# Ambient Air Pollution Exposure and Acute Osteoarthritis Exacerbations: A National Case-Crossover Analysis of 8 Million Outpatient Visits in China

## TL;DR

This study finds that short-term exposure to a mix of air pollutants, especially NO2 and SO2, increases the risk of osteoarthritis outpatient visits in China.

## Contribution

The study provides novel evidence that complex pollution mixtures, not individual pollutants, drive osteoarthritis healthcare demand.

## Key findings

- Short-term exposure to PM2.5, PM10, NO2, SO2, O3, and CO increases osteoarthritis outpatient visits by 1.75% to 4.01%.
- NO2 and SO2 showed the strongest associations across osteoarthritis subtypes.
- Population attributable fractions ranged from 2.15% for PM2.5 to 6.41% for NO2.

## Abstract

While the inflammatory properties of ambient air pollution may exacerbate osteoarthritis (OA), evidence on the population-level impact of multi-pollutant mixtures remains limited. This study quantifies the acute effects of short-term exposure to a complex mixture of six-criteria air pollutants on OA outpatient visits. In total, 8,146,141 OA visits from two national health insurance databases across 192 Chinese cities (2013–2017) were analyzed using a two-stage, time-stratified case-crossover design, combining conditional logistic regression with random-effects meta-analysis. The results showed that an interquartile range increase in the concentrations of PM2.5, PM10, NO2, SO2, O3, and CO was associated with significant increases in OA visits of 1.75%, 2.26%, 4.01%, 3.42%, 1.98%, and 1.87%, respectively. NO2 and SO2 demonstrated the strongest associations across OA subtypes. Multi-pollutant models confirmed that the risk of OA visits increased significantly under combined pollutant exposure. Population attributable fractions ranged from 2.15% for PM2.5 to 6.41% for NO2. This large-scale analysis provides novel evidence that transient exposure to complex pollution mixtures, rather than to individual pollutants, drives OA-related healthcare demand, with gaseous pollutants (NO2/SO2) being critical components. Our findings advocate for integrative air quality management strategies targeting co-emitted pollutants to mitigate OA exacerbations.