{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:55:37Z","timestamp":1787165737494,"version":"build-2736575974"},"reference-count":42,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Key Research and Development Programs of China","award":["2023YFC3604701"],"award-info":[{"award-number":["2023YFC3604701"]}]},{"name":"Key Research and Development Programs of Shaanxi Province","award":["2023YBSF406"],"award-info":[{"award-number":["2023YBSF406"]}]},{"name":"Health Scientific Research Project of Shaanxi province","award":["2022E007"],"award-info":[{"award-number":["2022E007"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxics"],"abstract":"<jats:p>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\u20132017) 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.<\/jats:p>","DOI":"10.3390\/toxics14010001","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T11:03:46Z","timestamp":1766142226000},"page":"1","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Ambient Air Pollution Exposure and Acute Osteoarthritis Exacerbations: A National Case-Crossover Analysis of 8 Million Outpatient Visits in China"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6175-5701","authenticated-orcid":false,"given":"Chao","family":"Li","sequence":"first","affiliation":[{"name":"Shaanxi Provincial Center for Disease Control and Prevention, Xi\u2019an 710054, China"},{"name":"Xijing Hospital, Air Force Military Medical University, Xi\u2019an 710032, China"},{"name":"Health Science Center, Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"},{"name":"Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6672-2039","authenticated-orcid":false,"given":"Hong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Shaanxi Provincial Center for Disease Control and Prevention, Xi\u2019an 710054, China"},{"name":"School of Humanities and Social Sciences, Xi\u2019an Jiaotong University, Xi\u2019an 710049, China"},{"name":"Tuberculosis Hospital of Shaanxi Province, Xi\u2019an 710100, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhui","family":"Chang","sequence":"additional","affiliation":[{"name":"Shaanxi Provincial Center for Disease Control and Prevention, Xi\u2019an 710054, China"},{"name":"Health Science Center, Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"},{"name":"Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunlong","family":"Song","sequence":"additional","affiliation":[{"name":"Shaanxi Provincial Center for Disease Control and Prevention, Xi\u2019an 710054, China"},{"name":"Health Science Center, Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"},{"name":"Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuchen","family":"Zhang","sequence":"additional","affiliation":[{"name":"Shaanxi Provincial Center for Disease Control and Prevention, Xi\u2019an 710054, China"},{"name":"Health Science Center, Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"},{"name":"Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Chen","sequence":"additional","affiliation":[{"name":"Shaanxi Provincial Center for Disease Control and Prevention, Xi\u2019an 710054, China"},{"name":"Health Science Center, Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"},{"name":"Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi\u2019an 710061, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongwei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Shaanxi Provincial Center for Disease Control and Prevention, Xi\u2019an 710054, China"},{"name":"Health Science Center, Xi\u2019an Jiaotong University, Xi\u2019an 710061, China"},{"name":"Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi\u2019an 710061, 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