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Life sciences · Journal article
Eco-environment & Health · September 19, 2026
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Ambient fine particulate matter (PM2.5) poses acute multi-organ health risks, but evidence on its constituent-specific early-stage morbidity risks remains limited. We conducted a nationwide time-stratified case-crossover study using over 212 million daily outpatient records for 12 major diseases from 274 Chinese cities during 2013-2017. City-specific associations between PM2.5 and its major constituents and cause-specific outpatient risks were estimated using conditional logistic regression, and pooled by random-effects models. Robustness and independence of constituent-specific associations were tested using three complementary models. Attributable fractions of outpatient visit burdens were quantified. Black carbon (BC) showed the strongest independent associations at lag0 with most cause-specific outpatient visits, in contrast to lag0-1 with most cause-specific hospital admissions. Estimated increases (95% confidence intervals) in outpatient visits ranged from 1.33% (0.93-1.74) for chronic kidney disease (CKD) to 3.89% (3.30-4.49) for chronic obstructive pulmonary disease (COPD) per interquartile range increase (1.8 μg/m3) in BC at lag0, with corresponding attributable fractions ranging from 2.38% (CKD) to 6.12% (COPD). Following stringent clean air policies since 2013, annual attributable fractions of PM2.5- and BC-associated outpatient visit burdens declined substantially, with relative reductions larger for outpatient visits than for hospital admissions for both PM2.5 (40.61% vs 30.00%) and BC (28.66% vs 21.14%). In conclusion, BC is a major contributor to PM2.5-associated cause-specific outpatient risks. Prioritizing the control of key PM2.5 constituents (e.g., BC)-rather than total PM2.5 mass alone-may help mitigate acute multi-organ morbidity risks. Outpatient visits may serve as a sensitive early-warning indicator for air pollution-related morbidity risks.