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Epidemiological characteristics of fractures of spine, hip, proximal humerus and forearm during the haze epidemic period

  • Author Footnotes
    1 These authors contributed equally to this work
    Hongzhi Lv
    Footnotes
    1 These authors contributed equally to this work
    Affiliations
    Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051 China
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  • Author Footnotes
    1 These authors contributed equally to this work
    Yaxiong Nie
    Footnotes
    1 These authors contributed equally to this work
    Affiliations
    Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, No.361 Zhongshan Road, Shijiazhuang 050017 China
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  • Author Footnotes
    1 These authors contributed equally to this work
    Xue Wang
    Footnotes
    1 These authors contributed equally to this work
    Affiliations
    Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, No.361 Zhongshan Road, Shijiazhuang 050017 China
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  • Wenjing Li
    Affiliations
    Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051 China
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  • Yan Wang
    Affiliations
    Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051 China
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  • Zixuan Li
    Affiliations
    Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, No.361 Zhongshan Road, Shijiazhuang 050017 China
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  • Xiaolin Zhang
    Correspondence
    Corresponding author at: 361 Zhongshan East Road, Shijiazhuang, 050017 China.
    Affiliations
    Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, No.361 Zhongshan Road, Shijiazhuang 050017 China
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  • Wei Chen
    Correspondence
    Corresponding author at: 139 Ziqiang Road, Shijiazhuang, 050051 China.
    Affiliations
    Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051 China
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  • Author Footnotes
    1 These authors contributed equally to this work

      Abstract

      Background

      Air pollutants have an impact on the occurrence of spine fractures, hip fractures, proximal humerus fractures and forearm fractures. This study aimed at evaluating the short-term impact of particulate matter with aerodynamic diameters of less than 2.5 µm (PM2.5) on the occurrence of those fractures in Shijiazhuang, Hebei, China.

      Methods

      The daily meteorological, pollution, and fracture data of Shijiazhuang from 2014 to 2019 were collected. Distribution characteristics of fractures were described using descriptive epidemiological methods. The distributed lag nonlinear model (DLNM) was used to reveal the description of those fractures in the exposed and lag dimensions at the same time. Based on gender and age (<18 years old, 18–69 years old and >69 years old), stratified analysis was performed. Sensitivity analysis was performed to ascertain the robustness of the results.

      Results

      Between 2014 and 2019, fracture incidences in Shijiazhuang exhibited an overall increasing trend, with an obvious seasonality. PM2.5 was positively related to daily fracture cases and the effects were more obvious in women, adolescents and people of working age. When PM2.5 concentrations increased by one interquartile range (IQR) (70 μg/m3), RR exhibited a unimodal distribution. Its peak appeared on the 16th day of lag (RR=1.005987, 95% CI:1.002472,1.009652), and the RRs were also statistically significant from the 10th to 22nd day of lag. Similarly, cumulative effects of each increase in the concentration of PM2.5 IQR also showed a unimodal distribution. The largest cumulative effect occurred on the 28th day of lag (RR=1.084457, 95% CI:1.012207,1.161864), and the cumulative RRs were also statistically significant from the 19th day to 30nd days. In the dose-response relationship, as PM2.5 concentrations increased, RR increased.

      Conclusion

      Year by year, fractures in Shijiazhuang City exhibited an increasing trend. PM2.5 can affect the occurrence of those fractures. The impact on women, adolescents and people of working age is even greater. The supervision of PM2.5 should be strengthened while large-scale emissions should be limited.

      Keywords

      Abbreviations:

      PM2.5 (particulate matter with aerodynamic diameters of less than 2.5 µm), IQR (interquartile range), DLNM (distributed lag nonlinear model), IOF (International Osteoporosis Foundation), EFPIA (European Federation of Pharmaceutical Industry Associations), PM (Particulate matter), 25OHD (25-hydroxyvitamin D)
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