Cardiorespiratory health effects of particulate ambient air pollution exposure in low-income and middle-income countries: a systematic review and meta-analysis

The association between high particulate matter pollution and daily cause-specific hospital admissions: a time-series study in Yichang, China

Particulate matter (PM) air pollution is one of the major causes of morbidity and mortality in China. In this study, we estimated the short-term effects of PM on cause-specific hospitalization in Yichang, China. Daily data for PM level, meteorological factors, and hospital admissions (total hospitalization counts = 391,960) in Yichang between 2015 and 2017 were collected. We conducted a time-series study and applied a generalized additive model to evaluate the association between every 10 μg/m³ increment of PM and percent increase of hospitalization. We found positive and statistically significant associations between PM and hospital admissions for multiple outcomes, including all-cause, total respiratory, total cardiovascular diseases, and disease subcategories (hypertensive disease, coronary heart disease, stroke and the stroke subtype, chronic obstructive pulmonary disease, and lower respiratory infection). Each 10 μg/m³ increase in PM_2.5 at Lag01 (a moving average of Lag0 to Lag1), was significantly associated with an increase of 1.31% (95% CI: 0.79%, 1.83%), 1.12% (95% CI: 0.40%, 1.84%), and 1.14% (95% CI: 0.53%, 1.75%) in hospitalizations for all-cause, CVD, and respiratory, respectively. The association for PM₁₀ with all-cause, CVD, and respiratory admissions was similar but weaker than PM_2.5. The effect on admissions persisted for up to 7 days, and peaked at Lag01. The associations between PM and all-cause hospitalizations were stronger among older individuals and in cold seasons. It is therefore important to continue implementation of emission abatement and other effective measures in Yichang and other cities in China.

Association between ambient and household air pollution with carotid intima-media thickness in peri-urban South India: CHAI-Project

BACKGROUND

Evidence linking ambient air pollution with atherosclerosis is lacking from low- and middle-income countries. Additionally, evidence regarding the association between household air pollution and atherosclerosis is limited. We evaluated the association between ambient fine particulate matter [particulate matter with an aerodynamic diameter of ≤2.5 µm (PM2.5)] and biomass fuel use on carotid intima-media thickness (CIMT), a surrogate of atherosclerosis, in India.

METHODS

We analysed the third follow-up of the Andhra Pradesh Children and Parent Study cohort (2010-2012), which recruited participants from 28 peri-urban villages. Our primary outcome was mean CIMT, measured using a standardized protocol. We estimated annual average PM2.5 outdoors at residence using land-use regression. Biomass cooking fuel was self-reported. We fitted a within-between linear-mixed model adjusting for potential confounders.

RESULTS

Among 3278 participants (48% women, mean age 38 years), mean PM2.5 was 32.7 [range 24.4-38.2] µg/m3, and 60% used biomass. After confounder adjustment, we observed positive associations between within-village variation in PM2.5 and CIMT in all participants [1.79%, 95% confidence interval (CI), -0.31 to 3.90 per 1  µg/m3 of PM2.5] and in men (2.98%, 95% CI, 0.23-5.72, per 1  µg/m3 of PM2.5). Use of biomass cooking fuel was associated with CIMT in all participants (1.60%, 95% CI, -0.46 to 3.65), especially in women with an unvented stove (6.14%, 95% CI, 1.40-10.89). The point-estimate for the PM2.5 association was larger in sub-groups with higher cardiometabolic risk profile.

CONCLUSIONS

Ambient and household air pollution were positively associated with CIMT in a peri-urban population of India, although with limited precision for some estimates. We observed differences in the association between ambient and household air pollution and CIMT by gender.

The Impact of the Media and Environmental Pollution on the Economy and Health Using a Modified Meta 2-Stage EBM Malmquist Model

China's pursuit of economic growth, rapid industrialization, and urbanization over the past few decades has resulted in high energy consumption, which in turn has caused serious environmental pollution problems, such as CO₂ and PM_2.5 emissions, the long-term exposure to which can seriously affect resident health. To resolve these air pollution problems, the Chinese government has put in place several policies to reduce air and environmental pollution. Past studies on energy and environmental efficiency have been mostly static, have ignored the dynamic changes over time and regional differences, and have rarely considered human health factors. Therefore, this study employed a modified meta 2-stage Epsilon-Based Measure (EBM) Malmquist model to explore the relationships between the economy, energy, the environment, health and media, and the regional differences in 31 Chinese cities from 2014 to 2016. It was found that (1) Haikou and Lhasa's efficiencies were 1 and were the best in all 3 years, and Shijiazhuang, Jinan and Shenyang's were the most improved; (2) there was a gap between the eastern, central and western technological frontiers, with Chengdu, Hohhot, Chongqing, and Nanchang having technological gap ratios below 0.70 in the western and central Chinese regions, and Haikou, Guangzhou, and Shanghai in eastern China having technological gap ratios above 0.90 in all 3 years; and (3) the variations in the health treatment stage were greater than in the production stage, indicating that technological changes and efficiency improvements in the health treatment stages in each city were not stable.

Association between ambient fine particulate pollution and hospital admissions for cause specific cardiovascular disease: time series study in 184 major Chinese cities

OBJECTIVE

To estimate the risks of daily hospital admissions for cause specific major cardiovascular diseases associated with short term exposure to ambient fine particulate matter (aerodynamic diameter ≤2.5 μm; PM_2.5) pollution in China.

DESIGN

National time series study.

SETTING

184 major cities in China.

POPULATION

8 834 533 hospital admissions for cardiovascular causes in 184 Chinese cities recorded by the national database of Urban Employee Basic Medical Insurance from 1 January 2014 to 31 December 2017.

MAIN OUTCOME MEASURES

Daily counts of city specific hospital admissions for primary diagnoses of ischaemic heart disease, heart failure, heart rhythm disturbances, ischaemic stroke, and haemorrhagic stroke among different demographic groups were used to estimate the associations between PM_2.5 and morbidity. An overdispersed generalised additive model was used to estimate city specific associations between PM_2.5 and cardiovascular admissions, and random effects meta-analysis used to combine the city specific estimates.

RESULTS

Over the study period, a mean of 47 hospital admissions per day (standard deviation 74) occurred for cardiovascular disease, 26 (53) for ischaemic heart disease, one (five) for heart failure, two (four) for heart rhythm disturbances, 14 (28) for ischaemic stroke, and two (four) for haemorrhagic stroke. At the national average level, an increase of 10 μg/m³ in PM_2.5 was associated with a 0.26% (95% confidence interval 0.17% to 0.35%) increase in hospital admissions on the same day for cardiovascular disease, 0.31% (0.22% to 0.40%) for ischaemic heart disease, 0.27% (0.04% to 0.51%) for heart failure, 0.29% (0.12% to 0.46%) for heart rhythm disturbances, and 0.29% (0.18% to 0.40%) for ischaemic stroke, but not with haemorrhagic stroke (-0.02% (-0.23% to 0.19%)). The national average association of PM_2.5 with cardiovascular disease was slightly non-linear, with a sharp slope at PM_2.5 levels below 50 μg/m³, a moderate slope at 50-250 μg/m³, and a plateau at concentrations higher than 250 μg/m³. Compared with days with PM_2.5 up to 15 μg/m³, days with PM_2.5 of 15-25, 25-35, 35-75, and 75 μg/m³ or more were significantly associated with increases in cardiovascular admissions of 1.1% (0 to 2.2%), 1.9% (0.6% to 3.2%), 2.6% (1.3% to 3.9%), and 3.8% (2.1% to 5.5%), respectively.According to projections, achieving the Chinese grade 2 (35 μg/m³), Chinese grade 1 (15 μg/m³), and World Health Organization (10 μg/m³) regulatory limits for annual mean PM_2.5 concentrations would reduce the annual number of admissions for cardiovascular disease in China. Assuming causality, which should be done with caution, this reduction would translate into an estimated 36 448 (95% confidence interval 24 441 to 48 471), 85 270 (57 129 to 113 494), and 97 516 (65 320 to 129 820), respectively.

CONCLUSIONS

These data suggest that in China, short term exposure to PM_2.5 is associated with increased hospital admissions for all major cardiovascular diseases except for haemorrhagic stroke, even for exposure levels not exceeding the current regulatory limits.

Impact of Media Reports and Environmental Pollution on Health and Health Expenditure Efficiency

Over the past few decades, China’s rapid economic, energy, and industrial developments have caused serious environmental damage. However, as there are large resource, energy use, economic, and environmental damage differences across Chinese regions, the Chinese government is seeking to reduce city pollution across the country. Most previous analyses have only looked at these issues on a single level; for example, the impact of environmental pollution on health, or energy and environmental efficiency analyses, but there have been few studies that have conducted overall analyses. Further, many of the methods that have been used in previous research have employed one-stage radial or non-radial analyses without considering regional differences. Therefore, this paper developed a meta undesirable two-stage EBM DEA model to analyze the energy, environment, health, and media communication efficiencies in 31 Chinese cities, from which it was found that the productivity efficiency in most cities was better than the health treatment efficiencies, the GDP and fixed asset efficiency improvements were small, the air quality index (AQI) and CO₂ efficiencies varied widely between the cities, media report and governance inputs were generally inefficient, the birth rate efficiencies were better than the respiratory disease efficiencies, and the technical gap was best in Guangzhou, Shanghai, and Lhasa. Also, it found that high-income cities have a higher technology gap than upper middle–income cities, and media reports efficiency have a high correlation with respiratory diseases and CO₂.

Novel evidence for a greater burden of ambient air pollution on cardiovascular disease

Ambient and household air pollution is a major health problem worldwide, contributing annually to approximately seven million of all-cause avoidable deaths, shorter life expectancy, and significant direct and indirect costs for the community. Air pollution is a complex mixture of gaseous and particulate materials that vary depending on their source and physicochemical features. Each material has detrimental effects on human health, but a number of experimental and clinical studies have shown a strong impact for fine particulate matter (PM_2.5). In particular, there is more and more evidence that PM_2.5 exerts adverse effects particularly on the cardiovascular system, contributing substantially (mainly through mechanisms of atherosclerosis, thrombosis and inflammation) to coronary artery and cerebrovascular disease, but also to heart failure, hypertension, diabetes and cardiac arrhythmias. In this review, we summarize knowledge on the mechanisms and magnitude of the cardiovascular adverse effects of short-and long-term exposure to ambient air pollution, particularly for the PM_2.5 size fraction. We also emphasize that very recent data indicate that the global mortality and morbidity burden of cardiovascular disease associated with this air pollutant is dramatically greater than what has been thought up to now.

Characteristics of cohort studies of long-term exposure to PM2.5: a systematic review

This study systematically reviewed all the cohort studies investigating the relationship between long-term exposure to PM_2.5 and any health outcome until February 2018. We searched ISI Web of Knowledge, Pubmed, and Scopus databases for peer-reviewed journal research articles published in English. We only extracted the results of the single-pollutant main analysis of each study, excluding the effect modifications and sensitivity analyses. Out of the initial 9523 articles, 203 articles were ultimately included for analysis. Based on the different characteristics of studies such as study design, outcome, exposure assessment method, and statistical model, we calculated the number and relative frequency of analyses with statistically significant and insignificant results. Most of the studies were prospective (84.8%), assessed both genders (66.5%), and focused on a specific age range (86.8%). Most of the articles (78.1%) had used modeling techniques for exposure assessment of cohorts' participants. Among the total of 317 health outcomes, the most investigated outcomes include mortality due to cardiovascular disease (6.19%), all causes (5.48%), lung cancer (4.00%), ischemic heart disease (3.50%), and non-accidental causes (3.50%). The percentage of analyses with statistically significant results were higher among studies that used prospective design, mortality as the outcome, fixed stations as exposure assessment method, hazard ratio as risk measure, and no covariate adjustment. We can somehow conclude that the choice of right characteristics for cohort studies can make a difference in their results.

Cardiorespiratory effects of heatwaves: A systematic review and meta-analysis of global epidemiological evidence

BACKGROUND

Heatwaves affect human health and global heatwave-related disease burden will continue to rise as climate change proceeds, but the effects of heatwaves on cardiovascular and respiratory diseases have not yet been investigated globally and nationally.

OBJECTIVES

This systematic review and meta-analysis aim to quantify heatwave effects on four major health outcomes: cardiovascular and respiratory morbidity and mortality.

METHODS

We searched PubMed, Scopus, Embase, and Web of Science for relevant studies from database inception to November 2018. Categories of morbidity included hospital admissions, emergency department visits, and ambulance attendances/call-outs. A random-effects meta-analysis model was used to pool previous estimates of heatwave effects on mortality and morbidity due to cardiovascular and respiratory diseases. Subgroup analyses by gender, age, and disease cause were conducted. Sensitivity analyses were performed by the categories of morbidity, heatwave definitions, study design, and using a leave-one-out cross validation approach. This study is registered with PROSPERO (number: CRD42018101964).

RESULTS

We identified 54 studies conducted in 20 countries. In total, there were significant associations between heatwaves and cardiovascular mortality (risk estimates (RE): 1.149, 95% confidence interval (CI): 1.090, 1.210) and respiratory mortality (RE: 1.183, 95%CI: 1.092, 1.282), but the magnitude of these associations varied across countries and studies. Heatwaves appeared to be marginally associated with cardiovascular and respiratory morbidities (RE: 0.999, 95%CI: 0.996, 1.002, p-value = 0.61 for cardiovascular morbidity; RE: 1.043, 95%CI: 0.995, 1.093; p-value = 0.08 for respiratory morbidity). For mortality, significant associations were observed for the elderly, ischemic heart disease, stroke, heart failure, and chronic obstructive pulmonary disease. Sensitivity analyses suggested that these findings were robust.

CONCLUSION

Mortality of cardiovascular and respiratory diseases appeared to be more vulnerable to heatwaves in comparison to morbidity. Considering high heterogeneity detected between studies and limited investigations into subpopulations, more research are required to provide a clearer picture of how heatwaves affect cardiovascular and respiratory diseases in different settings.

Characterising low-cost sensors in highly portable platforms to quantify personal exposure in diverse environments

The inaccurate quantification of personal exposure to air pollution introduces error and bias in health estimations, severely limiting causal inference in epidemiological research worldwide. Rapid advancements in affordable, miniaturised air pollution sensor technologies offer the potential to address this limitation by capturing the high variability of personal exposure during daily life in large-scale studies with unprecedented spatial and temporal resolution. However, concerns remain regarding the suitability of novel sensing technologies for scientific and policy purposes. In this paper we characterise the performance of a portable personal air quality monitor (PAM) that integrates multiple miniaturised sensors for nitrogen oxides (NO x ), carbon monoxide (CO), ozone (O3) and particulate matter (PM) measurements along with temperature, relative humidity, acceleration, noise and GPS sensors. Overall, the air pollution sensors showed high reproducibility (meanR ¯ 2 = 0.93, min-max: 0.80-1.00) and excellent agreement with standard instrumentation (meanR ¯ 2 = 0.82, min-max: 0.54-0.99) in outdoor, indoor and commuting microenvironments across seasons and different geographical settings. An important outcome of this study is that the error of the PAM is significantly smaller than the error introduced when estimating personal exposure based on sparsely distributed outdoor fixed monitoring stations. Hence, novel sensing technologies such as the ones demonstrated here can revolutionise health studies by providing highly resolved reliable exposure metrics at a large scale to investigate the underlying mechanisms of the effects of air pollution on health.

Ambient Particulate Air Pollution and Blood Pressure in Peri-urban India

BACKGROUND

Evidence linking long-term exposure to particulate air pollution to blood pressure (BP) in high-income countries may not be transportable to low- and middle-income countries. We examined cross-sectional associations between ambient fine particulate matter (PM2.5) and black carbon (BC) with BP (systolic [SBP] and diastolic [DBP]) and prevalent hypertension in adults from 28 peri-urban villages near Hyderabad, India.

METHODS

We studied 5531 participants from the Andhra Pradesh Children and Parents Study (18-84 years, 54% men). We measured BP (2010-2012) in the right arm and defined hypertension as SBP ≥130 mmHg and/or DBP ≥80 mmHg. We used land-use regression models to estimate annual average PM2.5 and BC at participant's residence. We applied linear and logistic nested mixed-effect models stratified by sex and adjusted by cooking fuel type to estimate associations between within-village PM2.5 or BC and health.

RESULTS

Mean (SD) PM2.5 was 33 µg/m (2.7) and BC was 2.5 µg/m (0.23). In women, a 1 µg/m increase in PM2.5 was associated with 1.4 mmHg higher SBP (95% confidence interval [CI]: 0.12, 2.7), 0.87 mmHg higher DBP (95% CI: -0.18, 1.9), and 4% higher odds of hypertension (95% CI: 0%, 9%). In men, associations with SBP (0.52 mmHg; 95% CI: -0.82, 1.8), DBP (0.41 mmHg; 95% CI: -0.69, 1.5), and hypertension (2% higher odds; 95% CI: -2%, 6%) were weaker. No associations were observed with BC.

CONCLUSION

We observed a positive association between ambient PM2.5 and BP and hypertension in women. Longitudinal studies in this region are needed to corroborate our findings.

Effect of Exposure to 2.5 μm Indoor Particulate Matter on Adult Lung Function in Jakarta

Objectives

Lung function impairment due to exposure to indoor air pollution of particulate matter size 2.5 micrometers (PM_2.5) is not well documented in Jakarta.

Methods

To assess whether there is an association between indoor PM_2.5 concentration and lung function impairment among the adult population, a cross-sectional design was implemented. There were 109 adults selected aged between 20 years and 65 years from the Pulo Gadung industrial area, East Jakarta. Association and logistic regression analysis were implemented for statistical analysis of the data.

Results

The average exposure to indoor PM_2.5 was 308 μg/m³. There were 38.5% of participants that had lung function impairment. PM_2.5 concentration was found to be associated with lung function impairment among the adult population living in Pulo Gadung industrial area after controlling for gender, duration of exposure, ventilation, smoking status, and humidity.

Conclusion

The results of this study suggest that PM_2.5 concentrations in the Pulo Gadung industrial area may be the main contributor to the impairment of lung function for adults living in the surrounding residential area.

A Two-stage Dynamic Undesirable Data Envelopment Analysis Model Focused on Media Reports and the Impact on Energy and Health Efficiency

Past research on energy and environmental issues in China has generally focused on energy and environmental efficiencies with no models having included the public health associations or the role of the media. Therefore, to fill this research gap, this paper used a modified Undesirable Dynamic Network model to analyze the efficiency of China’s energy, environment, health and media communications, from which it was found that the urban production efficiency stage was better than the health treatment stage, and that the energy efficiencies across the Chinese regions varied significantly, with only Beijing, Guangzhou, Lhasa and Nanning being found to have high efficiencies. Large urban gaps and low efficiencies were found for health expenditure, with the best performances being found in Fuzhou, Guangzhou, Haikou, Hefei, Nanning, and Urumqi. The regions with the best media communication efficiencies were Fuzhou, Guangzhou, Haikou, Hefei, Lhasa, Nanning and Urumqi, and the cities with the best respiratory disease efficiencies were Fuzhou, Guangzhou, Haikou, Lhasa, Nanning, Wuhan, Urumqi, Xian, and Yinchuan. Overall, significant efficiency improvements were needed in health expenditure and in particular in respiratory diseases as there were major differences across the country.

PM2.5 exposure induces systemic inflammation and oxidative stress in an intracranial atherosclerosis rat model

OBJECTIVES

Exposure to airborne particle (PM_2.5 ) is a risk factor for intracranial atherosclerosis (ICA). Because of the established role of systemic inflammation and oxidative stress by PM_2.5 , we determined whether these processes account for PM_2.5 -mediated ICA, and also whether omega-3 fatty acid (O3FA) dietary supplementation could attenuate them.

METHODS

Adult Sprague-Dawley rats were exposed to filtered air (FA) or PM_2.5 and fed either a normal chow diet (NCD) or a high-cholesterol diet (HCD), administered with or without O3FA (5 mg/kg/day by gavage) for 12 weeks. The lumen and thickness of the middle cerebral artery (MCA) were assessed. Serum tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), interleukin-1β (IL-1β), and interferon gamma (IFN-γ) were detected by ELISA. Reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase (SOD) activity, nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) activity, mRNA levels of Nrf2, HO-1, NQO-1, and protein level of NOX subunit gp91 were quantified to determine the oxidative profile of brain vessels.

RESULTS

PM_2.5 increased (P < .05) ICA, especially in the HCD group; elevated serum TNF-α, IL-6, IL-1β, and IFN-γ; increased cerebrovascular ROS, MDA, NOX activity, and gp91 protein levels; and decreased cerebrovascular SOD activity. Nrf2, HO-1, and NQO-1 mRNA levels were upregulated (P < .05) by PM_2.5 exposure, especially in the HCD group. O3FA attenuated (P < .05) PM_2.5 -induced systemic inflammation, vascular oxidative injury, and ICA.

CONCLUSIONS

PM_2.5 exposure induced systemic inflammation, cerebrovascular oxidative injury, and ICA in rats with HCD. O3FA prevented ICA development, and may therefore exert a protective effect against the atherogenic potential of PM_2.5 .

Association between short-term exposure to particulate matter air pollution and cause-specific mortality in Changzhou, China

BACKGROUND

Extensive studies have linked ambient particulate matter (PM) to an increased mortality burden from a wide range of causes. However, the effects of PM on mortality rates from specific causes were unclear. This study aimed to estimate the detrimental effects of PM on cause specific deaths in Changzhou, China.

METHOD

Data representing daily mortality rates, weather conditions and particulate air pollution levels were obtained from government-controlled agencies of Changzhou, from January 1, 2015 to December 31, 2016. An inverse distance weighting method was used to assess the population exposure to PM and a time-series was performed to detect the detrimental effects of PM.

RESULTS

Positive associations were identified between PMs and daily mortality rates from non-accidental, circulatory, hypertensive, respiratory and chronic lower respiratory causes at a lag of 0-3 days. The effects of PMs were strongest on hypertensive mortality, with an increase of 5.27% (95% confidence interval (CI): 2.43-8.19%) and 3.52% (95% CI: 1.55-5.53%), per 10 μg/m³ increment in PM_2.5 and PM₁₀ respectively. The elderly exhibited a higher mortality risk with PMs exposure. Females were more vulnerable to circulatory, hypertensive and respiratory death while males were more sensitive to chronic lower respiratory and neurodegenerative mortality. The effects were stronger in warm seasons for circulatory mortality and stronger in cold seasons for respiratory mortality.

CONCLUSION

These findings indicate that PM could exert adverse influences on the outcomes of several pathological processes, especially for women and the elderly with hypertension disease.

Ambient PM1 air pollution and cardiovascular disease prevalence: Insights from the 33 Communities Chinese Health Study

BACKGROUNDS

Evidence on the association between long-term exposure to particulate matter with aerodynamic diameter ≤2.5 μm (PM_2.5) and cardiovascular disease (CVD) is scarce in developing countries. Moreover, few studies assessed the role of the PM₁ (≤1.0 μm) size fraction and CVD. We investigated the associations between PM₁ and PM_2.5 and CVD prevalence in Chinese adults.

METHODS

In 2009, we randomly recruited 24,845 adults at the age of 18-74 years from 33 communities in Northeastern China. CVD status was determined by self-report of doctor-diagnosed CVD. Three-year (2006-08) average concentrations of PM₁ and PM_2.5 were assigned using a satellite-based exposure. We used spatial Generalized Linear Mixed Models to evaluate the associations between air pollutants and CVD prevalence, adjusting for multiple covariates. Stratified and interaction analyses and sensitivity analyses were also performed.

RESULTS

A 10 μg/m³ increase in long-term exposure to ambient PM₁ levels was associated a 12% higher odds for having CVD (OR = 1.12; 95% CI = 1.05-1.20). Compared to PM₁, association between PM_2.5 and CVD was lower (OR = 1.06; 95% CI = 1.01-1.11). No significant association was observed for PM_1-2.5 (1-2.5 μm) size fraction (OR = 0.98; 95% CI = 0.85-1.13). Stratified analyses showed greater effect estimates in men and the elder.

CONCLUSIONS

Long-term PM₁ exposure was positively related to CVD, especially in men and the elder. In addition, PM₁ may play a greater role than PM_2.5 in associations with CVD. Further longitudinal studies are warranted to confirm our findings.

The Impact of Economic Growth and Air Pollution on Public Health in 31 Chinese Cities

The rapid economic growth of China in the last twenty years has caused a commensurate rise in atmospheric pollution which has had an impact on both the environment and public health. Since 2013, SO₂, CO₂ and nitrogen oxide levels have reached a level that may cause climate change and have adverse effects on the health of the local residents. Past environmental efficiency analyses have rarely examined economic development, air pollution and health as interacting systems; therefore, this study used a new two-stage DEA model, the Modified Undesirable EBM Two Stage DEA (Epsilon-Based Measure) to explore the environmental, economic and health efficiencies in thirty-one major cities in China. The results were as follows: while all cities needed to improve their GDP, the environmental efficiencies were continuing to rise in most cities. The health efficiency index indicated that disease efficiency had increased in most cities but declined in one third; therefore, it is necessary to strengthen treatment. The respiratory disease treatment efficiency in most cities was rising, and the room for improvement had significantly reduced. There were improvements in the mortality rate in 15 cities; however, the mortality rate treatment efficiency declined in 11 cities.

Peak Expiratory Flow Rate, Blood Oxygen Saturation, and Pulse Rate among the Mine Tailing Community

Background

Chronic inhalation of dust impairs lung function and may cause respiratory symptoms. Very little attention has been paid to the health of community exposed to dust raised by mine tailing which is deposited for many years without precautionary measures. Therefore, a study of peak expiratory flow rate (PEFR), oxygen saturation (SPO₂), and their control groups in Kolar Gold Fields and Kolar was carried out.

Materials and Methods

Ventilatory function tests were done using 400 exposed community participants with the unexposed of same from Kolar who stayed in the mine tailing town for >3 years and aged 18-60 years. Their weight and height were taken and matched with controls who were not exposed to any known air pollutant. The percentage of SPO₂ of both the participants and their control population was determined using a pulse oximeter.

Results

Respirable dust level in the test sites was 1.492 ± 0.336 mg/m³ and it was significant with the control sites, which was 0.531 ± 0.783 mg/m³ with P < 0.05. There was highly significant difference in the mean values of SPO₂, pulse rate, and PEFR between the test and control participants with P < 0.001.

Conclusion

There is an increase in air pollution by increase in particulate matter <2.5 in the gold mining township, and the residents here had decreased PEFR, decreased SPO₂, and increased pulse rate. This proves that the mine tailing community people without precautionary measures may predispose to respiratory symptoms.

Particulate Matter Air Pollution: Effects on the Cardiovascular System

Air pollution is a complex mixture of gaseous and particulate components, each of which has detrimental effects on human health. While the composition of air pollution varies greatly depending on the source, studies from across the world have consistently shown that air pollution is an important modifiable risk factor for significantly increased morbidity and mortality. Moreover, clinical studies have generally shown a greater impact of particulate matter (PM) air pollution on health than the gaseous components. PM has wide-ranging deleterious effects on human health, particularly on the cardiovascular system. Both acute and chronic exposure to PM air pollution is associated with increased risk of death from cardiovascular diseases including ischemic heart disease, heart failure, and ischemic/thrombotic stroke. Particulate matter has also been shown to be an important endocrine disrupter, contributing to the development of metabolic diseases such as obesity and diabetes mellitus, which themselves are risk factors for cardiovascular disease. While the epidemiological evidence for the deleterious effects of PM air pollution on health is increasingly accepted, newer studies are shedding light on the mechanisms by which PM exerts its toxic effects. A greater understanding of how PM exerts toxic effects on human health is required in order to prevent and minimize the deleterious health effects of this ubiquitous environmental hazard. Air pollution is a growing public health problem and mortality due to air pollution is expected to double by 2050. Here, we review the epidemiological evidence for the cardiovascular effects of PM exposure and discuss current understanding about the biological mechanisms, by which PM exerts toxic effects on cardiovascular system to induce cardiovascular disease.