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Abstract: No previous study exists in China examining the impact of extreme temperature on morbidity outcomes. In this study, we investigated the impact of heat waves and cold spells on hospital admission in Shanghai, China. Daily hospital admission data between January 1, 2005 and December 31, 2008 were collected from the Shanghai Health Insurance Bureau. The heat wave was defined as a period of at least 7 consecutive days with daily maximum temperature above 35.0°C and daily average temperatures above the 97th percentile during the study period. The cold spell was defined as a period of at least 7 consecutive days with daily maximum temperature and daily average temperatures below the 3rd percentile during the study period. We calculated excess cases of hospitalization and rate ratios (RRs) to estimate the impacts of both heat wave and cold spell on hospital admission. We identified one heat wave period (from 24 July to 2 August, 2007) and one cold spell period (from 28 January to 3 February, 2008) between 2005 and 2008. The heat wave was associated with 2% (95% CI: 1%–4%), 8% (95%CI: 5%–11%), and 6% (95%CI: 0%–11%) increase of total, cardiovascular and respiratory hospital admission. The cold spell was associated with 38% (95%CI: 35%, 40%), 33% (95%CI: 28%, 37%) and 32% (95%CI: 24%, 40%) increase of total, cardiovascular and respiratory hospital admission. The differences between heat wave and cold spell-related hospital admission were statistically significant for all causes and cardiovascular causes, but not for respiratory causes. In conclusion, both heat wave and cold spell were associated with increased risk of hospital admissions in Shanghai. Cold spell seemed to have a larger impact on hospital admission than heat wave. Public health programs should be tailored to prevent extreme temperature-related health problems in the city. [Copyright &y& Elsevier]

Abstract: Few studies exist in China examining the association of ambient air pollution with morbidity outcomes. We conducted a time-series analysis to examine the association of outdoor air pollutants (PM10, SO2, and NO2) with hospital outpatient and emergency room visits in Shanghai, China, using 3years of daily data (2005–2007). Hospital and air pollution data were collected from the Shanghai Health Insurance Bureau and Shanghai Environmental Monitoring Center. Using a natural spline model, we examined effect of air pollutants with different lag structures including both single-day lag and multi-day lag. We examined effects of air pollution for the warm season (from April to September) and cool season (from October to March) separately. We found outdoor air pollution (SO2 and NO2) was associated with increased risk of hospital outpatient and emergency room visits in Shanghai. The effect estimates varied for different lag structures of pollutants’ concentrations. For lag 3, a 10μg/m3 increase in concentration of PM10, SO2 and NO2 corresponded to 0.11% (95%CI: −0.03%, 0.26%), 0.34% (95%CI: 0.06%, 0.61%) and 0.55% (95%CI: 0.14%, 0.97%) increase of outpatient visit; and 0.01% (95%CI: −0.09%, 0.10%), 0.17% (95%CI: 0.00%, 0.35%) and 0.08% (95%CI: −0.18%, 0.33%) increase of emergency room visit. The associations appeared to be more evident in the cool season than in the warm season. In conclusion, short-term exposure to outdoor air pollution was associated with increased risk of hospital outpatient and emergency room visits in Shanghai. Our analyses provide evidence that the current air pollution level has an adverse health effect and strengthen the rationale for further limiting air pollution levels in the city. [Copyright &y& Elsevier]