin Hyun Shin James G. Owen Kimberly Megan Mitchell Marc Smith-Doiron Parvin Dehghani Regional differences in acute hospitalization risk associated with NO2 by cause, season, age, sex, and trend: an ecological time series study in Canada BMC Public Health Acute hospitalization Air pollution Bayesian hierarchical model Nitrogen dioxide Over-dispersed generalized Poisson models Regional risk |
| title | Regional differences in acute hospitalization risk associated with NO2 by cause, season, age, sex, and trend: an ecological time series study in Canada |
| title_full | Regional differences in acute hospitalization risk associated with NO2 by cause, season, age, sex, and trend: an ecological time series study in Canada |
| title_fullStr | Regional differences in acute hospitalization risk associated with NO2 by cause, season, age, sex, and trend: an ecological time series study in Canada |
| title_full_unstemmed | Regional differences in acute hospitalization risk associated with NO2 by cause, season, age, sex, and trend: an ecological time series study in Canada |
| title_short | Regional differences in acute hospitalization risk associated with NO2 by cause, season, age, sex, and trend: an ecological time series study in Canada |
| title_sort | regional differences in acute hospitalization risk associated with no2 by cause season age sex and trend an ecological time series study in canada |
| topic | Acute hospitalization Air pollution Bayesian hierarchical model Nitrogen dioxide Over-dispersed generalized Poisson models Regional risk |
| url | https://doi.org/10.1186/s12889-025-22339-6 |
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