The spatial-temporal effect of air pollution on GP visits and hospital admissions by ethnicity in the United Kingdom: An individual-level analysis

Abstract

Background: Air pollution has been associated with increased rates of hospital admissions and general-practitioner (GP) visits. Yet, more research is to be done to reveal the spatial-temporal dimension of this association and whether ethnic minorities experience greater effects from exposure to air pollution compared to the rest of population. This study investigates the spatial-temporal effect of air pollution on GP visits and hospital admissions by ethnicity in the United-Kingdom (UK). Methods: We used individual-level longitudinal data from the “UK Household Longitudinal Study” including 46,442 adult individuals who provided 140,466 responses across five years (2015-2019). This data was linked to yearly concentrations of NO2, SO2, and particulate-matter (PM10, PM2.5) pollution using the Lower-Super-Output-Area (LSOA) of residence for each individual. We distinguished between spatial (between areas) and temporal (across time within each area) effects of air pollution on GP visits and hospital admissions and we used multilevel mixed-effects ordered logistic models for analysis. Results: Results showed higher odds of outpatient hospital admissions with increasing concentrations of NO2 (OR=1.009; 95%CI=1.006-1.013), SO2 (OR=1.063; 95%CI=1.030-1.097), PM10 (OR=1.013; 95%CI=1.006-1.021), and PM2.5 (OR=1.022; 95%CI=1.012-1.032) pollutants. Higher odds of GP visits were also observed with increasing concentrations of NO2 (OR=1.011; 95%CI=1.007-1.015) and SO2 (OR=1.123; 95%CI=1.087-1.160) pollutants. Decomposing air pollution into between (spatial: across LSOAs) and within (temporal: across years within each LSOA) effects, showed significant between effects for air pollution on GP visits and hospital admissions, but not within effects. We observed no differences between ethnic minorities and British-white for the association between air pollution and hospital admissions and GP visits. Conclusion: Using individual-level longitudinal data, our study supports the presence of a spatial-temporal association between air pollution and hospital admissions and GP visits. However, ethnic minorities do not seem to experience greater health-related effects from exposure to air pollution compared to the rest of population.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

The work presented in this paper was funded by the Royal Society of Edinburgh (RSE) Saltire Early Career Fellowships grant (RSE Grant Reference Number: 1846).

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This paper was granted ethical approval on the 14th of May 2020 by the author’s affiliated institution (School of Geography and Sustainable Development Ethics Committee, acting on behalf of the University Teaching and Research Ethics Committee (UTREC) at the University of St Andrews). The paper uses secondary adult (age 16+) fully anonymised data from the “Understanding Society: The UK Household Longitudinal Study (UKHLS)” and authors did not have access to potentially identifying information thus, obtaining participants’ informed consent is not applicable and was waved by the authors’ institution ethics committee. The University of Essex responsible for the UKHLS data collection and management has already obtained written informed consent from all the study participants (33). Requesting consent for health record linkage was approved at Wave 1 by the National Research Ethics Service (NRES) Oxfordshire REC A (08/H0604/124), and at Wave 4 by NRES Southampton REC A (11/SC/0274). Approval for the collection of biosocial data by trained nurses in Waves 2 and 3 of the main survey was obtained from the National Research Ethics Service (Understanding Society - UK Household Longitudinal Study: A Biosocial Component, Oxfordshire A REC, Reference: 10/H0604/2).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Data Availability

We cannot make the data underlying our analysis publicly available due to ethical and legal restrictions. We are using the “Understanding Society: The UK Household Longitudinal Study (UKHLS)” dataset which is an initiative funded by the Economic and Social Research Council and various Government Departments, with scientific leadership by the Institute for Social and Economic Research, University of Essex, and survey delivery by NatCen Social Research and Kantar Public. These data are protected by a copyright license and strictly distributed by the UK Data Service which is the largest digital repository for quantitative and qualitative social science and humanities research data in the UK. Therefore, data underlying our analysis can only be accessed through the UK Data Service for authorized researchers from the following URL: https://beta.ukdataservice.ac.uk/datacatalogue/series/series?id=2000053

https://beta.ukdataservice.ac.uk/datacatalogue/series/series?id=2000053

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