ORIGINAL RESEARCH article
Front. Public Health
Sec. Environmental Health and Exposome
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1658252
This article is part of the Research TopicClimate Change, Air Pollution, and Health Inequality: Vulnerability of Marginalized PopulationsView all 20 articles
Long-term Exposure to Ambient Air Pollutant and Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study in Xinjiang, China
Provisionally accepted
Zhichuang Lian1
Mengxuan Cui2*Chao Liu2Ying Chen1Ling Zhang1Bei Wang1Nurula Yakufu1Jiming Xu2,3Linfeng Li2*Xuemei Wei1*Julaiti Kelimu1*- 1People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
- 2Yidu Cloud Technology Company Ltd., Beijing, China
- 3Tsinghua University, Beijing, China
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While short-term ambient air pollution is implicated in chronic obstructive pulmonary disease (COPD) exacerbations, evidence for chronic exposure remains limited, particularly in vulnerable subgroups. This study evaluates longitudinal associations between major air pollutants and acute exacerbations (AEs), while identifying high-risk demographic and clinical subgroups.We analyzed 660 COPD patients from People's Hospital of Xinjiang (2020-2023).Annual average concentrations of PM2.5, PM10, O3, NO2, SO2, and CO were geocoded to residential addresses. Single-pollutant logistic regression models adjusted for 12 clinical/sociodemographic confounders assessed AE risks, with robustness verified by two-pollutant sensitivity analyses. Stratified analyses examined effect modification across 10 key parameters including disease severity, smoking status, comorbidities, and sociodemographic characteristics.Long-term ozone exposure demonstrated significant AE risk elevation (OR=1.007, p = 0.046). This association was confirmed to be robust in two-pollutant models. Stratified analyses revealed amplified effects in males (OR=1.009, p=0.046), those aged over 65 years (OR=1.012, p=0.014), Han ethnicity (OR=1.019, p=0.003), those with prior-year AEs (OR=1.008, p=0.048), and non-asthmatics (OR=1.014, p=0.009).This study establishes chronic ozone exposure as an emerging environmental determinant of COPD exacerbations, with disproportionate impacts on vulnerable subgroups. Our findings demand urgent integration of ozone mitigation into national respiratory health strategies and precision public health approaches to address environmental health inequities.
Keywords: Ozone exposure, Chronic obstructive pulmonary disease (COPD), Vulnerable population, Air polluants, exacerbation
Received: 02 Jul 2025; Accepted: 08 Aug 2025.
Copyright: © 2025 Lian, Cui, Liu, Chen, Zhang, Wang, Yakufu, Xu, Li, Wei and Kelimu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Mengxuan Cui, Yidu Cloud Technology Company Ltd., Beijing, China
Linfeng Li, Yidu Cloud Technology Company Ltd., Beijing, China
Xuemei Wei, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
Julaiti Kelimu, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
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