Particulate Matter Air Pollution: Effects on the Cardiovascular System

Uncovering the link between air pollution and neurodevelopmental alterations during pregnancy and early life exposure: A systematic review

Air pollution plays, nowadays, a huge role in human's health and in the personal economy. Moreover, there has been a rise in the prevalence of neurodevelopmental disorders like the Autism Spectrum Disorder (ASD) in recent years. Current scientific studies have established a link between prenatal or perinatal exposure to environmental pollutants and ASD. This systematic review summarizes the current literature available about the relationship between exposure to air pollutants (particulate matter [PM], Second Organic Aerosols [SOA], Diesel Exhaust [DE], and Traffic Related Air Pollution [TRAP]) and neurodevelopmental disorders in preclinical models using rats and mice. The articles were selected and filtered using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, and bias-evaluated using the SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) tool. Overall, our findings suggest that air pollutants are associated with negative developmental outcomes characterized by ASD-like behaviors, abnormal biochemical patterns, and impaired achievement of developmental milestones in rodents. However, there is not sufficient information in certain domains to establish a clear relationship. Short phrases for indexing terms: Air pollution affects neurodevelopment; PM exposure modifies glutamate system; Prenatal exposure combined with postnatal affect more to behavioral / cognitive domain; Air pollution modifies social behavior in rodents; Cognitive deficits can be detected after gestational exposure to air pollution.

Defining the in vivo mechanism of air pollutant toxicity using murine stress response biomarkers

Air pollution can cause a wide range of serious human diseases. For the informed instigation of interventions which prevent these outcomes there is an urgent need to develop robust in vivo biomarkers which provide insights into mechanisms of toxicity and relate pollutants to specific adverse outcomes. We exemplify for a first time the application of in vivo stress response reporters in establishing mechanisms of air pollution toxicity and the application of this knowledge in epidemiological studies. We first demonstrated the utility of reporter mice to understand toxicity mechanisms of air pollutants using diesel exhaust particles compounds. We observed that nitro-PAHs induced Hmox1 and CYP1a1 reporters in a time- and dose-dependent, cell- and tissue-specific manner. Using in vivo genetic and pharmacological approaches we confirmed that the NRF2 pathway mediated this Hmox1-reporter induction stress reporter activity. We then correlated the activation of stress-reporter models (oxidative stress/inflammation, DNA damage and Ah receptor -AhR- activity) with responses in primary human nasal cells exposed to chemicals present in particulate matter (PM; PM2.5-SRM2975, PM10-SRM1648b) or fresh roadside PM10. To exemplify their use in clinical studies, Pneumococcal adhesion was assessed in exposed primary human nasal epithelial cells (HPNEpC). The combined use of HPNEpC and in vivo reporters demonstrated that London roadside PM10 particles induced pneumococcal infection in HPNEpC mediated by oxidative stress responses. The combined use of in vivo reporter models with human data thus provides a robust approach to define the relationship between air pollutant exposure and health risks. Moreover, these models can be used in epidemiological studies to hazard ranking environmental pollutants by considering the complexity of mechanisms of toxicity. These data will facilitate the relationship between toxic potential and the level of pollutant exposure in populations to be established and potentially extremely valuable tools for intervention studies for disease prevention.

Evidence of the adverse effects of air pollution on the population's health in Spain: analysis of the economic costs of premature deaths

Exposure to ambient air pollution increases mortality and morbidity, leading disabilities, and premature deaths. Air pollution has been identified as a leading cause of global disease burden, especially in low- and middle-income countries in 2015 (Global Burden of Diseases, Injuries and Risk Factors Study, 2015). This study explores the relation between mortality rates and particulate matter (PM) concentrations in the 50 Spanish regions for the period 2002-2017. Moreover, we estimated the premature deaths due to PM in Spain according to welfare and production losses in 2017. Random-effects models were developed to evaluate the relation between mortality rates and PM concentrations. The economic cost of premature deaths was assessed using the Willingness to Pay approach to quantify welfare losses and the Human Capital method to estimate production losses. PM10 concentrations are positively related to mortality due to respiratory diseases and stroke. Based on 10,342 premature deaths in 2017, losses in welfare amount to EUR 36,227 million (3.1% of Spanish GDP). The economic value of current and future production losses reached EUR 229 million (0.02% of GDP). From a social perspective, air pollution is a public health concern that greatly impacts health and quality of life. Results highlight the need to implement or strengthen regulatory, fiscal, and health public policies to substantially benefit the population's health by reducing their exposure to air pollution.

Toxicological and histopathological alterations in the heart of young and adult albino rats exposed to mosquito coil smoke

Mosquito coil repellents are well-known indoor air pollutant with significant health concerns. The present study investigated the toxic effects of mosquito coil smoke on the heart of young and adult male rats. The animals were subjected to the smoke for 6 h/day, 6 days/week, for 4 weeks. Within the first hour after lighting the coil, significant amounts of formaldehyde, total volatile organic compounds, and particulate matter (PM2.5 and PM10) were detected. Both exposed ages, particularly the young group, showed a significant increase in the activities of serum aspartate aminotransferase, lactate dehydrogenase, creatine kinase-MB, and the levels of troponin I, myoglobin, Na+ levels, lipid profile, and inflammatory markers (interleukin-6 and C-reactive protein) as well as a significant decrease in K+ levels and cardiac Na-K ATPase activity, indicating development of cardiac inflammation and dysfunction. Furthermore, the toxic stress response was validated by significant downregulation at expression of the detoxifying enzyme cytochrome p450. Histopathological studies in both age groups, especially the young group, revealed cardiomyocyte degeneration and necrotic areas. Moreover, upregulation at the pro-apoptotic markers, caspase3, P53, and cytochrome C expressions, was detected by immunohistochemical approach in heart sections of the exposed groups. Finally, the myocardial dysfunctional effects of the coil active ingredient, meperfluthrin, were confirmed by the docking results which indicated a high binding affinity of meperfluthrin, with Na-K ATPase and caspase 3. In conclusion, both the young and adult exposed groups experienced significant cardiac toxicity changes evidenced by cell apoptosis and histopathological alterations as well as disruption of biochemical indicators.

Associations between short-term exposure to PM2.5, NO2 and O3 pollution and kidney-related conditions and the role of temperature-adjustment specification: A case-crossover study in New York state

Epidemiologic evidence on the relationship between air pollution and kidney disease remains inconclusive. We evaluated associations between short-term exposure to PM_2.5, NO₂ and O₃ and unplanned hospital visits for seven kidney-related conditions (acute kidney failure [AKF], urolithiasis, glomerular diseases [GD], renal tubulo-interstitial diseases, chronic kidney disease, dysnatremia, and volume depletion; n = 1,209,934) in New York State (2007-2016). We applied a case-crossover design with conditional logistic regression, controlling for temperature, dew point temperature, wind speed, and solar radiation. We used a three-pollutant model at lag 0-5 days of exposure as our main model. We also assessed the influence of model adjustment using different specifications of temperature by comparing seven temperature metrics (e.g., dry-bulb temperature, heat index) and five intraday temperature measures (e.g., daily mean, daily minimum, nighttime mean), according to model performance and association magnitudes between air pollutants and kidney-related conditions. In our main models, we adjusted for daytime mean outdoor wet-bulb globe temperature, which showed good model performance across all kidney-related conditions. We observed the odds ratios (ORs) for 5 μg/m³ increase in daily mean PM_2.5 to be 1.013 (95% confidence interval [CI]: 1.001, 1.025) for AKF, 1.107 (95% CI: 1.018, 1.203) for GD, and 1.027 (95% CI: 1.015, 1.038) for volume depletion; and the OR for 5 ppb increase in daily 1-hour maximum NO₂ to be 1.014 (95% CI; 1.008, 1.021) for AKF. We observed no associations with daily 8-hour maximum O₃ exposure. Association estimates varied by adjustment for different intraday temperature measures: estimates adjusted for measures with poorer model performance resulted in the greatest deviation from estimates adjusted for daytime mean, especially for AKF and volume depletion. Our findings indicate that short-term exposure to PM_2.5 and NO₂ is a risk factor for specific kidney-related conditions and underscore the need for careful adjustment of temperature in air pollution epidemiologic studies.

Scanning ion conductance microscopy reveals differential effect of PM2.5 exposure on A549 lung epithelial and SH-SY5Y neuroblastoma cell membranes

Numerous studies have linked a wide range of diseases including respiratory illnesses to harmful particulate matter (PM) emissions indoors and outdoors, such as incense PM and industrial PM. Because of their ability to penetrate the lower respiratory tract and the circulatory system, fine particles with diameters of 2.5 µm or less (PM2.5) are believed to be more hazardous than larger PMs. Despite the enormous number of studies focusing on the intracellular processes associated with PM2.5 exposure, there have been limited reports studying the biophysical properties of cell membranes, such as nanoscale morphological changes induced by PM2.5. Our study assesses the membrane topographical and structural effects of PM2.5 from incense PM2.5 exposure in real time on A549 lung carcinoma epithelial cells and SH-SY5Y neuroblastoma cells that had been fixed to preclude adaptive cell responses. The size distribution and mechanical properties of the PM2.5 sample were characterized with atomic force microscopy (AFM). Nanoscale morphological monitoring of the cell membranes utilizing scanning ion conductance microscopy (SICM) indicated statistically significant increasing membrane roughness at A549 cells at half an hour of exposure and visible damage at 4 h of exposure. In contrast, no significant increase in roughness was observed on SH-SY5Y cells after half an hour of PM2.5 exposure, although continued exposure to PM2.5 for up to 4 h affected an expansion of lesions already present before exposure commenced. These findings suggest that A549 cell membranes are more susceptible to structural damage by PM2.5 compared to SH-SY5Y cell membranes, corroborating more enhanced susceptibility of airway epithelial cells to exposure to PM2.5 than neuronal cells.

Ambient air pollution and the health-related quality of life of older adults: Evidence from Shandong China

Ambient air pollution is a major public health concern impacting all aspects of human health. There is a lack of studies on the impact of ambient air pollution on health-related quality of life (HRQoL) of older Chinese adults. Our study answers two questions: How concentrations of ambient air pollutants are associated with HRQoL among older adults in China and, second, what are the possible mechanisms through which ambient air pollution affects HRQoL. From the 2018 National Health Service Survey, we sampled 5717 aged 65 years or older residents for the eastern province of Shandong, China. Data on individual exposures to PM_2.5 and PM₁₀ (particulate matter with diameter less than or equal to 2.5 μm and 10 μm) and sulfur dioxide (SO₂) were collected from the ChinaHighAirPollutants (CHAP) datasets. Mixed-effects Tobit regression models and mixed-effects ordered Probit regression models were employed to examine the associations of long-term exposure to ambient air pollution with the European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L) scale comprising mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Socioeconomic, demographic and behavioral factors relating to HRQoL were also examined. The results show that for each 1 μg/m³ increase, EQ-5D-3L scores fell 0.002 for PM_2.5; 0.001 for PM₁₀ and 0.002 for SO₂. Long term exposure to PM_2.5, PM₁₀ and SO₂ were also associated with increased prevalence of pain/discomfort and anxiety/depression. The reduced HRQoL effects of ambient air pollution were exacerbated by higher socioeconomic status (affluent, urban and higher level of education). Our findings suggested that HRQoL of older Chinese adults was not only associated with demographic, socioeconomic, and health-related factors, but also negatively correlated with air pollution, especially through increased pain/discomfort and anxiety/depression. The paper proposes policy recommendations.

Assessing the cytotoxicity of aerosolized carbon black and benzo[a]pyrene with controlled physical and chemical properties on human lung epithelial cells

Atmospheric particulate matter (PM) is a complex mixture of hazardous particles containing hundreds of inorganic and organic species. Organic components, such as carbon black (CB) and benzo[a]pyrene (BaP), are known to exhibit diverse genotoxic and carcinogenic effects. The toxicity of CB and polycyclic aromatic hydrocarbons has been well studied, however the combined toxicity is much less understood. A spray-drying system was used to control the size and chemical composition of PMs. PMs were prepared by loading BaP on three different sized CBs (0.1 μm, 2.5 μm, and 10 μm) to obtain BaP-unloaded CB (CB0.1, CB2.5, and CB10) and BaP-loaded CB (CB0.1-BaP, CB2.5-BaP, and CB10-BaP). We analyzed cell viability, levels of oxidative stress, and pro-inflammatory cytokines using human lung cells (A549 epithelial cells). Cell viability decreased when exposed to all PMs (PM0.1, PM2.5, and PM10), regardless of the presence of BaP. The increase in PM size due to BaP-adsorption to CB resulted in insufficient toxic effects on human lung cells compared to CB alone. Smaller CBs reduced cell viability, leading to reactive oxygen species formation, which can cause damage to cellular structures deliver more harmful substances. Additionally, small CBs were predominant in inducing the expression of pro-inflammatory cytokines in A549 epithelial cells. These results indicate that the size of CB is a key factor that immediately affects the inflammation of lung cells, compared to the presence of BaP.

Seasonality of Polyaromatic Hydrocarbons (PAHs) and Their Derivatives in PM2.5 from Ljubljana, Combustion Aerosol Source Apportionment, and Cytotoxicity of Selected Nitrated Polyaromatic Hydrocarbons (NPAHs)

Airborne particulate matter (PM) is a vector of many toxic pollutants, including polyaromatic hydrocarbons (PAHs) and their derivatives. Especially harmful is the fine fraction (PM_2.5), which penetrates deep into the lungs during inhalation and causes various diseases. Amongst PM_2.5 components with toxic potential are nitrated PAHs (NPAHs), knowledge of which is still rudimentary. Three of the measured NPAHs (1-nitropyrene (1-nP), 9-nitroanthracene (9-nA), and 6-nitrochrysene (6-nC)) were detected in ambient PM_2.5 from Ljubljana, Slovenia, along with thirteen non-nitrated PAHs. The highest concentrations of pollutants, which are closely linked with incomplete combustion, were observed in the cold part of the year, whereas the concentrations of NPAHs were roughly an order of magnitude lower than those of PAHs throughout the year. Further on, we have evaluated the toxicity of four NPAHs, including 6-nitrobenzo[a]pyrene (6-nBaP), to the human kidney cell line, HEK293T. The most potent was 1-nP (IC₅₀ = 28.7 µM), followed by the other three NPAHs, whose IC₅₀ was above 400 or 800 µM. According to our cytotoxicity assessment, atmospheric 1-nP is the most harmful NPAH among the investigated ones. Despite low airborne concentrations of NPAHs in ambient air, they are generally considered harmful to human health. Therefore, systematic toxicological assessment of NPAHs at different trophic levels, starting with cytotoxicity testing, is necessary in order to accurately evaluate their threat and adopt appropriate abatement strategies.

Integrated assessment of personal monitor applications for evaluating exposure to urban stressors: A scoping review

Urban stressors pose a health risk, and individual-level assessments provide necessary and fine-grained insight into exposure. An ever-increasing amount of research literature on individual-level exposure to urban stressors using data collected with personal monitors, has called for an integrated assessment approach to identify trends, gaps and needs, and provide recommendations for future research. To this end, a scoping review of the respective literature was performed, as part of the H2020 URBANOME project. Moreover, three specific aims were identified: (i) determine current state of research, (ii) analyse literature according with a waterfall methodological framework and identify gaps and needs, and (iii) provide recommendations for more integrated, inclusive and robust approaches. Knowledge and gaps were extracted based on a systematic approach, e.g., data extraction questionnaires, as well as through the expertise of the researchers performing the review. The findings were assessed through a waterfall methodology of delineating projects into four phases. Studies described in the papers vary in their scope, with most assessing exposure in a single macro domain, though a trend of moving towards multi-domain assessment is evident. Simultaneous measurements of multiple stressors are not common, and papers predominantly assess exposure to air pollution. As urban environments become more diverse, stakeholders from different groups are included in the study designs. Most frequently (per the quadruple helix model), civil society/NGO groups are involved, followed by government and policymakers, while business or private sector stakeholders are less frequently represented. Participants in general function as data collectors and are rarely involved in other phases of the research. While more active involvement is not necessary, more collaborative approaches show higher engagement and motivation of participants to alter their lifestyles based on the research results. The identified trends, gaps and needs can aid future exposure research and provide recommendations on addressing different urban communities and stakeholders.

Wildfire-related smoke inhalation worsens cardiovascular risk in sleep disrupted rats

Introduction

As a lifestyle factor, poor sleep status is associated with increased cardiovascular morbidity and mortality and may be influenced by environmental stressors, including air pollution.

Methods

To determine whether exposure to air pollution modified cardiovascular effects of sleep disruption, we evaluated the effects of single or repeated (twice/wk for 4 wks) inhalation exposure to eucalyptus wood smoke (ES; 964 μg/m3 for 1 h), a key wildland fire air pollution source, on mild sleep loss in the form of gentle handling in rats. Blood pressure (BP) radiotelemetry and echocardiography were evaluated along with assessments of lung and systemic inflammation, cardiac and hypothalamic gene expression, and heart rate variability (HRV), a measure of cardiac autonomic tone.

Results and Discussion

GH alone disrupted sleep, as evidenced by active period-like locomotor activity, and increases in BP, heart rate (HR), and hypothalamic expression of the circadian gene Per2. A single bout of sleep disruption and ES, but neither alone, increased HR and BP as rats transitioned into their active period, a period aligned with a critical early morning window for stroke risk in humans. These responses were immediately preceded by reduced HRV, indicating increased cardiac sympathetic tone. In addition, only sleep disrupted rats exposed to ES had increased HR and BP during the final sleep disruption period. These rats also had increased cardiac output and cardiac expression of genes related to adrenergic function, and regulation of vasoconstriction and systemic blood pressure one day after final ES exposure. There was little evidence of lung or systemic inflammation, except for increases in serum LDL cholesterol and alanine aminotransferase. These results suggest that inhaled air pollution increases sleep perturbation-related cardiovascular risk, potentially in part by increased sympathetic activity.

Are children with sickle cell disease at particular risk from the harmful effects of air pollution? Evidence from a large, urban/peri-urban cohort

INTRODUCTION

Pathophysiologic pathways of sickle cell disease (SCD) and air pollution involve inflammation, oxidative stress, and endothelial damage. It is therefore plausible that children with SCD are especially prone to air pollution's harmful effects.

METHODS

Patient data were collected from a single-center, urban/peri-urban cohort of children with confirmed SCD. Daily ambient concentrations of particulate matter (PM2.5 ) were collected via satellite-derived remote-sensing technology, and carbon monoxide (CO), nitrogen dioxide (NO2 ), and ozone from local monitoring stations. We used multivariable regression to quantify associations of pollutant levels and daily counts of emergency department (ED) visits, accounting for weather and time trends. For comparison, we quantified the associations of pollutant levels with daily all-patient (non-SCD) ED visits to our center.

RESULTS

From 2010 to 2018, there were 17,731 ED visits by 1740 children with SCD (64.8% HbSS/HbSβ0 ). Vaso-occlusive events (57.8%), respiratory illness (17.1%), and fever (16.1%) were the most common visit diagnoses. Higher 3-day (lags 0-2) rolling mean PM2.5 and CO levels were associated with daily ED visits among those with SCD (PM2.5 incident rate ratio [IRR] 1.051 [95% confidence interval: 1.010-1.094] per 9.4 μg/m3 increase; CO 1.088 [1.045-1.132] per 0.5 ppm). NO2 showed positive associations in secondary analyses; ozone levels were not associated with ED visits. The comparison, all-patient ED visit analyses showed lower IRR for all pollutants.

CONCLUSIONS

Our results suggest short-term air pollution levels as triggers for SCD events and that children with SCD may be more vulnerable to air pollution than those without SCD. Targeted pollution-avoidance strategies could have significant clinical benefits in this population.

Investigation of the Immunogenic Properties of Ovalbumin Modified by Urban Airborne Particulate Matter

Exposure to air particulate matter (PM) is linked to the blood oxidative stress and systemic inflammation. The aim of this study was to elucidate whether oxidative PM modification of ovalbumin (OVA), the major antioxidant serum protein, may alter its antigenicity and/or immunogenicity. Ovalbumin was exposed via dialysis to the standard urban PM (SRM 1648a) or to PM with removed organic content (encoded as LAP). Both structural changes and biological properties of PM-modified OVA were measured. T lymphocytes and dendritic cells (the major antigen-presenting cells) isolated from C57BL/6 and OT-II (323-339 epitope) OVA-specific T cell receptor (TCR)-transgenic mice were used to test the effect of PM on OVA immunogenicity. The immunogenicity of both SRM 1648a and LAP-modified OVA was significantly higher than that of control OVA, as measured by the epitope-specific T cell proliferation and interferon γ production by the stimulated cells. This effect was associated with mild oxidative changes in the carrier molecule outside the structure of the OVA epitope and with increased resistance to proteolysis of PM-modified OVA. Interestingly, dendritic cells showed enhanced capacity for the uptake of proteins when the cells were cultured with PM-modified OVA. Our results suggest that the enhanced immunogenicity of PM-modified OVA is not associated with altered antigenicity or antigen presentation. However, it may result from slower degradation and longer persistence of modified antigens in dendritic cells. Whether this phenomenon is associated with enhanced risk prevalence of autoimmune diseases observed in the areas with high urban PM pollution needs to be explained.

Findings of indoor air pollution and childhood obesity in a cross-sectional study of Chinese schoolchildren

BACKGROUND

Air pollution exposures are increasingly suspected to influence the development of childhood adiposity, especially focusing on outdoor exposure, but few studies investigated indoor exposure and childhood obesity.

OBJECTIVES

We aimed to examine the association between exposure to multiple indoor air pollutants and childhood obesity in Chinese schoolchildren.

METHODS

In 2019, we recruited 6499 children aged 6-12 years from five Chinese elementary schools in Guangzhou, China. We measured age-sex-specific body mass index z score (z-BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) on standard procedures. Four different indoor air pollution (IAP) exposures, including cooking oil fumes (COFs), home decoration, secondhand smoke (SHS), and incense burning, were collected by questionnaire and then converted into an IAP exposure index with four categories. Association between indoor air pollutants and childhood overweight/obesity as well as four obese anthropometric indices were assessed by logistic regression models and multivariable linear regression models, respectively.

RESULTS

Children exposed to ≥3 types of indoor air pollutants had higher z-BMI (coefficient [β]:0.142, 95% confidence interval [CI]:0.011-0.274) and higher risk of overweight/obesity (odd ratio [OR]:1.27, 95%CI:1.01-1.60). And a dose-response relationship was discovered between the IAP exposure index and z-BMI as well as overweight/obesity (p_{for trend}<0.05). We also found that exposure to SHS and COFs was positively associated with z-BMI and overweight/obesity (p < 0.05). Moreover, there was a significant interaction between SHS exposure and COFs on the higher risk of overweight/obesity among schoolchildren. Boys appear more susceptible to multiple indoor air pollutants than girls.

CONCLUSIONS

Indoor air pollution exposures were positively associated with higher obese anthropometric indices and increased odds of overweight/obesity in Chinese schoolchildren. More well-designed cohort studies are needed to verify our results.

The protective effect of p-Coumaric acid on hepatic injury caused by particulate matter in the rat and determining the role of long noncoding RNAs MEG3 and HOTAIR

Increasing air pollution is associated with serious human health problems. P-coumaric acid (PC) is a herbal phenolic compound that exhibits beneficial pharmacological potentials. Here, the protective effect of PC on liver injury induced by air pollution was examined. Thirty-two adult male Wistar rats (200-250 g) were divided randomly into four groups (n = 8). The groups were; Control (rats received DMSO and then exposed to clean air), PC (rats received PC and then exposed to clean air), DMSO + Dust (rats received DMSO and then exposed to dust), and PC + Dust (the animals received PC and then exposed to dust). The clean air, DMSO, PC, and dust were administrated 3 days a week for 6 consecutive weeks. The rats were anesthetized and their blood samples and liver sections were taken to conduct molecular, biomedical, and histopathological tests. Dust exposure increased the liver enzymes, bilirubin, triglyceride, cholesterol, and the production of liver malondialdehyde, and decreased in liver total anti-oxidant capacity and serum high-density lipoprotein. It also increased the mRNA expression of inflammatory-related cytokines, decreased the mRNA expression of SIRT-1, decreased the expression levels of miR-20b5p, and MEG3 while increased the expression levels of miR-34a, and HOTAIR. Dust exposure also increased the liver content of three cytokines TNF-α, NF-κB, HMGB-1, and ATG-7 proteins. PC enhanced liver function against adverse effects of dust through recovering almost all the studied variables. Exposure to dust damaged the liver through induction of oxidative stress, inflammation, and autophagy. PC protected the liver against dust-induced cytotoxicity.

Critical review on emerging health effects associated with the indoor air quality and its sustainable management

Indoor air quality (IAQ) is one of the fundamental elements affecting people's health and well-being. Currently, there is a lack of awareness among people about the quantification, identification, and possible health effects of IAQ. Airborne pollutants such as volatile organic compounds (VOCs), particulate matter (PM), sulfur dioxide (SO2), carbon monoxide (CO), nitrous oxide (NO), polycyclic aromatic hydrocarbons (PAHs) microbial spores, pollen, allergens, etc. primarily contribute to IAQ deterioration. This review discusses the sources of major indoor air pollutants, molecular toxicity mechanisms, and their effects on cardiovascular, ocular, neurological, women, and foetal health. Additionally, contemporary strategies and sustainable methods for regulating and reducing pollutant concentrations are emphasized, and current initiatives to address and enhance IAQ are explored, along with their unique advantages and potentials. Due to their longer exposure times and particular physical characteristics, women and children are more at risk for poor indoor air quality. By triggering many toxicity mechanisms, including oxidative stress, DNA methylation, epigenetic modifications, and gene activation, indoor air pollution can cause a range of health issues. Low birth weight, acute lower respiratory tract infections, Sick building syndromes (SBS), and early death are more prevalent in exposed residents. On the other hand, the main causes of incapacity and early mortality are lung cancer, chronic obstructive pulmonary disease, and cardiovascular disorders. It's crucial to acknowledge anticipated research needs and implemented efficient interventions and policies to lower health hazards.

Exposure to real-ambient particulate matter induced vascular hypertrophy through activation of PDGFRβ

BACKGROUND

Vascular toxicity induced by particulate matter (PM) exposure exacerbates the onset and development of cardiovascular diseases; however, its detailed mechanism remains unclear. Platelet-derived growth factor receptor β (PDGFRβ) acts as a mitogen for vascular smooth muscle cells (VSMCs) and is therefore essential for normal vasoformation. However, the potential effects of PDGFRβ on VSMCs in PM-induced vascular toxicity have not yet been elucidated.

METHODS

To reveal the potential roles of PDGFRβ signalling in vascular toxicity, individually ventilated cage (IVC)-based real-ambient PM exposure system mouse models and PDGFRβ overexpression mouse models were established in vivo, along with in vitro VSMCs models.

RESULTS

Vascular hypertrophy was observed following PM-induced PDGFRβ activation in C57/B6 mice, and the regulation of hypertrophy-related genes led to vascular wall thickening. Enhanced PDGFRβ expression in VSMCs aggravated PM-induced smooth muscle hypertrophy, which was attenuated by inhibiting the PDGFRβ and janus kinase 2 /signal transducer and activator of transcription 3 (JAK2/STAT3) pathways.

CONCLUSION

Our study identified the PDGFRβ gene as a potential biomarker of PM-induced vascular toxicity. PDGFRβ induced hypertrophic effects through the activation of the JAK2/STAT3 pathway, which may be a biological target for the vascular toxic effects caused by PM exposure.

Meandered and muddled: a systematic review on the impact of air pollution on ocular health

From the years 1970-2023, a systematic overview of the diverse consequences of particulate matter on eye health and a disease classification according to acute, chronic, and genetic are presented using the PubMed, Research Gate, Google Scholar, and Science Direct databases. Various studies on medical aspects correlate with the eye and health. However, from an application perspective, there is limited research on the ocular surface and air pollution. The main objective of the study is to uncover the relationship between eye health and air pollution, particularly particulate matter, along with other external factors acting as aggravators. The secondary goal of the work is to examine the existing models for mimicking human eyes. The study is followed by a questionnaire survey in a workshop, in which the exposure-based investigation was tagged based on their activity. This paper establishes a relationship between particulate matter and its influence on human health, leading to numerous eye diseases like dry eyes, conjunctivitis, myopia, glaucoma, and trachoma. The results of the questionnaire survey indicate that about 68% of the people working in the workshop are symptomatic with tears, blurred vision, and mood swings, while 32% of the people were asymptomatic. Although there are approaches for conducting experiments, the evaluation is not well defined; empirical and numerical solutions for particle deposition on the eye are needed. There prevails a broad gap in the arena of ocular deposition modeling.

Brown Coal and Logwood Combustion in a Modern Heating Appliance: The Impact of Combustion Quality and Fuel on Organic Aerosol Composition

Residential heating with solid fuels is one of the major drivers for poor air quality in Central and Eastern Europe, and coal is still one of the major fuels in countries, such as Poland, the Czech Republic, and Hungary. In this work, emissions from a single-room heater fueled with brown coal briquettes (BCBs) and spruce logs (SLs) were analyzed for signatures of inorganic as well as semivolatile aromatic and low-volatile organic constituents. High variations in organic carbon (OC) emissions of BCB emissions, ranging from 5 to 22 mg MJ^-1, were associated to variations in carbon monoxide (CO) emissions, ranging from 900 to 1900 mg MJ^-1. Residential BCB combustion turned out to be an equally important source of levoglucosan, an established biomass burning marker, as spruce logwood combustion, but showed distinct higher ratios to manosan and galactosan. Signatures of polycyclic aromatic hydrocarbons emitted by BCB combustion exhibited defunctionalization and desubstitution with increasing combustion quality. Lastly, the concept of island and archipelago structural motifs adapted from petroleomics is used to describe the fraction low-volatile organic compounds in particulate emissions, where a transition from archipelago to island motifs in relation with decreasing CO emissions was observed in BCB emissions, while emissions from SL combustion exhibited the island motif.

Breathing Fresh Air in the City: Implementing Avenue Trees as a Sustainable Solution to Reduce Particulate Pollution in Urban Agglomerations

The issue of air pollution from particulate matter (PM) is getting worse as more and more people move into urban areas around the globe. Due to the complexity and diversity of pollution sources, it has long been hard to rely on source control techniques to manage this issue. Due to the fact that urban trees may provide a variety of ecosystem services, there is an urgent need to investigate alternative strategies for dramatically improving air quality. PM has always been a significant concern due to its adverse effects on humans and the entire ecosystem. The severity of this issue has risen in the current global environmental context. Numerous studies on respiratory and other human disorders have revealed a statistical relationship between human exposure to outdoor levels of particles or dust and harmful health effects. These risks are undeniably close to industrial areas where these airborne, inhalable particles are produced. The combined and individual effects of the particle and gaseous contaminants on plants' general physiology can be detrimental. According to research, plant leaves, the primary receptors of PM pollution, can function as biological filters to remove significant amounts of particles from the atmosphere of urban areas. This study showed that vegetation could provide a promising green infrastructure (GI) for better air quality through the canopy and leaf-level processes, going beyond its traditional role as a passive target and sink for air pollutants. Opportunities exist for urban GI as a natural remedy for urban pollution caused by PMs.

Long-term exposure to particulate matter on cardiovascular and respiratory diseases in low- and middle-income countries: A systematic review and meta-analysis

Background

Long-term exposure to particulate matter (PM) has essential and profound effects on human health, but most current studies focus on high-income countries. Evidence of the correlations between PM and health effects in low- and middle-income countries (LMICs), especially the risk factor PM1 (particles &lt; 1 μm in size), remains unclear.

Objective

To explore the effects of long-term exposure to particulate matter on the morbidity and mortality of cardiovascular and respiratory diseases in LMICs.

Methods

A systematic search was conducted in the PubMed, Web of Science, and Embase databases from inception to May 1, 2022. Cohort studies and case-control studies that examine the effects of PM1, PM2.5, and PM10 on the morbidity and mortality of cardiovascular and respiratory diseases in LMICs were included. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Outcomes were analyzed via a random effects model and are reported as the relative risk (RR) with 95% CI.

Results

Of the 1,978 studies that were identified, 38 met all the eligibility criteria. The studies indicated that long-term exposure to PM2.5, PM10, and PM1 was associated with cardiovascular and respiratory diseases: (1) Long-term exposure to PM2.5 was associated with an increased risk of cardiovascular morbidity (RR per 1.11 μg/m3, 95% CI: 1.05, 1.17) and mortality (RR per 1.10 μg/m3, 95% CI: 1.06, 1.14) and was significantly associated with respiratory mortality (RR 1.31, 95% CI: 1.25, 1.38) and morbidity (RR 1.08, 95% CI: 1.02, 1.04); (2) An increased risk of respiratory mortality was observed in the elderly (65+ years) (RR 1.21, 95% CI: 1.00, 1.47) with long-term exposure to PM2.5; (3) Long-term exposure to PM10 was associated with cardiovascular morbidity (RR 1.07, 95% CI 1.01, 1.13), respiratory morbidity (RR 1.43, 95% CI: 1.21, 1.69) and respiratory mortality (RR 1.28, 95% CI 1.10, 1.49); (4) A significant association between long-term exposure to PM1 and cardiovascular disease was also observed.

Conclusions

Long-term exposure to PM2.5, PM10 and PM1 was all related to cardiovascular and respiratory disease events. PM2.5 had a greater effect than PM10, especially on respiratory diseases, and the risk of respiratory mortality was significantly higher for LMICs than high-income countries. More studies are needed to confirm the effect of PM1 on cardiovascular and respiratory diseases.

Prediction of air pollutant concentrations based on TCN-BiLSTM-DMAttention with STL decomposition

A model with high accuracy and strong generalization performance is conducive to preventing serious pollution incidents and improving the decision-making ability of urban planning. This paper proposes a new neural network structure based on seasonal-trend decomposition using locally weighted scatterplot smoothing (Loess) (STL) and a dependency matrix attention mechanism (DMAttention) based on cosine similarity to predict the concentration of air pollutants. This method uses STL for series decomposition, temporal convolution, a bidirectional long short-term memory network (TCN-BiLSTM) for feature learning of the decomposed series, and DMAttention for interdependent moment feature emphasizing. In this paper, the long short-term memory network (LSTM) and the gated recurrent unit network (GRU) are set as the baseline models to design experiments. At the same time, to test the generalization performance of the model, short-term forecasts in hours were performed using PM_2.5, PM₁₀, SO₂, NO₂, CO, and O₃ data. The experimental results show that the model proposed in this paper is superior to the comparison model in terms of root mean square error (RMSE) and mean absolute percentage error (MAPE). The MAPE values of the 6 kinds of pollutants are 6.800%, 10.492%, 9.900%, 6.299%, 4.178%, and 7.304%, respectively. Compared with the baseline LSTM and GRU models, the average reduction is 49.111% and 43.212%, respectively.

Highly Efficient, Dual-Functional Self-Assembled Electrospun Nanofiber Filters for Simultaneous PM Removal and On-Site Eye-Readable Formaldehyde Sensing

Air pollution containing particulate matter (PM) and volatile organic compounds has caused magnificent burdens on individual health and global economy. Although advances in highly efficient or multifunctional nanofiber filters have been achieved, many existing filters can only deal with one type of air pollutant, such as capturing PM or absorbing and detecting toxic gas. Here, highly efficient, dual-functional, self-assembled electrospun nanofiber (SAEN) filters were developed for simultaneous PM removal and onsite eye-readable formaldehyde sensing fabricated on a commercial fabric mask. With the use of an electrolyte solution containing a formaldehyde-sensitive colorimetric agent as a collector during electrospinning, the one-step fabrication of the dual-functional SAEN filter on commercial masks, such as a fabric mask and a daily disposable mask, was achieved. The electrolyte solution also allowed the uniform deposition of electrospun nanofibers, thereby achieving the high efficiency of PM filtration with an increased quality factor up to twice that of commercial masks. The SAEN filter enabled onsite and eye-readable formaldehyde gas detection by changing its color from yellow to red under a 5 ppm concentrated formaldehyde gas atmosphere. The repetitive fabrication and detachment of the SAEN filter on a fabric mask minimized the waste of the mask while maintaining high filtration efficiency by replenishing the SAEN filters and reusing the fabric mask. Given the dual functionality of SAEN filters, this process could provide new insights into designing and developing high performance and dual-functional electrospun nanofiber filters for various applications, including individual protection and indoor purification applications.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s42765-023-00279-3.

Perinatal diesel exhaust exposure causes persistent changes in the brains of aged mice: An assessment of behavioral and biochemical endpoints related to neurodegenerative disease

Epidemiological studies support an association between air pollution exposure, specifically particulate matter (PM), and neurodegenerative disease. Diesel exhaust (DE) is a principal component of ambient air pollution and a major contributor of PM. Our study aimed to examine whether early-life perinatal DE exposure is sufficient to affect behavioral and biochemical endpoints related to Alzheimer's disease later in life. To achieve this, mice were perinatally exposed (embryonic day 0-postnatal day 21) to DE (250-300 μg/m3 ) or filtered air (FA), and allowed to reach aged status (>18 months). Mice underwent behavioral assessment at 6 and 20 months of age, with tissue collected at 22 months for biochemical endpoints. At 6 months, minimal changes were noted in home-cage behavior of DE treated animals. At 20 months, an alternation deficit was noted with the T-maze, although no difference was seen in the object location task or any home-cage metrics. DE exposure did not alter the expression of Aβ42, phosphorylated tau S199, or total tau. However, IBA-1 protein, a microglial activation marker, was significantly higher in DE exposed animals. Further, lipid peroxidation levels were significantly higher in the DE exposed animals compared to FA controls. Cytokine levels were largely unchanged with DE exposure, suggesting a lack of inflammation despite persistent lipid peroxidation. Taken together, the findings of this study support that perinatal exposure alone is sufficient to cause lasting changes in the brain, although the effects appear to be less striking than those previously reported in younger animals, suggesting some effects do not persist over time. These findings are encouraging from a public health standpoint and support the aggressive reduction of DE emissions to reduce lifetime exposure and potentially reduce disease outcome.

Exposure to ambient air pollution and lipid levels and blood pressure in an adult, Danish cohort

BACKGROUND

Air pollution is a well-recognized risk factor for cardiovascular disease. However, the mechanistic pathways underlying the association are not completely understood. Hence, further studies are required to shed light on potential mechanisms, through which air pollution may affect the development from subclinical to clinical cardiovascular disease.

OBJECTIVES

To investigate associations between short-term exposure to air pollution and high-density lipoprotein (HDL), non-high density lipoprotein (non-HDL), systolic and diastolic blood pressure.

METHODS

The study was conducted among 32,851 Danes from the Diet, Cancer and Health - Next Generations cohort, who had a blood sample taken and blood pressure measured. We measured HDL and non-HDL in the blood samples. We modelled exposure to fine particulate matter (PM_2.5), ultrafine particles (UFP), elemental carbon (EC) and nitrogen dioxide (NO₂) in time-windows from 24 h up to 90 days before blood sampling. Pollutants were modelled as total air pollution from all sources, and apportioned into contributions from non-traffic and traffic sources. We analyzed data using linear and logistic regression, with adjustment for socio-economic and lifestyle factors.

RESULTS

Air pollution exposure over 24 h to 30 days was generally adversely associated with lipid profile and blood pressure, e.g. for 30-day UFP-exposure, adjusted β-estimates were: -0.025 (-0.043; -0.006) for HDL, 0.086 (0.042; 0.130) for non-HDL, 2.45 (1.70; 3.11) for systolic and 1.56 (1.07; 20.4) for diastolic blood pressure, per 10,000 particles/cm³. The strongest associations were found for the non-traffic components of air pollution, and among those who were overweight/obese.

DISCUSSION

In this large study of air pollution and lipid levels and blood pressure, we found that 24-h to 30-day PM_2.5, UFP, EC and NO₂ concentrations were generally adversely associated with lipid profile and blood pressure, two important cardiovascular risk factors. The study suggests potential pathways, through which air pollution could affect the development of cardiovascular disease.

A systematic review and meta-analysis of air pollution and angina pectoris attacks: identification of hazardous pollutant, short-term effect, and vulnerable population

We conducted a systematic review and meta-analysis of global epidemiological studies of air pollution and angina pectoris, aiming to explore the deleterious air pollutant(s) and vulnerable sub-populations. PubMed and Web of Science databases were searched for eligible articles published between database inception and October 2021. Meta-analysis weighted by inverse-variance was utilized to pool effect estimates based on the type of air pollutant, including particulate matters (PM_2.5 and PM₁₀: particulate matter with an aerodynamic diameter ≤ 2.5 µm and ≤ 10 µm), gaseous pollutants (NO₂: nitrogen dioxide; CO: carbon monoxide; SO₂: sulfur dioxide, and O₃: ozone). Study-specific effect estimates were standardized and calculated with percentage change of angina pectoris for each 10 µg/m³ increase in air pollutant concentration. Twelve studies involving 663,276 angina events from Asia, America, Oceania, and Europe were finally included. Meta-analysis showed that each 10 µg/m³ increase in PM_2.5 and PM₁₀ concentration was associated with an increase of 0.66% (95%CI: 0.58%, 0.73%; p < 0.001) and 0.57% (95%CI: 0.20%, 0.94%; p = 0.003) in the risk of angina pectoris on the second day of exposure. Adverse effects were also observed for NO₂ (0.67%, 95%CI: 0.33%, 1.02%; p < v0.001) on the second day, CO (0.010%, 95%CI: 0.006%, 0.014%; p < 0.001). The elderly and patients with coronary artery disease (CAD) appeared to be at higher risk of angina pectoris. Our findings suggest that short-term exposure to PM_2.5, PM₁₀, NO₂, and CO was associated with an increased risk of angina pectoris, which may have implications for cardiologists and patients to prevent negative cardiovascular outcomes.

Empirical relationship between chromosomal damage and airborne particulate matter: A systematic review and meta-analysis of studies in exposed populations

Ambient particulate matter (PM) has gained significant attention as an environmental risk factor for human health. Although the association between ambient PM and micronucleus (MN) induction has been investigated, the quantitative association of PM and genomic instability is inconclusive. We conducted a systematic review and meta-analysis to study the association between PM exposure and MN endpoint. Four databases were systematically searched for studies published up to November 2022, to find papers investigating the relationship between ambient PM and MN induction. Random effect models were conducted to estimate the overall effect based on the Ratio of Means (RoM) with 95% confidence intervals (95% CIs). Subgroup analysis, funnel plot, and Egger and Begg tests, were also performed. Twenty-three studies across nine countries, including 4450 participants, were included. A meta-RoM of 2.13 for MN (95% CI 1.63-2.79) was observed for individuals exposed to ambient PM compared to non-exposed. A significant difference in the subgroup test was found for buccal cells (3.16, 95% CI 2.20-4.52) and low economy level (3.61, 95% CI 1.44-9.01). Our meta-analysis suggests the presence of an association between PM exposure and the frequency of MN and identified the kind of cells and economic status as possible effect modifiers. The use of effective methods, such as the MN assay, enables identification of early genetic damage in humans, which in turn may anticipate the risk of developing respiratory diseases, including lung cancer.

The differential impact of air pollutants on acute urticaria and chronic urticaria: a time series analysis

Several studies have revealed a relationship between short-term exposure to air pollution and the exacerbation of certain skin conditions. This study was developed to expand on these findings by exploring the potential association between exposure to air pollutants including particulate matter, sulfur dioxide, and ozone and the incidence of acute and chronic urticaria in Shenyang, China, from 2016 to 2018. Exposure-response relationships between daily mean concentrations of these airborne pollutants and visits to outpatient dermatological clinics for acute urticaria and chronic urticaria were evaluated via a time series analysis approach using a generalized additive model. This analysis revealed that a 10 μg/m³ increase in daily mean O₃_8h concentrations was associated with a 0.36% (95% CI, 0.31-0.41%), 0.35% (95% CI, 0.30-0.40%), and 0.34% (95% CI, 0.29-0.39%) increase in the number of outpatient visits for acute urticaria on that day (lag0), lagging day 1 (lag1), and lagging day 2 (lag2), respectively. O3 levels also had a similar but weaker effect on the frequency of patients seeking outpatient care for chronic urticaria. These analyses also revealed that estimated 0.47% (95% CI, 0.41-0.52%) and 0.46% (95% CI, 0.40-0.51%) increases in dermatological outpatient acute urticaria visits were observed for every 10μg/m3 rise in O3_8h concentrations on cumulative lagging days (lag01 and lag02). Increases in particulate matter (PM_2.5, PM₁₀) levels had a similar cumulative effect on patients with chronic urticaria. In summary, these results suggest that short-term O₃, PM_2.5, and PM₁₀ exposure can increase the risk of acute urticaria and chronic urticaria.

Association of Ambient Air Pollution with Blood Pressure in Adolescence: A Systematic-review and Meta-analysis

We systematically reviewed the association of ambient air pollution with blood pressure (BP) as a primary outcome in adolescents (10-19 years). Five databases (Ovid Medline, Ovid Embase, Web of Science, The Cochrane Library, and LILACS) were searched for relevant articles published up to August 2022. Meta-analyses were conducted using STATA v17 (Protocol - OSF Registries https://doi.org/10.17605/OSF.IO/96G5Q). Eight studies (5 cohort, 3 cross-sectional) with approximately 15,000 adolescents were included. Data from 6 studies were suitable for inclusion in the meta-analyses. In sub-group analyses, non-significant positive associations were observed for cohort studies assessing long-term exposure to PM₁₀, PM_2.5, and NO₂ on systolic and diastolic BP. At age 12 years old (3702 adolescents), we found significant positive associations for long-term exposure to PM_2.5(β=5.33 (1.56, 9.09) mmHg) and PM₁₀ (β=2.47 (0.10, 4.85) mmHg) on diastolic BP. Significant positive associations were observed (3,592 adolescents) for long-term exposure to PM₁₀(β=0.34 (0.19, 0.50) mmHg) and NO₂ on diastolic BP (β=0.40 (0.09, 0.71) mmHg), and PM₁₀ on systolic BP (β=0.48 (0.19, 0.77) mmHg). The overall quality of evidence analysed was graded as "low/very low." Insufficient data for short-term exposures to PM₂.₅, PM₁₀, NO₂, CO on BP led to their exclusion from the meta-analysis. Inconsistent associations were reported for gender-stratified results. The evidence, though of low-quality and limited, indicated that ambient air pollution was positively associated with adolescent BP. Future studies need improved measures of air pollutant exposures, consideration of gender and socio-economic circumstances on the observed pollution effects, as well as adjustment for other potential confounding factors.

Impact of air pollution on ischemic heart disease: Evidence, mechanisms, clinical perspectives

Ambient air pollution, and especially particulate matter (PM) air pollution <2.5 μm in diameter (PM_2.5), has clearly emerged as an important yet often overlooked risk factor for atherosclerosis and ischemic heart disease (IHD). In this review, we examine the available evidence demonstrating how acute and chronic PM_2.5 exposure clinically translates into a heightened coronary atherosclerotic burden and an increased risk of acute ischemic coronary events. Moreover, we provide insights into the pathophysiologic mechanisms underlying PM_2.5-mediated atherosclerosis, focusing on the specific biological mechanism through which PM_2.5 exerts its detrimental effects. Further, we discuss about the possible mechanisms that explain the recent findings reporting a strong association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, increased PM_2.5 exposure, and morbidity and mortality from IHD. We also address the possible mitigation strategies that should be implemented to reduce the impact of PM_2.5 on cardiovascular morbidity and mortality, and underscoring the strong need of clinical trials demonstrating the efficacy of specific interventions (including both PM_2.5 reduction and/or specific drugs) in reducing the incidence of IHD. Finally, we introduce the emerging concept of the exposome, highlighting the close relationship between PM_2.5 and other environmental exposures (i.e.: traffic noise and climate change) in terms of common underlying pathophysiologic mechanisms and possible mitigation strategies.

Characteristics and Risk Assessment of Environmentally Persistent Free Radicals (EPFRs) of PM2.5 in Lahore, Pakistan

Environmentally persistent free radicals (EPFRs) are an emerging pollutant and source of oxidative stress. Samples of PM2.5 were collected at the urban sites of Lahore in both winter and summertime of 2019. The chemical composition of PM2.5, EPRF concentration, OH radical generation, and risk assessment of EPFRs in PM2.5 were evaluated. The average concentration of PM2.5 in wintertime and summertime in Lahore is 15 and 4.6 times higher than the national environmental quality standards (NEQS) of Pakistan and WHO. The dominant components of PM2.5 are carbonaceous species. The concentration of EPFRs and reactive oxygen species (ROS), such as OH radicals, is higher in the winter than in the summertime. The secondary inorganic ions do not contribute to the generation of OH radicals, although the contribution of SO42+, NO3-, and NH4+ to the mass concentration of PM2.5 is greater in summertime. The atmospheric EPFRs are used to evaluate the exposure risk. The EPFRs in PM2.5 and cigarette smoke have shown similar toxicity to humans. In winter and summer, the residents of Lahore inhaled the amount of EPFRs equivalent to 4.0 and 0.6 cigarettes per person per day, respectively. Compared to Joaquin County, USA, the residents of Lahore are 1.8 to 14.5 times more exposed to EPFRs in summer and wintertime. The correlation analysis of atmospheric EPFRs (spin/m3) and carbonaceous species of PM2.5 indicates that coal combustion, biomass burning, and vehicle emissions are the possible sources of EPFRs in the winter and summertime. In both winter and summertime, metallic and carbonaceous species correlated well with OH radical generation, suggesting that vehicular emissions, coal combustion, and industrial emissions contributed to the OH radical generation. The study's findings provide valuable information and data for evaluating the potential health effects of EPFRs in South Asia and implementing effective air pollution control strategies.

Evaluation of Health Economic Loss Due to Particulate Matter Pollution in the Seoul Subway, South Korea

Evaluating an illness's economic impact is critical for developing and executing appropriate policies. South Korea has mandatory national health insurance in the form of NHIS that provides propitious conditions for assessing the national financial burden of illnesses. The purpose of our study is to provide a comprehensive assessment of the economic impact of PM_2.5 exposure in the subway and a comparative analysis of cause-specific mortality outcomes based on the prevalent health-risk assessment of the health effect endpoints (chronic obstructive pulmonary disease (COPD), asthma, and ischemic heart disease (IHD)). We used the National Health Insurance database to calculate the healthcare services provided to health-effect endpoints, with at least one primary diagnosis in 2019. Direct costs associated with health aid or medicine, treatment, and indirect costs (calculated based on the productivity loss in health effect endpoint patients, transportation, and caregivers, including morbidity and mortality costs) were both considered. The total cost for the exposed population for these endpoints was estimated to be USD 437 million per year. Medical costs were the largest component (22.08%), followed by loss of productivity and premature death (15.93%) and other costs such as transport and caregiver costs (11.46%). The total incurred costs (per 1000 persons) were accounted to be USD 0.1771 million, USD 0.42 million, and USD 0.8678 million for COPD, Asthma, and IHD, respectively. Given that the economic burden will rise as the prevalence of these diseases rises, it is vital to adopt effective preventative and management methods strategies aimed at the appropriate population.

Prenatal exposure to ambient air pollution is associated with early life immune perturbations

BACKGROUND

Exposure to ambient air pollution has been linked to asthma, allergic rhinitis, and other inflammatory disorders, but little is known about the underlying mechanisms.

OBJECTIVE

We studied the potential mechanisms leading from prenatal ambient air pollution exposure to asthma and allergy in childhood.

METHODS

Long-term exposure to nitrogen dioxide (NO₂) as well as to particulate matter with a diameter of ≤2.5 and ≤10 μm (PM_2.5 and PM₁₀) were modeled at the residence level from conception to 6 years of age in 700 Danish children followed clinically for development of asthma and allergy. Nasal mucosal immune mediators were assessed at age 4 weeks and 6 years, inflammatory markers in blood at 6 months, and nasal epithelial DNA methylation and gene expression at age 6 years.

RESULTS

Higher prenatal air pollution exposure with NO₂, PM_2.5, and PM₁₀ was associated with an altered nasal mucosal immune profile at 4 weeks, conferring an increased odds ratio [95% confidence interval] of 2.68 [1.58, 4.62] for allergic sensitization and 2.63 [1.18, 5.81] for allergic rhinitis at age 6 years, and with an altered immune profile in blood at age 6 months conferring increased risk of asthma at age 6 years (1.80 [1.18, 2.76]). Prenatal exposure to ambient air pollution was not robustly associated with immune mediator, epithelial DNA methylation, or gene expression changes in nasal cells at age 6 years.

CONCLUSION

Prenatal exposure to ambient air pollution was associated with early life immune perturbations conferring risk of allergic rhinitis and asthma. These findings suggest potential mechanisms of prenatal exposure to ambient air pollution on the developing immune system.

Association of long-term exposure to PM2.5 and survival following ischemic heart disease

BACKGROUND

Numerous studies have suggested that long-term exposure to particulate matter ≤2.5 μm (PM_2.5) may cause cardiovascular morbidity and mortality. However, susceptibility among those with a history of ischemic heart disease is less clearly understood. We aimed to evaluate whether long-term PM_2.5 exposure is related to mortality among patients with ischemic heart disease.

METHODS

We followed up 306,418 patients hospitalized with ischemic heart disease in seven major cities in South Korea between 2008 and 2016 using the National Health Insurance Database. We linked the modeled PM_2.5 data corresponding to each patient's administrative districts and estimated hazard ratios (HRs) of cause-specific mortality associated with the long-term exposure to PM_2.5 in time-varying Cox proportional hazard models after adjusting for individual- and area-level characteristics. We also estimated HRs by sex, age group (65-74 vs. ≥75 years), and household income.

RESULTS

Of the patients with ischemic heart disease, mean age at the discharge was 76.8 years, and 105,913 died during a mean follow-up duration of 21.4 months. The HR of all-cause mortality was 1.10 [95% confidence intervals (CI): 1.07, 1.14] per 10 μg/m³ increase in a 12-month moving average PM_2.5. The HRs of cardiovascular, stroke, and ischemic heart disease were 1.17 (95% CI: 1.11, 1.24), 1.17 (95% CI: 1.06, 1.30), and 1.25 (95% CI: 1.15, 1.35), respectively. The subgroup analyses showed that participants aged 65-74 years were more susceptible to adverse effects of PM_2.5 exposure. We did not observe any differences in the risk by sex and household income.

CONCLUSION

Mortality from all-cause and cardiovascular disease following hospitalization due to ischemic heart disease was higher among individuals with greater PM_2.5 exposure in seven major cities in South Korea. The result supports the association of long-term exposure to air pollution with poor prognosis among patients with ischemic heart disease.

Particulate matter 2.5, metropolitan status, and heart failure outcomes in US counties: A nationwide ecologic analysis

The relationship between particulate matter with a diameter of 2.5 micrometers or less (PM2.5) and heart failure (HF) hospitalizations and mortality in the US is unclear. Prior studies are limited to studying the effects of daily PM2.5 exposure on HF hospitalizations in specific geographic regions. Because PM2.5 can vary by geography, this study examines the effects of annual ambient PM2.5 exposure on HF hospitalizations and mortality at a county-level across the US. A cross-sectional analysis of county-level ambient PM2.5 concentration, HF hospitalizations, and HF mortality across 3135 US counties nationwide was performed, adjusting for county-level demographics, socioeconomic factors, comorbidities, and healthcare-associated behaviors. There was a moderate correlation between county PM2.5 and HF hospitalization among Medicare beneficiaries (r = 0.41) and a weak correlation between county PM2.5 and HF mortality (r = 0.08) (p-values < 0.01). After adjustment for various county level covariates, every 1 ug/m3 increase in annual PM2.5 concentration was associated with an increase of 0.51 HF Hospitalizations/1,000 Medicare Beneficiaries and 0.74 HF deaths/100,000 residents (p-values < 0.05). In addition, the relationship between PM2.5 and HF hospitalizations was similar when factoring in metropolitan status of the counties. In conclusion, increased ambient PM2.5 concentration level was associated with increased incidence of HF hospitalizations and mortality at the county level across the US. This calls for future studies exploring policies that reduce ambient particulate matter pollution and their downstream effects on potentially improving HF outcomes.

Evaluation of the Effectiveness of the National Clean Air Programme in Terms of Health Impacts from Exposure to PM2.5 and NO2 Concentrations in Poland

The health impact of air quality has recently become an emerging issue. Many regions, especially densely populated regions, have deteriorating air quality. The primary source of pollution in Poland is the municipal sector. Air pollutants have a negative impact on human health, contribute to premature deaths, and are the cause of various diseases. Over recent years, Europe's air quality has largely improved due to several measures to reduce pollutant emissions. The following paper presents the impact of annual average PM2.5 and NO₂ concentrations on premature deaths in Poland in 2019. Exposure to PM2.5 caused more than 19 000 premature deaths, and exposure to NO₂ contributed to around 6000 premature deaths in 2019. Taking 2019 as a baseline, the impact of the envisaged implementation of the national Clean Air Programme on the number of premature deaths is analysed. Implementing the mitigation measures focused on replacing inefficient stoves and boilers in individual households would significantly improve air quality, mainly particulate matter. Reducing PM2.5 concentrations would reduce premature deaths by around 3000 cases, while for NO_2, the number of premature deaths would not change much.

Chloroform Fraction of Prasiola japonica Ethanolic Extract Alleviates UPM 1648a-Induced Lung Injury by Suppressing NF-κB Signaling

Prasiola japonica is an edible alga, and the ethanol extract of P. japonica (Pj-EE) possesses various biological activities. Interestingly, in a recent study, we observed the potent anti-inflammatory activity of the chloroform fraction of Pj-EE (Pj-EE-CF). Thus, to extend the application of Pj-EE-CF, we further studied its effects on lung injury. To establish an experimental model of lung injury, we nasally administered urban particulate matter UPM 1648a (50 mg/kg) to mice. In addition, BEAS-2B cells were treated with 300 μg/mL of UPM 1648a for in vitro analysis. Intranasal administration of UPM 1648a increased lung injury score, macrophage infiltration, and upregulation of the inflammatory enzyme inducible nitric oxide synthase (iNOS) in lung tissues. On the other hand, oral administration of Pj-EE-CF (25, 50, and 100 mg/kg) alleviated these pathological features as assessed by lung wet/dry ratio, lung injury score, bronchoalveolar lavage fluid (BALF) protein amount in the lung tissues up to 70%, 95%, and 99%, respectively. In addition, Pj-EE-CF down-regulated the release of inflammatory cytokines, interleukins (ILs), tumor necrosis factor (TNF)-α, and interferon (IFN)-γ elevated by UPM 1648a in the lung tissues and lung BALF up to 95%. According to Western blot and luciferase assay, Pj-EE-CF (100 mg/kg in vivo or 50 and 100 μg/mL in vitro) significantly reduced the nuclear factor-κB (NF-κB) signal activated by UPM 1648a. Finally, UPM 1648a increased cellular reactive oxygen species (ROS) levels in BEAS-2B cells, while Pj-EE-CF reduced them. These results suggest that Pj-EE-CF alleviates UPM 1648a-induced lung damage via anti-inflammatory and antioxidant activities and by suppressing NF-κB signaling. In conclusion, these observations imply that Pj-EE-CF could be a practical component of food supplements to mitigate air pollution-derived lung damage.

Particulate matter exposure exacerbates cellular damage by increasing stress granule formation in respiratory syncytial virus-infected human lung organoids

Exposure to atmospheric particulate matter (PM) increases morbidity and mortality in respiratory diseases by causing various adverse health effects; however, the effects of PM exposure on cellular stress under virus-infected conditions remain unclear. The effects of PM under 10 μm (PM₁₀) and diesel PM (DPM) on respiratory syncytial virus (RSV) infection were investigated in human two-dimensional lung epithelial cells and human three-dimensional lung organoids mimicking the lung tissue. We evaluated the formation of stress granules, which are important in cellular adaptation to various stress conditions. Furthermore, we investigated the effects of repeated exposure to PM₁₀ and DPM on DNA damage and cell death during viral infection. PM₁₀ and DPM did not cause stress granule formation in the absence of RSV infection but drastically increased stress granule formation and signal transduction during RSV infection in human lung epithelial cells and human lung organoids. Further, repeated exposure to PM₁₀ and DPM caused cell death by severely damaging DNA under RSV infection conditions. Thus, PM₁₀ and DPM induce severe lung toxicity under stress conditions, such as viral infection, suggesting that the effects of PMs under various stressful conditions should be examined to accurately predict the lung toxicity of PM.

Partitioning of reactive oxygen species from indoor surfaces to indoor aerosols

Reactive oxygen species (ROS) are among the species thought to be responsible for the adverse health effects of particulate matter (PM) inhalation. Field studies suggest that indoor sources of ROS contribute to measured ROS on PM in indoor air. We hypothesize that ozone reacts on indoor surfaces to form semi-volatile ROS, in particular organic peroxides (OPX), which partition to airborne particles. To test this hypothesis, we modeled ozone-induced formation of OPX, its decay and its partitioning to PM in a residential building and compared the results to field measurements. Simulations indicate that, while ROS of outdoor origin is the primary contributor to indoor ROS (in PM), a substantial fraction of ROS present in indoor PM is from ozone-surface chemistry. At an air change rate equal to 1/h, and an outdoor ozone mixing ratio of 35 ppb, 25% of the ROS concentration in air is due to indoor formation and partitioning of OPX to PM. For the same conditions, but with a modest indoor source of PM (1.5 mg h^-1), 44% of indoor ROS on PM is of indoor origin. An indoor source of ozone, such as an electrostatic air cleaner, also increases OPX present in indoor PM. The results of the simulations support the hypothesis that ozone-induced formation of OPX on indoor surfaces, and subsequent partitioning to aerosols, is sufficient to explain field observations. Therefore, indoor sourced ROS could contribute meaningfully to total inhaled PM-ROS.

Consequential Impact of Particulate Matter Linked Inter-Fibrillar Mitochondrial Dysfunction in Rat Myocardium Subjected to Ischemia Reperfusion Injury

A previous study has reported that exposure to PM_2.5 from diesel exhaust (diesel particulate matter (DPM)) for 21 days can deteriorate the cardiac recovery from myocardial ischemia reperfusion injury (IR), where the latter is facilitated by the efficiency of mitochondrial subpopulations. Many investigators have demonstrated that IR impact on cardiac mitochondrial subpopulations is distinct. In the present study, we decipher the role of PM_2.5 on IR associated mitochondrial dysfunction at the subpopulation level by administrating PM_2.5 directly to isolated female rat hearts via KH buffer. Our results demonstrated that PM_2.5 administered heart (PM_C) severely deteriorated ETC enzyme activity (NQR, SQR, QCR, and COX) and ATP level in both IFM and SSM from the normal control. Comparatively, the declined activity was prominent in IFM fraction. Moreover, in the presence of IR (PM_IR), mitochondrial oxidative stress was higher in both subpopulations from the normal, where the IFM fraction of mitochondria experienced elevated oxidative stress than SSM. Furthermore, we assessed the in vitro protein translation capacity of IFM and SSM and found a declined ability in both subpopulations where the inability of IFM was significant in both PM_C and PM_IR groups. In support of these results, the expression of mitochondrial genes involved in fission, fusion, and mitophagy events along with the DNA maintenance genes such as GUF1, LRPPRC, and HSD17-b10 were significantly altered from the control. Based on the above results, we conclude that PM_2.5 administration to the heart inflicted mitochondrial damage especially to the IFM fraction, that not only deteriorated the cardiac physiology but also reduced its ability to resist IR injury.

Deficiency of interleukin-6 receptor ameliorates PM2.5 exposure-induced pulmonary dysfunction and inflammation but not abnormalities in glucose homeostasis

BACKGROUND

Ambient fine particulate matter (PM_2.5) exposure increases local and systemic interleukin-6 (IL-6). However, the pathogenic role of IL-6 signalling following PM_2.5 exposure, particularly in the development of pulmonary dysfunction and abnormal glucose homeostasis, has hardly been investigated.

RESULTS

In the study, IL-6 receptor (IL-6R)-deficient (IL-6R^-/-) and wildtype littermate (IL-6R^+/+) mice were exposed to concentrated ambient PM_2.5 (CAP) or filtered air (FA), and their pulmonary and metabolic responses to these exposures were analyzed. Our results demonstrated that IL-6R deficiency markedly alleviated PM_2.5 exposure-induced increases in lung inflammatory markers including the inflammation score of histological analysis, the number of macrophages in bronchoalveolar lavage fluid (BALF), and mRNA expressions of TNFα, IL-1β and IL-6 and abnormalities in lung function test. However, IL-6R deficiency did not reduce the hepatic insulin resistance nor systemic glucose intolerance and insulin resistance induced by PM_2.5 exposure.

CONCLUSION

Our findings support the crucial role of IL-6 signalling in the development of pulmonary inflammation and dysfunction due to PM_2.5 exposure but question the putative central role of pulmonary inflammation for the extra-pulmonary dysfunctions following PM_2.5 exposure, providing a deep mechanistic insight into the pathogenesis caused by PM_2.5 exposure.

[Environment and cardiovascular health: causes, consequences and opportunities in prevention and treatment]

The environment is a strong determinant of cardiovascular health. Environmental cardiology studies the contribution of environmental exposures with the aim of minimizing the harmful influences of pollution and promoting cardiovascular health through specific preventive or therapeutic strategies. The present review focuses on particulate matter and metals, which are the pollutants with the strongest level of scientific evidence, and includes possible interventions. Legislation, mitigation and control of pollutants in air, water and food, as well as environmental policies for heart-healthy spaces, are key measures for cardiovascular health. Individual strategies include the chelation of divalent metals such as lead and cadmium, metals that can only be removed from the body via chelation. The TACT (Trial to Assess Chelation Therapy, NCT00044213) clinical trial demonstrated cardiovascular benefit in patients with a previous myocardial infarction, especially in those with diabetes. Currently, the TACT2 trial (NCT02733185) is replicating the TACT results in people with diabetes. Data from the United States and Argentina have also shown the potential usefulness of chelation in severe peripheral arterial disease. More research and action in environmental cardiology could substantially help to improve the prevention and treatment of cardiovascular disease.

Associations between long-term air pollution exposure and the incidence of cardiovascular diseases among American older adults

BACKGROUND & AIM

Numerous studies have linked air pollution with cardiovascular diseases. Fewer studies examined the associations at low concentration levels or assessed potential modifiers. Some investigations only examined hospitalizations, which can miss incident cases. This study aims to address these gaps through a nationwide cohort study of Medicare enrollees.

METHODS

Our study cohort comprise all Medicare enrollees (≥65 years old) continuously enrolled in the fee-for-service program and both Medicare part A and B across the contiguous U.S. from 2000 to 2016. We examined the associations of population-weighted ZIP code-level annual average PM2.5, NO2, and warm-season O3 (May-October), with the first diagnoses of atrial fibrillation (AF), congestive heart failure (CHF), and stroke. We fit multi-pollutant Cox proportional hazards models adjusted for individual demographic characteristics and area-level covariates. We further examined these associations at low pollutant concentration levels and the potential effect modifications by race/ethnicity and comorbidities (diabetes, hypertension, hyperlipidemia).

RESULTS

Elevated PM2.5 and NO2 levels were associated with increased incidence of AF, CHF, and stroke. For each 1 μg/m3 increase in annual PM2.5, hazard ratios (HRs) were 1.0059 (95%CI: 1.0054-1.0064), 1.0260 (95%CI: 1.0256-1.0264), and 1.0279 (95%CI: 1.0274-1.0284), respectively. For each1 ppb increase in annual NO2, HRs are 1.0057 (95%CI: 1.0056-1.0059), 1.0112 (95%CI: 1.0110-1.0113), and 1.0095 (95%CI: 1.0093-1.0096), respectively. For warm-season O3, each 1 ppb increase was associated with increased incidence of CHF (HR=1.0035, 95%CI: 1.0033-1.0037) and stroke (HR=1.0026, 95%CI: 1.0023-1.0028). Larger magnitudes of HRs were observed when restricted to pollutants levels lower than NAAQS standards. Generally higher risks were observed for Black people and diabetics.

CONCLUSIONS

Long-term exposure to PM2.5, NO2, and warm-season O3 were associated with increased incidence of cardiovascular diseases, even at low pollutant concentration levels. Black people and people with diabetes were found to be vulnerable populations.

Environment and cardiovascular health: causes, consequences and opportunities in prevention and treatment

The environment is a strong determinant of cardiovascular health. Environmental cardiology studies the contribution of environmental exposures with the aim of minimizing the harmful influences of pollution and promoting cardiovascular health through specific preventive or therapeutic strategies. The present review focuses on particulate matter and metals, which are the pollutants with the strongest level of scientific evidence, and includes possible interventions. Legislation, mitigation and control of pollutants in air, water and food, as well as environmental policies for heart-healthy spaces, are key measures for cardiovascular health. Individual strategies include the chelation of divalent metals such as lead and cadmium, metals that can only be removed from the body via chelation. The TACT (Trial to Assess Chelation Therapy, NCT00044213) clinical trial demonstrated cardiovascular benefit in patients with a previous myocardial infarction, especially in those with diabetes. Currently, the TACT2 trial (NCT02733185) is replicating the TACT results in people with diabetes. Data from the United States and Argentina have also shown the potential usefulness of chelation in severe peripheral arterial disease. More research and action in environmental cardiology could substantially help to improve the prevention and treatment of cardiovascular disease.

Chronic Exposure to Fine Particulate Matter Increases Mortality Through Pathways of Metabolic and Cardiovascular Disease: Insights From a Large Mediation Analysis

Background Long-term exposure to outdoor fine particulate matter (PM2.5) is the leading environmental risk factor for premature mortality worldwide. Characterizing important pathways through which PM2.5 increases individuals' mortality risk can clarify the PM2.5-mortality relationship and identify possible points of interventions. Recent evidence has linked PM2.5 to the onset of diabetes and cardiovascular disease, but to what extent these associations contribute to the effect of PM2.5 on mortality remains poorly understood. Methods and Results We conducted a population-based cohort study to investigate how the effect of PM2.5 on nonaccidental mortality is mediated by its impacts on incident diabetes, acute myocardial infarction, and stroke. Our study population comprised ≈200 000 individuals aged 20 to 90 years who participated in population-based health surveys in Ontario, Canada, from 1996 to 2014. Follow-up extended until December 2017. Using causal mediation analyses with Aalen additive hazards models, we decomposed the total effect of PM2.5 on mortality into a direct effect and several path-specific indirect effects mediated by diabetes, each cardiovascular event, or both combined. A series of sensitivity analyses were also conducted. After adjusting for various individual- and neighborhood-level covariates, we estimated that for every 1000 adults, each 10 μg/m3 increase in PM2.5 was associated with ≈2 incident cases of diabetes, ≈1 major cardiovascular event (acute myocardial infarction and stroke combined), and ≈2 deaths annually. Among PM2.5-related deaths, 31.7% (95% CI, 17.2%-53.2%) were attributable to diabetes and major cardiovascular events in relation to PM2.5. Specifically, 4.5% were explained by PM2.5-induced diabetes, 22.8% by PM2.5-induced major cardiovascular events, and 4.5% through their interaction. Conclusions This study suggests that a significant portion of the estimated effect of long-term exposure to PM2.5 on deaths can be attributed to its effect on diabetes and cardiovascular diseases, highlighting the significance of PM2.5 on deteriorating cardiovascular health. Our findings should raise awareness among professionals that improving metabolic and cardiovascular health may reduce mortality burden in areas with higher exposure to air pollution.

Carbonaceous Nanoparticle Air Pollution: Toxicity and Detection in Biological Samples

Among the different air pollutants, particulate matter (PM) is of great concern due to its abundant presence in the atmosphere, which results in adverse effects on the environment and human health. The different components of PM can be classified based on their physicochemical properties. Carbonaceous particles (CPs) constitute a major fraction of ultrafine PM and have the most harmful effects. Herein, we present a detailed overview of the main components of CPs, e.g., carbon black (CB), black carbon (BC), and brown carbon (BrC), from natural and anthropogenic sources. The emission sources and the adverse effects of CPs on the environment and human health are discussed. Particularly, we provide a detailed overview of the reported toxic effects of CPs in the human body, such as respiratory effects, cardiovascular effects, neurodegenerative effects, carcinogenic effects, etc. In addition, we also discuss the challenges faced by and limitations of the available analytical techniques for the qualitative and quantitative detection of CPs in atmospheric and biological samples. Considering the heterogeneous nature of CPs and biological samples, a detailed overview of different analytical techniques for the detection of CPs in (real-exposure) biological samples is also provided. This review provides useful insights into the classification, toxicity, and detection of CPs in biological samples.

Association Between Long-term Ambient PM2.5 Exposure and Cardiovascular Outcomes Among US Hemodialysis Patients

RATIONALE & OBJECTIVE

Ambient PM_2.5 (particulate matter with a diameter of 2.5 microns) is a ubiquitous air pollutant with established adverse cardiovascular (CV) effects. However, quantitative estimates of the association between PM_2.5 exposure and CV outcomes in the setting of kidney disease are limited. This study assessed the association of long-term PM_2.5 exposure with CV events and cardiovascular disease (CVD)-specific mortality among patients receiving maintenance in-center hemodialysis (HD).

STUDY DESIGN

Retrospective cohort study.

SETTINGS & PARTICIPANTS

314,079 adult kidney failure patients initiating HD between 2011 and 2016 identified from the US Renal Data System.

EXPOSURE

Estimated daily ZIP code-level PM_2.5 concentrations were used to calculate each participant's annual average PM_2.5 exposure based on the dialysis clinics visited during the 365 days before the outcome.

OUTCOME

CV event and CVD-specific mortality were ascertained based on ICD-9/ICD-10 diagnostic codes and recorded cause of death from Centers for Medicare & Medicaid Services form 2746.

ANALYTICAL APPROACH

Discrete time hazards models were used to estimate hazards ratios per 1 μg/m³ greater annual average PM_2.5, adjusting for temperature, humidity, day of the week, season, age at baseline, race, employment status, and geographic region. Effect measure modification was assessed for age, sex, race, and baseline comorbidities.

RESULTS

Each 1 μg/m³ greater annual average PM_2.5 was associated with a greater rate of CV events (HR, 1.02 [95% CI, 1.01-1.02]) and CVD-specific mortality (HR, 1.02 [95% CI, 1.02-1.03]). The association was more pronounced for people who initiated dialysis at an older age, had chronic obstructive pulmonary disease (COPD) at baseline, or were Asian. Evidence of effect modification was also observed across strata of race, and other baseline comorbidities.

LIMITATIONS

Potential exposure misclassification and unmeasured confounding.

CONCLUSIONS

Long-term ambient PM_2.5 exposure was associated with CVD outcomes among patients receiving maintenance in-center HD. Stronger associations between long-term PM_2.5 exposure and adverse effects were observed among patients who were of advanced age, had COPD, or were Asian.

PLAIN-LANGUAGE SUMMARY

Long-term exposure to air pollution, also called PM_2.5, has been linked to adverse cardiovascular outcomes. However, little is known about the association of PM_2.5 and outcomes among patients receiving dialysis, who are individuals with high cardiovascular disease burdens. We conducted an epidemiological study to assess the association between the annual PM_2.5 exposure and cardiovascular events and death among patients receiving regular outpatient hemodialysis in the United States between 2011 and 2016. We found a higher risk of heart attacks, strokes, and related events in patients exposed to higher levels of air pollution. Stronger associations between air pollution and adverse health events were observed among patients who were older at the start of dialysis, had chronic obstructive pulmonary disease, or were Asian. These findings bolster the evidence base linking air pollution and adverse health outcomes and may inform policy makers and clinicians.