Association between ambient BTEX mixture and neurological hospitalizations: A multicity time-series study in Taiwan

Background: Benzene, toluene, ethylbenzene, and xylenes, collectively known as BTEX, are hazardous chemical mixtures, and their neurological health effects have not been thoroughly evaluated. We examined the association between BTEX exposure and neurological hospital admissions. Methods: This was a multicity time-series study conducted in five major Taiwanese cities. Daily hospital admission records for diseases of the nervous system from January 1, 2016, to December 31, 2017, were collected from the National Health Insurance Research Database. Ambient BTEX and criteria pollutant concentrations and weather factors were collected from Photochemical Assessment Monitoring Stations. We applied a Poisson generalized additive model (GAM) and weighted quantile sum regression to calculate city-specific effect estimates for BTEX and conducted a random-effects meta-analysis to pool estimates. Results: We recorded 68 neurological hospitalizations per day during the study period. The daily mean BTEX mixture concentrations were 22.5 µg/m³, ranging from 18.3 µg/m³ in Kaohsiung to 27.0 µg/m³ in Taichung, and toluene (13.6 µg/m³) and xylene (5.8 µg/m³) were the dominant chemicals. Neurological hospitalizations increased by an average of 1.6 % (95 % CI: 0.6–2.6 %) for every interquartile range (15.8 µg/m³) increase in BTEX at lag 0 estimated using a GAM model. A quartile increase in the weighted sum of BTEX exposure was associated with a 1.7 % (95 % CI: 0.6–2.8 %) increase in daily neurological hospitalizations. Conclusion: We found consistent acute adverse effects of BTEX on neurological hospitalizations in Taiwan, with toluene and xylene as the dominant chemicals. These findings aid the development of more targeted public health interventions.