Impact of Air Pollution and Trans-Boundary Haze on Nation-Wide Emergency Department Visits and Hospital Admissions in Singapore

Sze Ling Chan, Andrew FW Ho, Huicong Ding, Nan Liu, Arul Earnest, Mariko S. Koh, Jolyn ST Chuah, Zheng Yi Lau, Kelvin Bryan Tan, Huili Zheng, Geoffrey G. Morgan, Marcus Eng Ong

Research output: Contribution to journalArticleResearchpeer-review

4 Citations (Scopus)


INTRODUCTION: Air pollution is associated with adverse health outcomes. However, its impact on emergency health services is less well understood. We investigated the impact of air pollution on nation-wide emergency department (ED) visits and hospital admissions to public hospitals in Singapore. MATERIALS AND METHODS: Anonymised administrative and clinical data of all ED visits to public hospitals in Singapore from January 2010 to December 2015 were retrieved and analysed. Primary and secondary outcomes were defined as ED visits and hospital admissions, respectively. Conditional Poisson regression was used to model the effect of Pollutant Standards Index (PSI) on each outcome. Both outcomes were stratified according to subgroups defined a priori based on age, diagnosis, gender, patient acuity and time of day. RESULTS: There were 5,791,945 ED visits, of which 1,552,187 resulted in hospital admissions. No significant association between PSI and total ED visits (Relative risk [RR], 1.002; 99.2% confidence interval [CI], 0.995-1.008; P = 0.509) or hospital admissions (RR, 1.005; 99.2% CI, 0.996-1.014; P = 0.112) was found. However, for every 30-unit increase in PSI, significant increases in ED visits (RR, 1.023; 99.2% CI, 1.011-1.036; P = 1.24 × 10-6 ) and hospital admissions (RR, 1.027; 99.2% CI, 1.010-1.043; P = 2.02 × 10-5 ) for respiratory conditions were found. CONCLUSION: Increased PSI was not associated with increase in total ED visits and hospital admissions, but was associated with increased ED visits and hospital admissions for respiratory conditions in Singapore.

Original languageEnglish
Pages (from-to)78-87
Number of pages10
JournalAnnals of the Academy of Medicine Singapore
Issue number2
Publication statusPublished - 2 Feb 2020

Cite this