Short-Term Air Pollution and Fracture Admissions in Beijing

Ning Wang^1,2Rongrong Xu^1,3Feng Luo¹Renwei Cao^4,5ZhongYu Wang William^4,5Shuo Chen^4,5贤 赵^4,5Shuai Lu^4,5Yejun ZHA^4,5Yongjie Wei^1,2,3Minjuan Li^4,5*Qiujin Xu^1,2*

• ¹Chinese Research Academy of Environmental Sciences, Beijing, China
• ²Nanjing Medical University, Nanjing, China
• ³Tongji University College of Environmental Science and Engineering, Shanghai, China
• ⁴Beijing Research Institute of Traumatology and Orthopaedics, Beijing, China
• ⁵Beijing Jishuitan Hospital Affiliated to Capital Medical University, Beijing, China

Limited evidence exists on the links between ambient air pollution exposure and fractures.This study aimed to investigate the association between short-term air pollutants exposure and hospital admissions for fracture. We collected data on six criteria air pollutants and daily fracture admission data from Beijing Jishuitan Hospital between June 2021 to May 2023. Generalized additive models (GAM) with quasi-Poisson regression were applied to quantify the effects of air pollutants on admissions. We identified 16,532 records on fracture admission. At the lag03 day, a 1μg/m³ increase in PM2.5 and NO2 was significantly associated with a 0.12% (95% CI: 0.01%, 0.23%) and 0.26% (95% CI: 0.01%, 0.51%) increase in fracture admissions, respectively. The exposure-response curve for PM2.5 exhibited a slight decline at lower concentrations, which may reflect a model artifact due to sparse data in this range, followed by a sharp rise as concentrations increased. Stratified analyses revealed stronger associations were observed in the younger population and a significant association between PM2.5 exposure and fracture risk in males. Additionally, PM2.5 was significantly associated with admissions for fragility fractures. This study suggests that short-term exposure to air pollution may increase the risk of fracture-related hospitalizations, with observed cumulative lag effects. elevates fracture risk (Hernlund et al., 2013, Li et al., 2025). The Global Burden of Disease (GBD) Study highlights a marked rise in absolute fracture incidence between 1990 and 2019, with elderly populations demonstrating disproportionately higher vulnerability(2021). Beyond individual health impacts, fractures impose multifaceted societal burdens, including work absenteeism, productivity loss, disability, diminished quality of life, and escalating healthcare costs (Pike et al., 2010, Borgström et al., 2020, Tatangelo et al., 2019). For instance, hip fractures often result in severe functional decline requiring prolonged rehabilitation and custodial care (Amarilla-Donoso et al., 2020). The 2019 GBD assessment further underscores fractures as a critical component of global health loss metrics(2020). While fracture etiology remains multifactorial, emerging evidence suggests air pollution may exacerbate fracture risk through bone density reduction and osteoporosis progression (Prada et al., 2023).Air pollution constitutes a major global environment health threat(Carvalho, 2021), exemplified by China's 2017 estimates of 124,000 air pollution-attributable deaths (95% UI: