Abstract
The evidence on the health and economic impacts of air pollution with schizophrenia is scarce, especially in developing countries. In this study, we aimed to systemically examine the short-term effects of PM2.5 (particulate matter ≤ 2.5 μm in diameter), PM10 (≤ 10 μm in diameter), NO2 (nitrogen dioxide), SO2 (sulfur dioxide), CO (carbon monoxide), and O3 (ozone) on hospital admissions for schizophrenia in a Chinese coastal city (Qingdao) and to further assess the corresponding attributable risk and economic burden. A generalized additive model (GAM) was applied to model the impact of air pollution on schizophrenia, and the corresponding economic burden including the direct costs (medical expenses) and indirect costs (productivity loss). Stratified analyses were also performed by age, gender, and season (warm or cold). Our results showed that for a 10 μg/m3 increase in the concentrations of PM2.5, PM10, SO2, and CO at lag5, the corresponding relative risks (RRs) were 1.0160 (95% CI: 1.0038–1.0282), 1.0097 (1.0018–1.0177), 1.0738 (1.0222–1.01280), and 1.0013 (1.0001–1.0026), respectively. However, no significant effect of NO2 or O3 on schizophrenia admissions was found. The stratified analysis indicated that females and younger individuals (< 45 years old) appeared to be more vulnerable, but no significant difference was found between seasons. Furthermore, 12.41% of schizophrenia hospitalizations were attributable to exposure to air pollution exceeding the World Health Organization (WHO) air quality standard, with a total economic burden of 89.67 million RMB during the study period. At the individual level, excessive air pollution exposure resulted in an economic burden of 8232.08 RMB per hospitalization. Our study found that short-term exposure to air pollutants increased the risk of hospital admissions for schizophrenia and resulted in a substantial economic burden. Considerable health benefits can be achieved by further reducing air pollution.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
References
Bai L, Zhang X, Zhang Y, Cheng Q, Duan J, Gao J, Xu Z, Zhang H, Wang S, Su H (2019) Ambient concentrations of NO2 and hospital admissions for schizophrenia. Occup Environ Med 76(2):125–131. https://doi.org/10.1136/oemed-2018-105162
Chen C, Liu C, Chen R, Wang W, Li W, Kan H, Fu C (2018) Ambient air pollution and daily hospital admissions for mental disorders in Shanghai, China. Sci Total Environ 613–614:324–330. https://doi.org/10.1016/j.scitotenv.2017.09.098
Chen E, Bazargan-Hejazi S, Ani C, Hindman D, Pan D, Ebrahim G, Shirazi A, Banta JE (2021) Schizophrenia hospitalization in the US 2005–2014: examination of trends in demographics, length of stay, and cost. Medicine 100(15):e25206. https://doi.org/10.1097/MD.0000000000025206
Chong HY, Teoh SL, Wu DB, Kotirum S, Chiou CF, Chaiyakunapruk N (2016) Global economic burden of schizophrenia: a systematic review. Neuropsychiatr Dis Treat 12:357–373. https://doi.org/10.2147/NDT.S96649
Duan J, Cheng Q, Luo X, Bai L, Zhang H, Wang S, Xu Z, Gao J, Zhang Y, Su H (2018) Is the serious ambient air pollution associated with increased admissions for schizophrenia? Sci Total Environ 644:14–19. https://doi.org/10.1016/j.scitotenv.2018.06.218
Gao Q, Xu Q, Guo X, Fan H, Zhu H (2017) Particulate matter air pollution associated with hospital admissions for mental disorders: a time-series study in Beijing, China. Eur Psychiatry 44:68–75. https://doi.org/10.1016/j.eurpsy.2017.02.492
Gu S, Li D, Lu B, Huang R, Xu G (2020) Associations between ambient air pollution and daily incidence of pediatric hand, foot and mouth disease in Ningbo, 2014–2016: a distributed lag nonlinear model. Epidemiol Infect 148:e46. https://doi.org/10.1017/S0950268820000321
Guo H, Chen M (2018) Short-term effect of air pollution on asthma patient visits in Shanghai area and assessment of economic costs. Ecotoxicol Environ Saf 161:184–189. https://doi.org/10.1016/j.ecoenv.2018.05.089
Guo L, Zhu N, Guo Z, Li GK, Chen C, Sang N, Yao QC (2012) Particulate matter (PM10) exposure induces endothelial dysfunction and inflammation in rat brain. J Hazard Mater 213–214:28–37. https://doi.org/10.1016/j.jhazmat.2012.01.034
Huttunen K, Siponen T, Salonen I, Yli-Tuomi T, Aurela M, Dufva H, Hillamo R, Linkola E, Pekkanen J, Pennanen A, Peters A, Salonen RO, Schneider A, Tiittanen P, Hirvonen MR, Lanki T (2012) Low-level exposure to ambient particulate matter is associated with systemic inflammation in ischemic heart disease patients. Environ Res 116:44–51. https://doi.org/10.1016/j.envres.2012.04.004
Ji Y, Liu B, Song J, Pan R, Cheng J, Su H, Wang H (2021) Particulate matter pollution associated with schizophrenia hospital re-admissions: a time-series study in a coastal Chinese city. Environ Sci Pollut Res Int. https://doi.org/10.1007/s11356-021-14816-3
Jia Z, Wei Y, Li X, Yang L, Liu H, Guo C, Zhang L, Li N, Guo S, Qian Y, Li Z (2018) Exposure to ambient air particles increases the risk of mental disorder: findings from a natural experiment in Beijing. Int J Environ Res Public Health 15(1):160. https://doi.org/10.3390/ijerph15010160
Kan H, London SJ, Chen G, Zhang Y, Song G, Zhao N, Jiang L, Chen B (2008) Season, sex, age, and education as modifiers of the effects of outdoor air pollution on daily mortality in Shanghai, China: the Public Health and Air Pollution in Asia (PAPA) study. Environ Health Perspect 116(9):1183–1188. https://doi.org/10.1289/ehp.10851
Kanner J, Pollack AZ, Ranasinghe S, Stevens DR, Nobles C, Rohn M, Sherman S, Mendola P (2021) Chronic exposure to air pollution and risk of mental health disorders complicating pregnancy. Environ Res 196:110937. https://doi.org/10.1016/j.envres.2021.110937
Kennelly B (2017) How should cost-of-illness studies be interpreted? Lancet Psychiatry 4(10):735–736. https://doi.org/10.1016/S2215-0366(17)30364-4
Lavigne E, Gasparrini A, Wang X, Chen H, Yagouti A, Fleury MD, Cakmak S (2014) Extreme ambient temperatures and cardiorespiratory emergency room visits: assessing risk by comorbid health conditions in a time series study. Environ Health 13(1):5. https://doi.org/10.1186/1476-069X-13-5
Li H, Zhang S, Qian ZM, Xie XH, Luo Y, Han R, Hou J, Wang C, McMillin SE, Wu S, Tian F, Deng WF, Lin H (2020) Short-term effects of air pollution on cause-specific mental disorders in three subtropical Chinese cities. Environ Res 191:110214. https://doi.org/10.1016/j.envres.2020.110214
Liang Z, Xu C, Cao Y, Kan HD, Chen RJ, Yao CY, Liu XL, Xiang Y, Wu N, Wu L, Li YF, Ji AL, Cai TJ (2019) The association between short-term ambient air pollution and daily outpatient visits for schizophrenia: a hospital-based study. Environ Pollut 244:102–108. https://doi.org/10.1016/j.envpol.2018.09.142
Liu Y, Xie S, Yu Q, Huo X, Ming X, Wang J, Zhou Y, Peng Z, Zhang H, Cui X, Xiang H, Huang X, Zhou T, Chen W, Shi T (2017) Short-term effects of ambient air pollution on pediatric outpatient visits for respiratory diseases in Yichang city, China. Environ Pollut 227:116–124. https://doi.org/10.1016/j.envpol.2017.04.029
Lu P, Zhang Y, Xia G, Zhang W, Xu R, Wang C, Guo Y, Li S (2020) Attributable risks associated with hospital outpatient visits for mental disorders due to air pollution: a multi-city study in China. Environ Int 143:105906. https://doi.org/10.1016/j.envint.2020.105906
Mennini FS, Marcellusi A, Gazzillo S et al (2021) Economic impact of schizophrenia from a hospital and social security system perspective in Italy. Clin Drug Investig 41(2):183–191. https://doi.org/10.1007/s40261-020-00991-7
Meng Z, Zhang B (2003) Oxidative damage of sulfur dioxide inhalation on brains and livers of mice. Environ Toxicol Pharmacol 13(1):1–8. https://doi.org/10.1016/s1382-6689(02)00106-0
Marder SR, Cannon TD (2019) Schizophrenia. N Engl J Med 381(18):1753–1761. https://doi.org/10.1056/NEJMra1808803
World Health Organization (2016) Ambient air pollution: a global assessment of exposure and burden of disease. World Health Organization, Geneva. https://apps.who.int/iris/handle/10665/250141
Qiu H, Zhu X, Wang L, Pan J, Pu X, Zeng X, Zhang L, Peng Z, Zhou L (2019) Attributable risk of hospital admissions for overall and specific mental disorders due to particulate matter pollution: a time-series study in Chengdu, China. Environ Res 170:230–237. https://doi.org/10.1016/j.envres.2018.12.019
Segev Z, Arif AA, Rohrer JE (2012) Activity limitations and healthcare access as correlates of frequent mental distress in adults 65 years and older: a behavioral risk factor surveillance stud—2008. J Prim Care Community Health 3(1):17–22. https://doi.org/10.1177/2150131911412380
Song J, Zheng L, Lu M, Gui L, Xu D, Wu W, Liu Y (2018) Acute effects of ambient particulate matter pollution on hospital admissions for mental and behavioral disorders: a time-series study in Shijiazhuang, China. Sci Total Environ 636:205–211. https://doi.org/10.1016/j.scitotenv.2018.04.187
Szyszkowicz M, Rowe BH, Colman I (2009) Air pollution and daily emergency department visits for depression. Int J Occup Med Environ Health 22(4):355–362. https://doi.org/10.2478/v10001-009-0031-6
Tong L, Li K, Zhou Q (2016) Season, sex and age as modifiers in the association of psychosis morbidity with air pollutants: a rising problem in a Chinese metropolis. Sci Total Environ 541:928–933. https://doi.org/10.1016/j.scitotenv.2015.09.066
Tang C, Chen Y, Song Q, Ma J, Zhou Y, Gong L, Chen X, Qu J, Luo Y (2021) Short-term exposure to air pollution and occurrence of emergency stroke in Chongqing, China. Int Arch Occup Environ Health 94(1):69–76. https://doi.org/10.1007/s00420-020-01557-y
Wang F, Liu H, Li H, Liu J, Guo X, Yuan J, Hu Y, Wang J, Lu L (2018) Ambient concentrations of particulate matter and hospitalization for depression in 26 Chinese cities: a case-crossover study. Environ Int 14:115–122. https://doi.org/10.1016/j.envint.2018.02.012
Wu Z, Chen X, Li G, Tian L, Wang Z, Xiong X, Yang C, Zhou Z, Pan X (2020) Attributable risk and economic cost of hospital admissions for mental disorders due to PM2.5 in Beijing. Sci Total Environ 718:137274. https://doi.org/10.1016/j.scitotenv.2020.137274
Zhai J, Guo X, Chen M, Zhao J, Su Z (2013) An investigation of economic costs of schizophrenia in two areas of China. Int J Ment Heal Syst 7(1):26. https://doi.org/10.1186/1752-4458-7-26
Zhang C, Ding R, Xiao C, Xu Y, Cheng H, Zhu F, Lei R, Di D, Zhao Q, Cao J (2017) Association between air pollution and cardiovascular mortality in Hefei, China: a time-series analysis. Environ Pollut 229:790–797. https://doi.org/10.1016/j.envpol.2017.06.022
Zhang C, Li S, Guo GL, Hao JW, Cheng P, Xiong LL, Chen ST, Cao JY, Guo YW, Hao JH (2021) Acute associations between air pollution on premature rupture of membranes in Hefei, China. Environ Geochem Health 43(9):3393–3406. https://doi.org/10.1007/s10653-021-00833-1
Zhang P, Zhou X (2020) Health and economic impacts of particulate matter pollution on hospital admissions for mental disorders in Chengdu, Southwestern China. Sci Total Environ 733:139114. https://doi.org/10.1016/j.scitotenv.2020.139114
Zhong P, Huang S, Zhang X, Wu S, Zhu Y, Li Y, Ma L (2018) Individual-level modifiers of the acute effects of air pollution on mortality in Wuhan, China. Glob Health Res Policy 3:27. https://doi.org/10.1186/s41256-018-0080-0
Funding
This work was supported by the National Natural Science Foundation of China (No. 71774001 to H.W., No. 81773518 to H.S., No. 42105165 to J.C.) and the High-level Scientific Research Foundation of Anhui Medical University (No. 0305044201 to J.C.).
Author information
Authors and Affiliations
Contributions
YHJ and JS contributed to data curation, investigation, formal analysis, and original draft. BL and RBP contributed to validation; JC, HW, and HS contributed to conceptualization, funding acquisition, methodology, and writing—review and editing. All authors read and approved the final manuscript.
Corresponding authors
Ethics declarations
Ethics approval and consent to participate
This was a retrospective study, and there was no direct contact with the patients. Consequently, informed consent was not obtained. Our protocol was approved by the Ethics Committee of Anhui Medical University (No: 20170295) and complied with the Declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Additional information
Responsible Editor: Lotfi Aleya
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Ji, Y., Liu, B., Song, J. et al. Short-term effects and economic burden assessment of ambient air pollution on hospitalizations for schizophrenia. Environ Sci Pollut Res 29, 45449–45460 (2022). https://doi.org/10.1007/s11356-022-19026-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11356-022-19026-z