ORIGINAL RESEARCH article
Front. Public Health
Sec. Environmental Health and Exposome
This article is part of the Research TopicExposure Assessment as a Cornerstone of Risk and Health Impact AssessmentView all 3 articles
Association Between Air Pollution and Emergency Department Visits for Unintentional Injuries in Four Cities of Shandong Province, China
Provisionally accepted
- Shandong Academy of Medical Sciences (SDAMS), Jinan, China
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Objective: To study the relationship between emergency department visits for unintentional injuries and air pollutants in four cities in Shandong Province, China (2019-2022). Methods: From 2019 to 2022, the data on air pollutants and unintentional injury emergency department visits were extracted from four cities in Shandong Province (Dezhou, Jinan, Zibo, and Heze). We used the dynamic factor model (DFM) to determine the trend of emergency visits and the distributed lag nonlinear model (DLNM) to analyze the lag effect of air pollutants on these visits. We also conducted a meta-analysis to summarize the impact estimates of air pollutants on emergency visits. Results: The dynamic factor model showed that from 2019 to 2022, the number of emergency visits for unintentional injuries in the four cities in Shandong Province was cyclical, with the highest number of emergency visits in summer every year. PM2.5, PM10, CO, SO2, NO2, and O3 exhibited single-day lag effects on emergency visits for unintentional injuries, with the highest risk observed at Lag4, Lag5, Lag4, Lag3, Lag1, and Lag3, respectively. The corresponding relative risks (RRs) and 95% confidence intervals (CIs) were 1.014(1.007, 1.021), 1.015(1.006, 1.023), 1.085(1.038, 1.134), 1.036(1.013, 1.060), 1.121(1.069, 1.175), and 1.084(1.052, 1.116). Additionally, PM2.5, PM10, CO, SO2, NO2, and O3 demonstrated cumulative lag effects, with the highest risk observed at Lag07, Lag07, Lag06, Lag05, Lag06, and Lag05, respectively. The RRs (95% CIs) were 1.058(1.033, 1.083), 1.037(1.003, 1.072), 1.468(1.244, 1.733), 1.099(1.039, 1.161), 1.221(1.097, 1.359), and 1.227(1.138, 1.323). Conclusion: Emergency visits for unintentional injuries in the four cities exhibited an annual cyclical pattern, with the peak occurring in summer. Exposure to high concentrations of air pollutants increased the risk of unintentional injuries, with distinct effects observed across different pollutants, each exhibiting specific single-day and cumulative lag effects.
Keywords: unintentional injuries, Air Pollutants, Dynamic factor model, Distributed lagnonlinear model, Emergency department visits
Received: 22 Sep 2025; Accepted: 21 Nov 2025.
Copyright: © 2025 Dong, Liu, He, Li, Ding, Yang and Liu. 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: Xuena Liu, xnliu@sdfmu.edu.cn
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