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Extensive researches have linked air pollutants with cardiovascular disease (CVD) and respiratory diseases (RD), however, there is limited evidence on causal effects of air pollutants on morbidity of CVD or RD with comorbidities, particularly diabetes mellitus in elder patients. We included hospital admissions for CVD or RD among elder (≥65 years) diabetic patients between 2014 and 2019 in Beijing. A time‐stratified case‐crossover design based on negative‐control exposure was used to assess causal associations of short‐term exposure to air pollutants with CVD and RD among diabetic patients with the maximum lag of 7 days. A random forest regression model was used to calculate the contribution magnitude of air pollutants. A total of 493,046 hospital admissions were recorded. Per 10 μg/m3 uptick in PM1, PM2.5, PM10, SO2, NO2, O3, and 1 mg/m3 in CO was associated with 0.29 (0.05, 0.53), 0.14 (0.02, 0.26), 0.06 (0.00, 0.12), 0.36 (0.01, 0.70), 0.21 (0.02, 0.40), −0.08 (−0.25, 0.09), and 4.59 (0.56, 8.61) causal effect estimator for admission of CVD among diabetic patients, corresponding to 0.12 (0.05, 0.18), 0.09 (0.05, 0.13), 0.05, 0.23 (0.06, 0.41), 0.10 (0.02, 0.19), −0.04 (−0.06, −0.01), and 3.91(1.81, 6.01) causal effect estimator for RD among diabetic patients. The effect of gaseous pollutants was higher than particulate pollutants in random forest model. Short‐term exposure to air pollution was causally associated with increased admission of CVD and RD among elder diabetic patients. Gaseous pollutants had a greater contribution to CVD and RD among elder diabetic patients. Plain Language Summary: Although researches for cardiovascular disease (CVD) and respiratory diseases (RD) with air pollutants are widely reported, there is little evidence for causal associations of air pollution with CVD combined with diabetes mellitus (CVD‐DM) and RD combined with diabetes mellitus (RD‐DM) in elder patients. We included elder hospital admissions (aged ≥65 years) on comorbid CVD‐DM and RD‐DM patients between 2014 and 2019 in Beijing, China, to assess associations and causal inferences between air pollutants with CVD‐DM and RD‐DM. Random forest regression model was used to calculate the contribution magnitude of air pollutants. We found that exposure to air pollution increased admissions of CVD‐DM and RD‐DM in the elderly. Gaseous pollutants had a greater contribution to CVD‐DM and RD‐DM. The finding may lead to policy changes to reduce air pollution concentration, particularly gaseous pollutants to decrease hospital admissions. Key Points: Investigated causal associations of air pollutants on comorbid elderly populationA stable and accurate effect of air pollution was gained base on large sample sizesThe effects of gaseous pollutants are stronger than those of PM for the elderly [ABSTRACT FROM AUTHOR]

Extensive studies have linked PM 2.5 and PM 10 with respiratory diseases (RD). However, few is known about causal association between PM 1 and morbidity of RD. We aimed to assess the causal effects of PM 1 on cause-specific RD. Hospital admission data were obtained for RD during 2014 and 2019 in Beijing, China. Negative control exposure and extreme gradient boosting with SHapley Additive exPlanation was used to explore the causality and contribution between PM 1 and RD. Stratified analysis by gender, age, and season was conducted. A total of 1,183,591 admissions for RD were recorded. Per interquartile range (28 μg/m3) uptick in concentration of PM 1 corresponded to a 3.08% [95% confidence interval (CI): 1.66%–4.52%] increment in morbidity of total RD. And that was 4.47% (95% CI: 2.46%–6.52%) and 0.15% (95% CI: 1.44%-1.78%), for COPD and asthma, respectively. Significantly positive causal associations were observed for PM 1 with total RD and COPD. Females and the elderly had higher effects on total RD, COPD, and asthma only in the warm months (Z = 3.03, P = 0.002; Z = 4.01, P < 0.001; Z = 3.92, P < 0.001; Z = 2.11, P = 0.035; Z = 2.44, P = 0.015). Contribution of PM 1 ranked first, second and second for total RD, COPD, and asthma among air pollutants. PM 1 was causally associated with increased morbidity of total RD and COPD, but not causally associated with asthma. Females and the elderly were more vulnerable to PM 1 -associated effects on RD. • Exposure to PM 1 was causally associated with increased morbidity of COPD. • Females and the elderly were more vulnerable to PM 1 -associated effects. • PM 1 contributed higher to respiratory diseases, especially compared to other PM. [ABSTRACT FROM AUTHOR]

[Display omitted] • The first comprehensive description of the relationship between air pollution and hospital admissions, length of stay, and costs for patients with cardiovascular disease with comorbid diabetes mellites. • First application of WHO 2021 air quality standards to a real-world study. • PM 2.5 and PM 10 are positively associated with hospital admissions, hospital cost and length of hospital stay for patients with cardiovascular disease with comorbid diabetes mellites. • Policy changes to reduce air pollutants exposure may reduce cardiovascular disease with comorbid diabetes mellites admissions and substantial savings in health care spending and hospital stay. Evidence on the effects of the air pollutants on the hospital admissions, hospital cost and length of stay (LOS) among patients with comorbidities remains limited in China, particularly for patients with cardiovascular diseases and comorbid diabetes mellitus (CVD-DM). We collected daily data on CVD-DM patients from 242 hospitals in Beijing between 2014 and 2019. Generalized additive model was employed to quantify the associations between admissions, LOS, and hospital cost for CVD-DM patients and air pollutants. We further evaluated the attributable risk posed by air pollutants to CVD-DM patients, using both Chinese and WHO air quality guidelines as reference. Per 10 ug/m3 increase of particles with an aerodynamic diameter < 2.5 μm (PM 2.5), particles with an aerodynamic diameter < 10 μm (PM 10), sulfur dioxide (SO 2), nitrogen dioxide (NO 2), carbonic oxide (CO) and ozone (O 3) corresponded to a 0.64% (95% CI : 0.57 to 0.71), 0.52% (95% CI : 0.46 to 0.57), 0.93% (95% CI : 0.67 to 1.20), 0.98% (95% CI : 0.81 to 1.16), 1.66% (95% CI : 1.18 to 2.14) and 0.53% (95% CI : 0.45 to 0.61) increment for CVD-DM patients' admissions. Among the six pollutants, particulate pollutants (PM 2.5 and PM 10) in most lag days exhibited adverse effects on LOS and hospital cost. For every 10 ug/m3 increase in PM 2.5 and PM 10 , the absolute increase with LOS will increase 62.08 days (95% CI : 28.93 to 95.23) and 51.77 days (95% CI :22.88 to 80.66), respectively. The absolute increase with hospital cost will increase 105.04 Chinese Yuan (CNY) (95% CI : 49.27 to 160.81) and 81.76 CNY (95% CI : 42.01 to 121.51) in PM 2.5 and PM 10 , respectively. Given WHO 2021 air quality guideline as the reference, PM 2.5 had the maximum attributable fraction of 3.34% (95% CI : 2.94% to 3.75%), corresponding to an avoidable of 65,845 (95% CI : 57,953 to 73,812) patients with CVD-DM. PM 2.5 and PM 10 are positively associated with hospital admissions, hospital cost and LOS for patients with CVD-DM. Policy changes to reduce air pollutants exposure may reduce CVD-DM admissions and substantial savings in health care spending and LOS. [ABSTRACT FROM AUTHOR]