The impact of the synergistic effect of SO2 and PM2.5/PM10 on obstructive lung disease in subtropical Taiwan

Te-Yu Chen; Szu-Chia Chen; Chih-Wen Wang; Hung-Pin Tu; Pei-Shih Chen; Stephen Chu-Sung Hu; Chiu-Hui Li; Da-Wei Wu; Chih-Hsing Hung; Chao-Hung Kuo

doi:10.3389/fpubh.2023.1229820

The impact of the synergistic effect of SO₂ and PM_2.5/PM₁₀ on obstructive lung disease in subtropical Taiwan

Front Public Health. 2023 Sep 22:11:1229820. doi: 10.3389/fpubh.2023.1229820. eCollection 2023.

Authors

Te-Yu Chen¹, Szu-Chia Chen^{2

3

4

5}, Chih-Wen Wang^{3

4

5

6}, Hung-Pin Tu⁷, Pei-Shih Chen^{5

8

9

10}, Stephen Chu-Sung Hu^{5

11

12}, Chiu-Hui Li¹³, Da-Wei Wu^{3

4

5

14

15}, Chih-Hsing Hung^{5

16}, Chao-Hung Kuo^{5

17}

Affiliations

¹ School of Post-baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
² Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
³ Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴ Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁶ Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁷ Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁸ Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁹ Institute of Environmental Engineering, College of Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan.
¹⁰ Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
¹¹ Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
¹² Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹³ Doctoral Degree Program, Department of International Business, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan.
¹⁴ Doctoral Degree Program, Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁵ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁶ Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁷ Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

Abstract

Background: Chronic Obstructive lung diseases (COPD) are complex conditions influenced by various environmental, lifestyle, and genetic factors. Ambient air pollution has been identified as a potential risk factor, causing 4.2 million deaths worldwide in 2016, accounting for 25% of all COPD-related deaths and 26% of all respiratory infection-related deaths. This study aims to evaluate the associations among chronic lung diseases, air pollution, and meteorological factors.

Methods: This cross-sectional study obtained data from the Taiwan Biobank and Taiwan Air Quality Monitoring Database. We defined obstructive lung disease as patients with FEV1/FVC < 70%. Descriptive analysis between spirometry groups was performed using one-way ANOVA and the chi-square or Fisher's exact test. A generalized additive model (GAM) was used to evaluate the relationship between SO₂ and PM_2.5/PM₁₀ through equations and splines fitting.

Results: A total of 2,635 participants were enrolled. Regarding environmental factors, higher temperature, higher relative humidity, and lower rainfall were risk factors for obstructive lung disease. SO₂ was positively correlated with PM₁₀ and PM_2.5, with correlation coefficients of 0.53 (p < 0.0001) and 0.52 (p < 0.0001), respectively. Additionally, SO₂ modified the relative risk of obstructive impairment for both PM₁₀ [β coefficient (β) = 0.01, p = 0.0052] and PM_2.5 (β = 0.01, p = 0.0155). Further analysis per standard deviation (per SD) increase revealed that SO₂ also modified the relationship for both PM₁₀ (β = 0.11, p = 0.0052) and PM_2.5 (β = 0.09, p = 0.0155). Our GAM analysis showed a quadratic pattern for SO₂ (per SD) and PM₁₀ (per SD) in model 1, and a quadratic pattern for SO₂ (per SD) in model 2. Moreover, our findings confirmed synergistic effects among temperature, SO₂ and PM_2.5/PM₁₀, as demonstrated by the significant associations of bivariate (SO₂ vs. PM₁₀, SO₂ vs. PM_2.5) thin-plate smoothing splines in models 1 and 2 with obstructive impairment (p < 0.0001).

Conclusion: Our study showed high temperature, humidity, and low rainfall increased the risk of obstructive lung disease. Synergistic effects were observed among temperature, SO₂, and PM_2.5/PM₁₀. The impact of air pollutants on obstructive lung disease should consider these interactions.

Keywords: air pollutants; climate factors; generalized additive model; obstructive lung disease; synergistic effect.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Air Pollutants* / adverse effects
Air Pollutants* / analysis
Cross-Sectional Studies
Humans
Particulate Matter / adverse effects
Particulate Matter / analysis
Pulmonary Disease, Chronic Obstructive* / epidemiology
Pulmonary Disease, Chronic Obstructive* / etiology
Taiwan / epidemiology

Substances

Air Pollutants
Particulate Matter