Interrupted time series analysis using autoregressive integrated moving average (ARIMA) models: Effects of air pollution control policies on intracerebral hemorrhage mortality in Tianjin, China

Abstract

Abstract Background: This research aims to quantitively evaluate the associations between air pollution control policies in Beijing-Tianjin-Hebei region and intracerebral hemorrhage (ICH) deaths in Tianjin and provide scientific evidence for the prevention and control of ICH as well as the management of air pollution. Methods: This study used an interrupted time series analysis. Based on the data of ICH death cases in Tianjin collected by the Tianjin Center for Disease Control and Prevention, Autoregressive integrated moving average models (ARIMA) were fitted to assess the changes in ICH deaths before and after the interventions of air pollution control policies. Results: There were 63,944 ICH deaths in Tianjin from 2009 to 2020, with an overall decreasing trend in ICH mortality. The secular trend change of the intervention in June 2014 was statistically significant (p = 0.03), with 0.69 (1.30 to 0.07) fewer ICH deaths per month. The immediate change of the intervention in October 2017 was statistically significant (p = 0.04), with 25.74 (50.62 to 0.85) fewer deaths from ICH in the month. A statistically significant immediate change in the intervention in December 2017 (p = 0.04), with 26.58 (-52.02 to -1.14) fewer deaths from ICH in the month. Moreover, a statistically significant immediate change in the intervention in March 2018 (p = 0.02), the number of ICH deaths decreased by 30.40 (56.41 to 4.40) in the month. After the interventions, an estimated 5984.76 ICH deaths (8.56%) were prevented. Conclusion: The interventions of air pollution control policies during the study period were significantly associated with the reductions in ICH deaths in Tianjin. Surviving ICH patients and women were more sensitive to the protective effects of the interventions. Public health gains can be achieved by implementing interventions of air pollution control policy in cities with high levels of air pollution.