Short-term air pollution exposure is associated with hospital length of stay and hospitalization costs among inpatients with type 2 diabetes: a hospital-based study

ABSTRACT

Air pollution is a risk factor for type 2 diabetes (T2D), exerting heavy economic burden on both individuals and societies. However, there is no apparent report regarding the influence of air pollutants such as particulate matter (PM_2.5 and PM₁₀), sulfur dioxide (SO₂), carbon monoxide (CO), nitrogen dioxide (NO₂), and ozone (O₃) on financial burden to individuals and societies suffering from T2D. This study aimed to determine whether short-term (no more than 16 d) air pollution exposure was associated with T2D-related length of stay (LOS) and hospitalization expenses incurred by patients. This investigation examined 2840 T2D patients hospitalized from December 17, 2013 to May 31, 2016 in China. Multiple linear regression analysis was applied to determine the association between short-term (no more than 16 d) ambient air pollution, LOS, and hospitalization expenses, controlling for age, gender, ethnicity, marital status, and weather conditions. Sulfur dioxide (SO₂) and carbon monoxide (CO) were significantly positively while nitrogen dioxide (NO₂) was negatively associated with presence of T2D, LOS, and expenses. A 10-μg/m³ rise in 16-d (lag 0–15) average concentrations of SO₂ and CO prior to hospitalization was correlated with a significant elevation in LOS and elevation in expenses in T2D patients. However, a 10-μg/m³ rise in 16-d average NO₂ was associated with marked negative alterations in LOS and hospital costs in T2D patients. Taken together, data demonstrate that exposure to air pollutants impacts differently on LOS and hospitalization costs for T2D patients. This is the first apparent report regarding the correlation between air pollution exposure and clinical costs of T2D in China. It is of interest that air pollutants affected T2D patients differently as evidenced by LOS and clinical expenses where SO₂ and CO exhibited a positive adverse relationship in contrast to NO₂.

Conflict of interest

The authors declare that they have no actual or potential competing interests, financial or otherwise.

Additional information

Funding

This study was supported by National Natural Science Foundation of China: [Grant Numbers 81673211, 81372952], Scientific Research Foundation of Chongqing Medical and Pharmaceutical College: [Grant Number ygz2017402], Natural Science Foundation of Chongqing: [Grant Number cstc2012jjA10070], and Science and Technology Research and Development Program of Shaanxi Province: [Grant Number 2013KJXX-92].