Sex-difference in air pollution-related acute circulatory and respiratory mortality and hospitalization

• Published in: The Science of the total environment 2022-02, Vol.806 (Pt 3), p.150515-150515, Article 150515
• Main Authors: Shin, Hwashin H., Maquiling, Aubrey, Thomson, Errol M., Park, In-Woo, Stieb, Dave M., Dehghani, Parvin
• Format: Article
• Language: English
• Subjects: Air Pollutants - analysis; Air Pollutants - toxicity; Air Pollution - adverse effects; Air Pollution - analysis; Bayes Theorem; Canada; Environmental Exposure - analysis; Female; Ground-level ozone; Hospitalization; Humans; Male; Mortality; Nitrogen dioxide; Particulate Matter - analysis; Particulate Matter - toxicity; PM2.5; Pneumonia; Sex-difference; Time Factors
• ISSN: 0048-9697; 1879-1026
• DOI: 10.1016/j.scitotenv.2021.150515

Numerous studies have estimated adverse effects of short-term exposure to ambient air pollution on public health. Few have focused on sex-differences, and results have been inconsistent. The purpose of this study was three-fold: to identify sex-differences in air pollution-related health outcomes; to examine sex-differences by cause and season; and to examine time trends in sex-differences. Daily data were collected on circulatory- and respiratory-related mortality (for 29 years) and cause-specific hospitalization (for 17 years) with hourly concentrations of ozone (O3), nitrogen dioxide (NO2), and fine particulate matter (PM2.5). For hospitalization, more specific causes were examined: ischemic heart disease (IHD), other heart disease (OHD), cerebrovascular disease (CEV), chronic lower respiratory diseases (CLRD), and Influenza/Pneumonia (InfPn). Generalized Poisson models were applied to 24 Canadian cities, and the city-specific estimates were combined for nationwide estimates for each sex using Bayesian hierarchical models. Finally, sex-differences were tested statistically based on their interval estimates, considering the correlation between sex-specific national estimates. Sex-differences were more frequently observed for hospitalization than mortality, respiratory than circulatory health outcomes, and warm than cold season. For hospitalization, males were at higher risk (M > F) for warm season (OHD and InfPn from O3; IHD from NO2; and InfPn from PM2.5), but F > M for cold season (CEV from O3 and OHD from NO2). For mortality, we found F > M only for circulatory diseases from ozone during the warm season. Among the above-mentioned sex-differences, three cases showed consistent time trends over the years: while M > F for OHD from O3 and IHD from NO2, F > M for OHD from NO2. We found that sex-differences in effect of ambient air pollution varied over health outcome, cause, season and time. In particular, the consistent trends (either F > M or M > F) across 17 years provide stronger evidence of sex-differences in hospitalizations, and warrant investigation in other populations. [Display omitted] •We found sex-differences in effects of ambient air pollutants on public health.•Sex-differences varied by cause, air pollutant, and season.•Sex-differences were more frequently observed for hospitalization than mortality.•Sex-differences were more common for respiratory than circulatory hospitalization.