Associations between fine particle, coarse particle, black carbon and hospital visits in a Chinese city

• Few studies in Asian developing countries have examined the effects of PM2.5, PM10–2.5 and BC simultaneously.
• In Shanghai, we observed significant associations of PM2.5, PM 10–2.5, and BC with daily hospital visits.
• The associations appeared to be more evident for emergency-room visits than for outpatient visits.
• We found significant effects of BC after adjustment for PM2.5 or PM10–2.5.

China is one of the countries with the highest ambient particle levels in the world; however, there have been no epidemiologic studies examining the effects of fine particle (PM2.5), coarse particle (PM10–2.5) and black carbon (BC) simultaneously on morbidity outcomes. In this study, we conducted a time-series analysis to evaluate the acute effects of PM2.5, PM10–2.5, and BC on daily hospital visits in Shanghai, China. During our study period, the mean daily concentrations of PM2.5, PM10–2.5 and BC were 53.9 μg/m3, 38.4 μg/m3 and 3.9 μg/m3, respectively. We found significant associations of PM2.5, PM 10–2.5, and BC with daily hospital visits. An inter-quartile range increase of the average concentrations of the current and previous days in PM2.5, PM10–2.5 and BC was associated with a 1.88% (95% CI: 0.69% to 3.06%), a 1.30% (95% CI: 0.25% to 2.34%) and a 1.33% (95% CI: 0.34% to 2.32%) increase in emergency-room visits, respectively. For outpatient visits, the corresponding estimated changes were − 2.44% (95% CI: − 6.62% to 1.74%), 1.09% (95% CI: − 2.72% to 4.90%) and 3.34% (95% CI: 0.10% to 6.57%) respectively. The effects of BC were more robust than the effects of PM2.5 and PM10–2.5 in two-pollutant models. To our knowledge, this is the first study in China, or even in Asian developing countries, to report the effect of PM2.5, PM10–2.5, and BC simultaneously on morbidity. Our findings also suggest that BC could serve as a valuable air quality indicator that reflects the health risks of airborne particles.