The unique characteristics of air pollution in high-altitude regions may significantly influence the transmission and incidence of influenza. However, current research on this phenomenon is limited, and further investigation is urgently needed.

This study collected influenza outpatient data from Qinghai Province between January 1, 2016, and December 31, 2021. We employed a time-stratified case-crossover design combined with conditional Poisson regression models to quantitatively analyze the relationship between air pollutants (PM2.5, SO2, NO2) and influenza incidence and explored the moderating role of temperature in this relationship. Additionally, stratified analyses were conducted to identify potential vulnerable populations.

The study results indicated that exposure to PM2.5, SO2, and NO2 was positively associated with the risk of influenza incidence. For every 10 µg/m³ increase in the concentration of PM2.5, SO2, and NO2, the percentage change in relative risk (RR) of influenza incidence was 0.35% (95% CI: 0.02%, 0.68%), 2.24% (95% CI: 1.42%, 3.06%), and 1.91% (95% CI: 1.16%, 2.67%), respectively. Under low-temperature conditions, the impact of pollutants other than O3 on influenza incidence was particularly pronounced. Children, the elderly, and individuals living at altitudes of 3000–3500 m were more sensitive to these pollutants.

This study revealed a close link between air pollution and influenza in high-altitude regions, with greater health risks under low-temperature conditions. The findings underscore the necessity of strengthening air quality monitoring and raising public awareness of environmental health.