Long-Term PM2.5 Exposure and Respiratory, Cancer, and Cardiovascular Mortality in Older US Adults

Low Levels of Air Pollution and Health: Effect Estimates, Methodological Challenges, and Future Directions

PURPOSE OF REVIEW

Fine particle (PM2.5) levels have been decreasing in the USA over the past decades. Our goal was to assess the current literature to characterize the association between PM2.5 and adverse health at low exposure levels.

RECENT FINDINGS

We reviewed 26 papers that examined the association between short- and long-term exposure to PM2.5 and cardio-respiratory morbidity and mortality. There is evidence suggesting that these associations are stronger at lower levels. However, there are certain methodological and interpretational limitations specific to studies of low PM2.5 levels, and further methodological development is warranted. There is strong agreement across studies that air pollution effects on adverse health are still observable at low concentrations, even well below current US standards. These findings suggest that US standards need to be reevaluated, given that further improving air quality has the potential of benefiting public health.

The effect of exposure time and concentration of airborne PM2.5 on lung injury in mice: A transcriptome analysis

The association between airborne fine particulate matter (PM2.5) concentration and the risk of respiratory diseases has been well documented by epidemiological studies. However, the mechanism underlying the harmful effect of PM2.5 has not been fully understood. In this study, we exposed the C57BL/6J mice to airborne PM2.5 for 3 months (mean daily concentration ~50 or ~110 μg/m3, defined as PM2.5-3L or PM2.5-3H) or 6 months (mean daily concentration ~50 μg/m3, defined as PM2.5-6L) through a whole-body exposure system. Histological and biochemical analysis revealed that PM2.5-3H exposure caused more severe lung injury than did PM2.5-3L, and the difference was greater than that of PM2.5-6L vs PM2.5-3L exposure. With RNA-sequencing technique, we found that the lungs exposed with different concentration of PM2.5 have distinct transcriptional profiles. PM2.5-3H exposure caused more differentially expressed genes (DEGs) in lungs than did PM2.5-3L or PM2.5-6L. The DEGs induced by PM2.5-3L or PM2.5-6L exposure were mainly enriched in immune pathways, including Hematopoietic cell lineage and Cytokine-cytokine receptor interaction, while the DEGs induced by PM2.5-3H exposure were mainly enriched in cardiovascular disease pathways, including Hypertrophic cardiomyopathy and Dilated cardiomyopathy. In addition, we found that upregulation of Cd5l and reduction of Hspa1 and peroxiredoxin-4 was associated with PM2.5-induced pulmonary inflammation and oxidative stress. These results may provide new insight into the cytotoxicity mechanism of PM2.5 and help to development of new strategies to attenuate air pollution associated respiratory disease.

Long-term exposure to atmospheric metals assessed by mosses and mortality in France

BACKGROUND

Long-term exposure to air pollution affects health, but little is known about exposure to atmospheric metals. Estimating exposure to atmospheric metals across large spatial areas remains challenging. Metal concentrations in mosses could constitute a useful proxy. Here, we linked moss biomonitoring and epidemiological data to investigate the associations between long-term exposure to metals and mortality.

METHODS

We modelled and mapped 13 atmospheric metals from a 20-year national moss biomonitoring program to derive exposure estimates across France. In the population-based Gazel cohort, we included 11,382 participants from low to intermediate population density areas and assigned modelled metals to their residential addresses. We distinguished between airborne metals that are primarily of natural origin and those primarily of anthropogenic origin. Associations were estimated between exposure to metals and mortality (natural-cause, cardiovascular and respiratory), using Cox models, with confounder adjustment at individual level.

FINDINGS

Between 1996 and 2017, there were 1313 deaths in the cohort (including 181 cardiovascular and 33 respiratory). Exposure to the anthropogenic metals was associated with an increased risk of natural-cause mortality (hazard ratio of 1.16 [1.08-1.24] per interquartile range of exposure), while metals from natural sources were not.

INTERPRETATION

Some atmospheric anthropogenic metals may be associated with excess mortality - even in areas with relatively low levels of exposure to air pollution. Consistent with the previous literature, our findings support the use of moss biomonitoring as a tool to assess health effects of air pollution exposure at individual level.

Health symptoms among adults living near a coal-burning power plant

Coal ash is a waste product generated when coal is burned for energy. The purpose of this study was to assess health symptoms in adults living near a coal-burning power plant and compare the symptoms to a non-exposed population. A community-based mixed methods study was conducted with four neighborhoods adjacent to a coal-burning power plant. The comparison population was not exposed to coal ash and did not live near a coal-burning power plant. Adults who lived near the coal-burning power plant were significantly more likely to suffer from respiratory (AOR = 5.27, 95% CI = 2.16-12.0), gingiva (AOR = 2.46, 95% CI = 1.46-4.15), and skin symptoms (AOR = 3.37, 95% CI = 2.09-5.43). Results suggest that health symptoms may develop in people living near coal-burning power plants.

LncRNA MALAT1, an lncRNA acting via the miR-204/ZEB1 pathway, mediates the EMT induced by organic extract of PM2.5 in lung bronchial epithelial cells

Extensive cohort studies have explored the hazards of particulate matter with aerodynamic diameter 2.5 μm or smaller (PM2.5) to human respiratory health; however, the molecular mechanisms for PM2.5 carcinogenesis are poorly understood. Long non-coding RNAs (lncRNAs) are involved in various pathophysiological processes. In the present study, we investigated the effect of PM2.5 on the epithelial-mesenchymal transition (EMT) in lung bronchial epithelial cells and the underlying mechanisms mediated by an lncRNA. Organic extracts of PM2.5 from Shanghai were used to treat human bronchial epithelial cell lines (HBE and BEAS-2B). The PM2.5 organic extracts induced the EMT and cell transformation. High levels of metastasis-associated lung adenocarcinoma transcript 1 (MALAT1), mediated by NF-κB, were involved in the EMT process. For both cell lines, there was a similar response. In addition, MALAT1 interacted with miR-204 and reversed the inhibitory effect of its target gene, ZEB1, thereby contributing to the EMT and malignant transformation. In sum, these findings show that NF-κB transcriptionally regulates MALAT1, which, by binding with miR-204 and releasing ZEB1, promotes the EMT. These results offer an understanding of the regulatory network of the PM2.5-induced EMT that relates to the health risks associated with PM2.5.

The association of PM2.5 with airway innate antimicrobial activities of salivary agglutinin and surfactant protein D

Fine particulate matter ≤2.5 μm (PM_2.5) is a prominent global public health risk factor that can cause respiratory infection by downregulating the amounts of antimicrobial proteins and peptides (AMPs). Both salivary agglutinin (SAG) and surfactant protein D (SPD) are important AMPs in respiratory mucosal fluid, providing protection against airway pathogen invasion and infection by inducing microbial aggregation and enhancing pathogen clearance. However, the relationship between PM_2.5 and these AMPs is unclear. To better understand the relationship between PM_2.5 and airway innate immune defenses, we review the respiratory antimicrobial activities of SAG and SPD, as well as the adverse effects of PM_2.5 on airway innate antimicrobial defense. We speculate there exists a dual effect between PM_2.5 and respiratory antimicrobial activity, which means that PM_2.5 suppresses respiratory antimicrobial activity through downregulating airway AMPs, while airway AMPs accelerate PM_2.5 clearance by inducing PM_2.5 microbial aggregation. We propose further research on the relationship between PM_2.5 and these AMPs.

Determination of endogenous substance change in PM2.5-induced rat plasma and lung samples by UPLC-MS/MS method to identify potential markers for lung impairment

Exposure to fine particulate matter (PM_2.5) could induce lung impairment aggravation. Moreover, endogenous substances are known to play a significant role in lung impairment. Therefore, the research objectives was to investigate the influence of PM_2.5-induced lung impairment on the levels of the eight endogenous substances, γ-aminobutyric acid (GABA), acetylcholine (ACh), glutamate (Glu), serotonin (5-HT), 5-hydroxyindole-3-acetic acid (5-HIAA), noradrenaline (NE), dopamine (DA), and 3, 4-dihydroxyphenylacetic acid (DOPAC). A sensitive UPLC-MS/MS method for the simultaneous determination of these endogenous substances in rat plasma and lung tissues was developed. The validated method was successfully applied for comparing profiles of analytes in rat plasma and lung tissues. The results indicated that five endogenous substances, namely, GABA, Ach, Glu, DA, and DOPAC, had a significant change in the rats with PM_2.5-induced lung impairment.

[Flu-like disease in summer - what do we know about it?]

Durchsucht man die deutschsprachige medizinische Literatur nach dem Begriff „Sommergrippe“, scheitert man kläglich. Jeder glaubt zu wissen, was damit gemeint ist, doch keiner schreibt darüber. Ist das überhaupt ein seriöses Thema?

Wildland firefighter smoke exposure and risk of lung cancer and cardiovascular disease mortality

Wildland firefighters are exposed to wood smoke, which contains hazardous air pollutants, by suppressing thousands of wildfires across the U. S. each year. We estimated the relative risk of lung cancer and cardiovascular disease mortality from existing PM_2.5 exposure-response relationships using measured PM₄ concentrations from smoke and breathing rates from wildland firefighter field studies across different exposure scenarios. To estimate the relative risk of lung cancer (LC) and cardiovascular disease (CVD) mortality from exposure to PM_2.5 from smoke, we used an existing exposure-response (ER) relationship. We estimated the daily dose of wildfire smoke PM_2.5 from measured concentrations of PM₄, estimated wildland firefighter breathing rates, daily shift duration (hours per day) and frequency of exposure (fire days per year and career duration). Firefighters who worked 49 days per year were exposed to a daily dose of PM₄ that ranged from 0.15 mg to 0.74 mg for a 5- and 25-year career, respectively. The daily dose for firefighters working 98 days per year of PM₄ ranged from 0.30 mg to 1.49 mg. Across all exposure scenarios (49 and 98 fire days per year) and career durations (5-25 years), we estimated that wildland firefighters were at an increased risk of LC (8 percent to 43 percent) and CVD (16 percent to 30 percent) mortality. This unique approach assessed long term health risks for wildland firefighters and demonstrated that wildland firefighters have an increased risk of lung cancer and cardiovascular disease mortality.

Effect and threshold of PM2.5 on population mortality in a highly polluted area: a study on applicability of standards

For assessing the effect and threshold of PM_2.5 on mortality in highly polluted areas and further studying the standard applicability, daily data on meteorological factors, air pollutants, and mortality were obtained in Jinan, China, from 2011 to 2017. A generalized additive model (GAM) and a distributed lag non-linear model (DLNM) were employed to assess the nonlinearity and the hysteresis of associations. We further explored the breakpoints to evaluate the existence of the threshold. The correlation between mortality and PM_2.5 was nonlinear. The impact of average PM_2.5 on non-accidental mortality (RR = 1.11; 95% CI = 1.06, 1.16), cardiovascular disease (CVD) mortality (RR = 1.17; 95% CI = 1.10, 1.24), and respiratory disease (RD) mortality (RR = 1.17; 95% CI = 1.10, 1.24) reached the highest in the current day (lag 0). The excess risks of PM_2.5 at secondary standard level to non-accidental, CVD, and RD mortality are 8.79% (95% CI = 3.84, 13.98), 14.41% (95% CI = 7.79, 21.43), 15.35% (95% CI = 1.76, 30.74), respectively. The saturation points exist in highly polluted areas. Above the saturation points of 247 μg/m³ for non-accidental mortality, 245 μg/m³ for CVD mortality, and 250 μg/m³ for RD mortality, the model of all three relationships presented a harvesting effect. This study underscores the necessity of the ongoing efforts of reducing particulate air pollution and the adjustment of the standards in seriously polluted areas to adapt to regional conditions. At the same time, for highly polluted areas, it is advocated to strengthen personal protection to decrease the saturation point and control the concentration of pollutants as much as possible, which will substantially save more cost that benefits the public.

Compromised Air Quality and Healthcare Safety from Smoking inside Hospitals in Shantou, China

Achieving smoke-free healthcare facilities remains a great challenge in countries with a high smoking prevalence and weak regulation. Assessment of the impact of environmental tobacco smoke (ETS) and its constituent PM_2.5 on the air quality in Chinese hospitals has not been reported. In this study, we conducted air quality surveys by measuring real-time PM_2.5 concentrations with Dylos Air Quality Monitors in five tertiary hospitals in Shantou, China during summer (July-August 2016) and winter (November-February 2017). Twenty-eight-day surveys inside the hospitals showed median PM_2.5 concentrations above the China Air Quality Standard in elevator lobbies (51.0 μg/m³, IQR 34.5-91.7), restrooms (40.2, 27.1-70.3), and corridors (36.5, 23.0-77.4). Evidence of tobacco smoking was significantly associated with PM_2.5 spikes observed in all the survey locations, contributing to the air quality undesirable for health in 49.1% of total survey hours or 29.3% of summer and 75.4% of winter survey hours inside the buildings, and 33.5%, 25.7%, and 6.8% of survey hours in doctor offices, nurse stations, and patient rooms, respectively. In conclusion, smoking inside hospitals induces PM_2.5 spikes that significantly compromise the air quality and impose significant health risk to the hospital inhabitants. Reinforcing comprehensive smoking ban with the vested interest of all stakeholders followed by creative disciplinary actions are suggested to ensure healthcare safety.

Long-term exposure to fine particulate matter and natural-cause and cause-specific mortality in Japan

Supplemental Digital Content is available in the text.

Background:

A number of studies have linked long-term exposure to particulate matter with aerodynamic diameter <2.5 µm (PM_2.5) with mortality, but most of these studies were conducted in Europe and North America. Studies in Asian countries had been conducted at relatively high exposures. We evaluated the association of long-term exposure to PM_2.5 and natural-cause and cause-specific mortality in Japan, where PM_2.5 levels are relatively low compared with levels in other Asian countries.

Methods:

A cohort of 75,531 participants underwent basic health checkups in Okayama City in 2006 or 2007. We followed the participants until the end of 2016. Average PM_2.5 levels from 2006 to 2010 were obtained and assigned to the participants by geographical location. We used the Cox proportional hazard models to estimate hazard ratios for a 5-μg/m³ increase in PM_2.5 levels for natural-cause or cause-specific mortality, adjusting for potential confounders.

Results:

PM_2.5 exposure was associated with increased risk of mortality; the hazard ratios were 1.29 (95% confidence interval = 1.18, 1.41) for mortality from natural causes, 1.16 (1.02, 1.32) for cardiorespiratory mortality, and 1.63 (1.13, 2.34) for lung cancer mortality. PM_2.5 exposure was more strongly associated with cardiorespiratory mortality from hypertension, pneumonia and influenza, and chronic obstructive pulmonary disease than with ischemic heart disease or cerebrovascular disease. Elderly participants and smokers tended to have higher effect estimates.

Conclusion:

Long-term exposure to PM_2.5 can increase the risk of natural-cause, cardiorespiratory, and lung cancer mortality in Japan.

Different health effects of indoor- and outdoor-originated PM2.5 on cardiopulmonary function in COPD patients and healthy elderly adults

Numerous research has explored the associations of outdoor or indoor fine particulate matter (PM_2.5 ) and health effects; however, few studies compared the effects of indoor PM_2.5 originated from outdoor (PM_2.5,os ) and indoor sources (PM_2.5,is ). To assess the associations of PM_2.5,os and PM_2.5,is with cardiopulmonary function in patients with chronic obstructive pulmonary disease (COPD) and healthy elderly adults, blood pressure (BP) and pulmonary function were repeatedly examined in 43 COPD patients and their 32 healthy spouses in Beijing, China. Iron was used as tracer element to separate PM_2.5,os and PM_2.5,is . Mixed-effects models were applied to assess the associations of PM_2.5,os or PM_2.5,is and health effects after controlling for potential confounders. There was a reduction in forced expiratory volume in first second (FEV₁ ) in COPD patients associated with PM_2.5,is during the heating season. PM_2.5,os was positively associated with diastolic BP (DBP) in healthy elderly adults during the heating season. There was a reduction in peak expiratory flow (PEF) in healthy elderly adults associated with PM_2.5,os during the non-heating season. Exposure to indoor- and outdoor-originated PM_2.5 had different health effects on cardiopulmonary function in different populations. The results provide supporting evidence for improving indoor air quality to promote public health among susceptible population.

Long-term NO2 exposures and cause-specific mortality in American older adults

BACKGROUND

The impact of long-term exposure to nitrogen dioxide (NO₂) on cause-specific mortality is poorly understood.

OBJECTIVE

To assess mortality risks associated with long-term NO₂ exposure and evaluate confounding of this association.

METHODS

We examined the association between 12-month moving average NO₂ exposure and cause-specific mortality in 14.1 million US Medicare beneficiaries between 2000 and 2008. Associations were examined using age, gender, and race-stratified and state-adjusted Poisson regression models. We assessed the potential for confounding by PM_2.5 and behavioral covariates and unmeasured confounding by decomposing NO₂ into its spatial and spatio-temporal components.

RESULTS

We found significant associations between 12-month NO₂ exposure and increased mortality from all-causes [risk ratio (RR): 1.052; 95% CI: 1.051, 1.054; per 10 ppb], cardiovascular (CVD) (1.133; 95% CI: 1.130, 1.137) and respiratory disease (1.050; 95% CI: 1.044, 1.056), all cancers (1.021; 95% CI: 1.017, 1.025), ischemic heart disease (IHD) (1.221; 95% CI: 1.217, 1.226), cerebrovascular (CBV) disease (1.092; 95% CI: 1.085, 1.100), and for the first time pneumonia (1.275; 95% CI: 1.263, 1.287). Associations generally remained positive and statistically significant after adjustment for PM_2.5 and behavioral factors.

CONCLUSIONS

Our findings provide additional evidence of the increased risk posed by long-term NO₂ exposures on increased mortality from all-causes, CVD, respiratory disease, IHD, CBV, and cancer and provide new evidence of their impact on mortality from pneumonia. Unmeasured confounding of these associations was present, however, demonstrating the need to understand sources of this confounding.

Fine particulate matter induces mitochondrial dysfunction and oxidative stress in human SH-SY5Y cells

Exposure to ambient fine particulate matter (PM_2.5) is associated with neurodegenerative diseases. Mitochondrion is key to brain degeneration. However, the underlying mechanism of PM_2.5-induced brain injury, especially mitochondrial damage, is still unclear. In this study, changes in mitochondrial dynamics, mitochondrial permeability transition pore (mPTP), mitochondrial DNA (mtDNA) and oxidative stress in human SH-SY5Y cells exposed to PM_2.5 at different concentrations (0, 25, 100, and 250 μg mL^-1) were investigated. The results showed that PM_2.5 caused more mitochondrial swell, accompanied by the opening of mPTP and the decrease of ATP levels, mitochondrial membrane potential and mtDNA copy number in SH-SY5Y cells. PM_2.5 significantly enhanced the expression of mitochondrial fission/fusion genes (Drp1 and OPA1) and affected the gene expression of CypD, SIRT3, and COX Ⅳ in SH-SY5Y cells. Besides, PM_2.5 triggered the increase of cellular ROS, Ca²⁺ and Aβ-42 levels, inhibition of manganese-superoxide dismutase (SOD₂) activities, reduction of GSH levels GSH/GSSG ratio, and elevation of mitochondrial malondialdehyde contents. It suggests that mitochondrial dysfunction and oxidative stress are the potential mechanisms underlying PM_2.5-induced brain nerve cell injury, which may be related to neurological diseases. Additionally, our study elucidated that PM_2.5 components trigger different cytotoxicity.

Fine Particulate Air Pollution and Hospital Utilization for Upper Respiratory Tract Infections in Beijing, China

Few studies have examined the association between fine particulate matter (PM_2.5) and upper respiratory tract infections (URTI) in urban cities. The principal aim of the present study was to evaluate the short-term impact of PM_2.5 on the incidence of URTI in Beijing, China. Data on hospital visits due to URTI from 1 October 2010 to 30 September 2012 were obtained from the Beijing Medical Claim Data for Employees, a health insurance database. Daily PM_2.5 concentration was acquired from the embassy of the United States of America (US) located in Beijing. A generalized additive Poisson model was used to analyze the effect of PM_2.5 on hospital visits for URTI. We found that a 10 μg/m³ increase in PM_2.5 concentration was associated with 0.84% (95% CI, 0.05⁻1.64%) increase in hospital admissions for URTI at lag 0⁻3 days, but there were no significant associations with emergency room or outpatient visits. Compared to females, males were more likely to be hospitalized for URTI when the PM_2.5 level increased, but other findings did not differ by age group or gender. The study suggests that short-term variations in PM_2.5 concentrations have small but detectable impacts on hospital utilization due to URTI in adults.

Inhibition of ATP citrate lyase (ACLY) protects airway epithelia from PM2.5-induced epithelial-mesenchymal transition

Epidemiological studies have associated ambient fine particulate matter (PM_2.5) exposure with lung cancer, in which epithelial-mesenchymal transition (EMT) is an initial process. Thus, it is important to identify the key molecule or pathway involved in the PM_2.5 induced EMT. Human bronchial epithelial (HBE) cells were exposed to PM_2.5 (100 or 500 μg/ml) for 30 passages and analyzed by metabolomics to identify the alteration of metabolites related to PM_2.5 exposure. The expression levels of EMT markers were evaluated by qRT-PCR and Western blot assays in HBE cells and murine lung tissues. Reduced epithelial markers, increased mesenchymal markers expression levels and increased capacity of metastasis were observed in PM_2.5-exposed HBE cells. Metabolomics analysis suggested upregulation of citrate acid with fold change (FC) of 2.89 or 4.18 in 100 or 500 μg/ml PM_2.5 treated HBE cells. For both of the in vitro and in vivo study, the up-regulation of ATP citrate lyase (ACLY) was confirmed following PM_2.5 exposure. Importantly, ACLY knockdown in HBE cells reversed EMT, migration and invasion capacities in HBE cells induced by PM_2.5. Taken together, our data suggest that inhibition of ACLY demonstrates a protection against PM_2.5-induced EMT, providing a concern on the molecular mechanisms of PM_2.5-associated pulmonary disorders.

Association Between Outdoor Air Pollution Levels and Inpatient Outcomes in Pediatric Pneumonia Hospitalizations, 2007 to 2008

OBJECTIVE

Pneumonia is a leading cause of pediatric admissions. Although air pollutants are associated with poor outcomes, few national studies have examined associations between pollutant levels and inpatient pediatric pneumonia outcomes. We examined the relationship between ozone (O₃) and fine particulate matter with a diameter ≤2.5 µm (PM_2.5) and outcomes related to disease severity.

METHODS

In this cross-sectional study, we obtained discharge data from the 2007 to 2008 Nationwide Inpatient Sample and pollution data from the Air Quality System. Patients ≤18years with a principal diagnosis of pneumonia were included. Discharge data were linked to O₃ and PM_2.5 levels (predictors) from the patient's ZIP Code (not publicly available) from day of admission. Outcomes were mortality, intubation, length of stay (LOS), and total costs. We calculated weighted national estimates and performed multivariable analyses adjusting for sociodemographic and hospital factors.

RESULTS

There were a total of 57,972 (278,871 weighted) subjects. Median PM_2.5 level was 9.5 (interquartile range [IQR] 6.8-13.4) µg/m³. Median O₃ level was 35.6 (IQR 28.2-45.2) parts per billion. Mortality was 0.1%; 0.75% of patients were intubated. Median LOS was 2 (IQR 2-4) days. Median costs were $3089 (IQR $2023-$5177). Greater levels of PM_2.5 and O₃ were associated with mortality, longer LOS, and greater costs. Greater O₃ levels were associated with increased odds of intubation.

CONCLUSIONS

Greater levels of O₃ and PM_2.5 were associated with more severe presentations of pneumonia. Future work should examine these relationships in more recent years and over a longer time period.

Early warning signals for critical transitions in cardiopulmonary health, related to air pollution in an urban Chinese population

Respiratory, and cardio-cerebrovascular health-related diseases significantly threaten human health and together with air pollution form a complex pathophysiological system. Other complex biological systems show that increased variance and autocorrelations in time series may act as valid early warning signals for critical transitions. On population level, we determined the likelihood that increased variance and autocorrelation of hospital visit on cardiopulmonary disease preceded critical transitions in population health by human-pollution interactions. We investigated long-term hospital visits from a hospital in Nanjing City, China during 2006-2016 for the most important cardiopulmonary diseases likely to be influenced by air pollution: cerebrovascular accident disease (CVAD), coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), lung cancer disease (LCD), and the grouped categories of respiratory system disease (RESD) and cardio-cerebrovascular system disease (CCD). The time series of standard deviations (SDs) and autocorrelation at-lag-1 (AR-1) were studied as potential Early-Warning Indicators (EWIs) of transitions in population health. Elevated SDs provided an early warning for critical transitions in visit for LCD and overall CCD and CVAD, for the period of 2012-2013, after which a real transition of increased visit occurred for these disease categories. Statistical testing showed that these SDs were significantly increased (p < 0.1). The long-term air pollution together with intermittent pollution episodes may have triggered critical transitions in population health for cardiopulmonary disease. It is recommended to consider significant increases in variability in time series of relevant system parameters, such as visit, as early warning signs for future transitions in populations' health states.

Long-Term Exposure to Air Pollutants and Cancer Mortality: A Meta-Analysis of Cohort Studies

The aim of this study was to examine the relationship between main air pollutants and all cancer mortality by performing a meta-analysis. We searched PubMed, EMBASE (a biomedical and pharmacological bibliographic database of published literature produced by Elsevier), and the reference lists of other reviews until April 2018. A random-effects model was employed to analyze the meta-estimates of each pollutant. A total of 30 cohort studies were included in the final analysis. Overall risk estimates of cancer mortality for 10 µg/m³ per increase of particulate matter (PM)2.5, PM10, and NO₂ were 1.17 (95% confidence interval (CI): 1.11⁻1.24), 1.09 (95% CI: 1.04⁻1.14), and 1.06 (95% CI: 1.02⁻1.10), respectively. With respect to the type of cancer, significant hazardous influences of PM2.5 were noticed for lung cancer mortality and non-lung cancer mortality including liver cancer, colorectal cancer, bladder cancer, and kidney cancer, respectively, while PM10 had harmful effects on mortality from lung cancer, pancreas cancer, and larynx cancer. Our meta-analysis of cohort studies indicates that exposure to the main air pollutants is associated with increased mortality from all cancers.

Satellite-based short- and long-term exposure to PM2.5 and adult mortality in urban Beijing, China

Severe and persistent haze accompanied by high concentrations of fine particulate matter (PM_2.5) has become a great public health concern in urban China. However, research on the health effects of PM_2.5 in China has been hindered by the lack of high-quality exposure estimates. In this study, we assessed the excess mortality associated with both short- and long-term exposure to ambient PM_2.5 simultaneously using satellite-derived exposure data at a high spatiotemporal resolution. Adult registries of non-accidental, respiratory and cardiovascular deaths in urban Beijing in 2013 were collected. Exposure levels were estimated from daily satellite-based PM_2.5 concentrations at 1 km spatial resolution from 2004 to 2013. Mixed Poisson regression models were fitted to estimate the cause-specific mortality in association with PM_2.5 exposures. With the mutual adjustment of short- and long-term exposure of PM_2.5, the percent increases associated with every 10 μg/m³ increase in short-term PM_2.5 exposure were 0.09% (95% CI: -0.14%, 0.33%; lag 01), 1.02% (95% CI: 0.08%, 1.97%; lag 04) and 0.09% (95% CI: -0.23%, 0.42%; lag 01) for non-accidental, respiratory and cardiovascular mortality, respectively; those attributable to every 10 μg/m³ increase in long-term PM_2.5 exposure (9-year moving average) were 16.78% (95% CI: 10.58%, 23.33%), 44.14% (95% CI: 20.73%, 72.10%) and 3.72% (95% CI: -3.75%, 11.77%), respectively. Both associations of short- and long-term exposure with the cause-specific mortality decreased after they were mutually adjusted. Associations between short-term exposure to satellite-based PM_2.5 and cause-specific mortality were larger than those estimated using fixed measurements. Satellite-based PM_2.5 predictions help to improve the spatiotemporal resolution of exposure assessments and the mutual adjustment model provide better estimation of PM_2.5 associated health effects. Effects attributable to long-term exposure of PM_2.5 were larger than those of short-term exposure, which should be more concerned for public health.

Methodological factors influencing inhalation bioaccessibility of metal(loid)s in PM2.5 using simulated lung fluid

In this study, methodological factors influencing the dissolution of metal(loid)s in simulated lung fluid (SLF) was assessed in order to develop a standardised method for the assessment of inhalation bioaccessibility in PM_2.5. To achieve this aim, the effects of solid to liquid (S/L) ratio (1:100 to 1:5000), agitation (magnetic agitation, occasional shaking, orbital and end-over-end rotation), composition of SLF (artificial lysosomal fluid: ALF; phagolysosomal simulant fluid: PSF) and extraction time (1-120 h) on metal(loid) bioaccessibility were investigated using PM_2.5 from three Australian mining/smelting impacted soils and a certified reference material. The results highlighted that SLF composition significantly (p < 0.001) influenced metal(loid) bioaccessibility and that when a S/L ratio of 1:5000 and end-over-end rotation was used, metal(loid) solubility plateaued after approximately 24 h. Additionally, in order to assess the exposure of metal(loid)s via incidental ingestion of surface dust, PM_2.5 was subjected to simulated gastro-intestinal tract (GIT) solutions and the results were compared to extraction using SLF. Although As bioaccessibility in SLF (24 h) was significantly lower than in simulated GIT solutions (p < 0.05), Pb bioaccessibility was equal to or significantly higher than that extracted using simulated GIT solutions (p < 0.05).

Determination and Prediction of Respirable Dust and Crystalline-Free Silica in the Taiwanese Foundry Industry

Background: Respirable crystalline silica (RCS) has been recognized as a human carcinogen; however, the measurement and analysis of RCS in small-scale foundries is rare and difficult. This study aimed to measure respirable dust and RCS levels among 236 foundry workers in Taiwan and used these data to establish predictive models for personal exposure. Methods: Personal sampling of various production processes were measured gravimetrically and analyzed using the X-ray diffraction method. Multiple linear regression was used to establish predictive models. Results: Foundry workers were exposed to geometric means and geometric standard deviations of 0.52 ± 4.0 mg/m³ and 0.027 ± 15 mg/m³ for respirable dust and RCS, respectively. The highest exposure levels were observed among workers in the sand blasting process, with geometric means of 1.6 mg/m³ and 0.099 mg/m³ for respirable dust and RCS, respectively. The predictive exposure model for respirable dust fitted the data well (R² = 0.75; adjusted R² = 0.64), and the predictive capacity for RCS was higher (R² = 0.89; adjusted R² = 0.84). Conclusions: Foundry workers in the sand blasting process may be exposed to the highest levels of respirable dust and RCS. The developed models can be applied to predict respirable dust and RCS levels adequately in small-scale foundry workers for epidemiological studies.

The severity of lung injury and metabolic disorders induced by ambient PM2.5 exposure is associated with cumulative dose

Lots of epidemiological and experimental studies have found that ambient fine particulate matter (PM_2.5) exposure is associated with the development of cardiopulmonary diseases, obesity and diabetes. This study focused on the effects of cumulative PM_2.5 exposure on pulmonary and systemic inflammation and insulin resistance. Thirty-two 6-week-old male Balb/c mice were randomly divided into four groups (FA, PM, WEEK and DAY groups) and were continuously or intermittently exposed to concentrated PM_2.5 or filtered air (FA) for four weeks using Shanghai Meteorological and Environmental Animal Exposure System ("Shanghai-METAS"). The levels of IL-6 and TNF-α in serum, bronchoalveolar lavage fluid (BALF), lung tissues and white adipose tissue (WAT) were measured. Meanwhile, the expression of NF-κB and phosphor-NF-κB in lung tissue was detected by Western blot. Glucose tolerance and insulin resistance were also determined at the end of exposure. The results found that the mice in PM group displayed moderate inflammatory cell infiltration in lung, whereas the mice in WEEK and DAY groups displayed slight inflammatory cell infiltration in lung. Compared with the mice in FA group, the mRNA expressions of IL-6 and TNF-α in lung tissue and WAT significantly increased in the mice of PM group. Importantly, IL-6 and TNF-α mRNA expressions in PM group were higher than those in WEEK and DAY groups. The protein expression of phospho-NF-κB in lung tissue showed that PM group showed the activation of NF-κB, which was higher than that in the WEEK and DAY groups. Meanwhile, the mice in PM group showed more severe glucose tolerance and insulin resistance than that in the WEEK and DAY groups. The results suggested that the reduction of PM_2.5 cumulative exposure may alleviate pulmonary and adipose inflammation, insulin resistance and glucose tolerance impairment. The results provided a clue that the interruption of ambient PM_2.5 exposures by systems such as indoor air purification could be of benefit to people's health.

Air Pollution and Cardiovascular Disease: A Focus on Vulnerable Populations Worldwide

Purpose of review

Certain subgroups defined by sociodemographics (race/ethnicity, age, sex and socioeconomic status [SES]), geographic location (rural vs. urban), comorbid conditions and country economic conditions (developed vs. developing) may disproportionately suffer the adverse cardiovascular effects of exposure to ambient air pollution. Yet, previous reviews have had a broad focus on the general population without consideration of these potentially vulnerable populations.

Recent findings

Over the past decade, a wealth of epidemiologic studies have linked air pollutants including particulate matter, oxides of nitrogen, and carbon monoxide to cardiovascular disease (CVD) risk factors, subclinical CVD, clinical cardiovascular outcomes and cardiovascular mortality in certain susceptible populations. Highest risk for poor CVD outcomes from air pollution exist in racial/ethnic minorities, especially in blacks compared to whites in the U.S, those at low SES, elderly populations, women, those with certain comorbid conditions and developing countries compared to developed countries. However, findings are less consistent for urban compared to rural populations.

Summary

Vulnerable subgroups including racial/ethnic minorities, women, the elderly, smokers, diabetics and those with prior heart disease had higher risk for adverse cardiovascular outcomes from exposure to air pollution. There is limited data from developing countries where concentrations of air pollutants are more extreme and cardiovascular event rates are higher than that of developed countries. Further epidemiologic studies are needed to understand and address the marked disparities in CVD risk conferred by air pollution globally, particularly among these vulnerable subgroups.

Lung cancer and particulate pollution: A critical review of spatial and temporal analysis evidence

BACKGROUND

Particulate matter (PM) has been recognized as one of the key risk factors of lung cancer. However, spatial and temporal patterns of this association remain unclear. Spatiotemporal analyses incorporate the spatial and temporal structure of the data within random effects models, generating more accurate evaluations of PM-lung cancer associations at a scale that can better inform lung cancer prevention programs.

METHODS

We conducted a critical review of spatial and temporal analyses of PM and lung cancer. The databases of PubMed, Web of Science and Scopus were searched for potential articles published until September 30, 2017. We included studies that applied spatial and temporal analyses to evaluate the associations of PM_2.5 (inhalable particles with diameters that are 2.5 µm and smaller) and PM₁₀ (inhalable particles with diameters that are 10 µm and smaller) with lung cancer.

RESULTS

We identified 17 articles eligible for the review. Of these, 11 focused on PM_2.5, five on PM₁₀, and one on both. These studies suggested a significant positive association between PM_2.5 exposure and the risk of lung cancer. Relative risks of lung cancer mortality ranged from 1.08 (95% confidence interval (CI): 1.07-1.09) to 1.60 (95%CI: 1.09-2.33) for 10 µg/m³ increase in PM_2.5 exposure. The association between PM₁₀ and lung cancer had been less well researched and the results were not consistent. In terms of the analysis methods, 16 papers undertook spatial analysis and one paper employed temporal analysis. No paper included spatial and temporal analyses simultaneously and considered spatiotemporal uncertainty into model predictions. Among the 16 papers with spatial analyses, thirteen studies presented maps, while only five and 11 studies utilized spatial exploration and modeling methods, respectively.

CONCLUSIONS

Advanced spatial and temporal epidemiological methods were seldom applied to PM-lung cancer associations. Further research is urgently needed to develop and employ robust and comprehensive spatiotemporal analysis methods for the evaluation of PM-lung cancer associations and the support of lung cancer prevention strategies.

Ventilation and Air Quality in Student Dormitories in China: A Case Study during Summer in Nanjing

The Air quality in student dormitories can have a major impact on the health of millions of students in China. This study aims to investigate the ventilation and air quality in student dormitories. Questionnaire survey was conducted in eight dormitory buildings and field measurements were conducted in one dormitory during the summer in Nanjing. The survey result reveals that most students thought the indoor and outdoor air quality was neutral and the correlation between indoor and outdoor perceived air quality is statistically significant. There are few indoor PM2.5 and ozone sources in dormitories and natural ventilation is the most common form of ventilation. However, there is no statistically significant correlation between window opening behaviors and the perceptions of indoor and outdoor air quality. The field measurement result shows the measured I/O ratios of PM2.5 and ozone over 37 days are in the range of 0.42⁻0.79 and 0.21⁻1.00, respectively. The I/O ratios for PM2.5 and ozone are 0.49 ± 0.05 and 0.26 ± 0.05 in the case of the window being closed, and the I/O ratios for PM2.5 and ozone are 0.65 ± 0.08 and 0.50 ± 0.15 in the case of the window being open. The outdoor and indoor ozone concentrations show pronounced diurnal periodic variations, while the PM2.5 concentrations do not. Finally, recommended open/close window strategies are discussed to reduce indoor pollutant levels. Understanding the indoor/outdoor PM2.5 and ozone concentrations in different window patterns can be a guidance to preventing high indoor PM2.5 and ozone exposure in student dormitories.

Impact of long-term temporal trends in fine particulate matter (PM2.5) on associations of annual PM2.5 exposure and mortality

Decreasing ambient fine particulate matter (PM_2.5) concentrations over time together with increasing life expectancy raise concerns about temporal confounding of associations between PM_2.5 and mortality. To address this issue, we examined PM_2.5-associated mortality risk ratios (MRRs) estimated for approximately 20,000,000 US Medicare beneficiaries, who lived within six miles of an Environmental Protection Agency air quality monitoring site, between December 2000 and December 2012. We assessed temporal confounding by examining whether PM_2.5-associated MRRs vary by study period length. We then evaluated three approaches to control for temporal confounding: (1) assessing exposures using the residual of PM_2.5 regressed on time; (2) adding a penalized spline term for time to the health model; and (3) including a term that describes temporal variability in PM_2.5 into the health model, with this term estimated using decomposition approaches. We found a 10 μg/m³ increase in PM_2.5 exposure to be associated with a 1.20 times (95% confidence interval [CI] = 1.20, 1.21) higher risk of mortality across the 13-year study period, with the magnitude of the association decreasing with shorter study periods. MRRs remained statistically significant but were attenuated when models adjusted for long-term time trends in PM_2.5. The residual-based, time-adjusted MRR equaled 1.12 (95% CI = 1.11, 1.12) per 10 μg/m³ for the 13-year study period and did not change when shorter study periods were examined. Spline- and decomposition-based approaches produced similar but less-stable MRRs. Our findings suggest that epidemiological studies of long-term PM_2.5 can be confounded by long-term time trends, and this confounding can be controlled using the residuals of PM_2.5 regressed on time.

Impacts of air pollution wave on years of life lost: A crucial way to communicate the health risks of air pollution to the public

Limited studies have explored the impacts of exposure to sustained high levels of air pollution (air pollution wave) on mortality. Given that the frequency, intensity and duration of air pollution wave has been increasing in highly polluted regions recently, understanding the impacts of air pollution wave is crucial. In this study, air pollution wave was defined as 2 or more consecutive days with air pollution index (API) > 100. The impacts of air pollution wave on years of life lost (YLL) due to non-accidental, cardiovascular and respiratory deaths were evaluated by considering both consecutive days with high levels of air pollution and daily air pollution levels in Tianjin, China, from 2006 to 2011. The results showed the durational effect of consecutive days with high levels of air pollution was substantial in addition to the effect of daily air pollution. For instance, the durational effect was related to an increase in YLL of 116.6 (95% CI: 4.8, 228.5) years from non-accidental deaths when the air pollution wave was sustained for 4 days, while the corresponding daily air pollution's effect was 121.2 (95% CI: 55.2, 187.1) years. A better interpretation of the health risks of air pollution wave is crucial for air pollution control policy making and public health interventions.

Air pollution is associated with the development of atherosclerosis via the cooperation of CD36 and NLRP3 inflammasome in ApoE-/- mice

Previous studies have indicated that the main air pollutant fine particulate matter (≤2.5 μm; PM_2.5) exposure is associated with the development of atherosclerosis. Although the mechanism is not fully illustrated, the inflammatory responses play an important role. The present study aimed to explore whether PM_2.5-exacerbated atherosclerosis was mediated by the cooperation of cluster of differentiation 36 (CD36) and nucleotide-binding oligomerization domain-like receptor protein (NLRP3) inflammasome in apolipoprotein E^-/- (ApoE^-/-) mice. Thirty-two ApoE^-/- mice were randomly divided into two groups. One group was fed with high fat chow (HFC) for 10 weeks to establish atherosclerotic model, and the other was fed with normal chow (NC). From week 11, the mice were exposed to concentrated PM_2.5 (PM) or filtered air (FA) using Shanghai Meteorological and Environmental Animal Exposure System for 16 weeks. In both NC and HFC groups, PM_2.5 exposure induced the formation of atherosclerosis plaque. Similarly, PM mice appeared higher lipid content in the aortic root than that in the FA mice. Compared with the FA mice, PM mice appeared a decrease in high density lipoprotein-cholesterol (HDL-C) and apolipoprotein A1 along with an increase in apolipoprotein B, low density lipoprotein-cholesterol (LDL-C) and oxidized low-density lipoprotein (ox-LDL). Moreover, PM_2.5 exposure induced increase of CD36 in serum and aorta. In both NC and HFC groups, NLRP3 inflammasome activation-related indicators were activated or increased in the aorta of the PM mice when compared with the FA mice. The cooperation of CD36 and NLRP3 inflammasome activation may be the potential mechanisms linkixposed to concentrated PM_2.5 (PM) or filtered air (FA) using Shanghai Meteorological and Environmental Animal Exposure System for 16 weeks. In both NC and HFC groups, PM_2.5 exposure induced the formation of atherosclerosis plaque. Similarly, PM mice appeared higher lipid content in the aortic root than that in the FA mice. Compared with the FA mice, PM mice appeared a decrease in high density lipoprotein-cholesterol (HDL-C) and apolipoprotein A1 along with an increase in apolipoprotein B, low density lipoprotein-cholesterol (LDL-C) and oxidized low-density lipoprotein (ox-LDL). Moreover, PM_2.5 exposure induced increase of CD36 in serum and aorta. In both NC and HFC groups, NLRP3 inflammasome activation-related indicators were activated or increased in the aorta of the PM mice when compared with the FA mice. The cooperation of CD36 and NLRP3 inflammasome activation may be the potential mechanisms linking air pollution and HFC-induced atherosclerosis even in the mice with NC intake.

Effects of sub-chronic exposure to atmospheric PM2.5 on fibrosis, inflammation, endoplasmic reticulum stress and apoptosis in the livers of rats

Epidemiological studies have revealed that exposure to PM2.5 is linked to liver cancer. However, the hepatic toxicity and relevant molecular mechanisms of PM2.5 have not yet been fully described. Herein, we report on our investigation of the fibrosis, inflammation, endoplasmic reticulum (ER) stress and apoptosis in the livers of rats, caused by exposure to PM2.5 during summer and winter in Taiyuan, China. Male SD rats were sub-chronically exposed to PM2.5 (in summer: 0.2, 0.6, 1.5 mg per kg of b.w.; in winter: 0.3, 1.5, 2.7 mg per kg of b.w.) via intratracheal instillation once every 3 days for 60 days. The results showed that exposure to high dosages of PM2.5 caused the following: (1) hepatic histopathological changes and liver function decline through elevating the activities of AST, ALT, CYP450 and GST; (2) triggered liver fibrosis, in which TGF-β1, Col I, Col III, and MMP13 mRNA and protein expression were significantly upregulated, and enhanced inflammation with the overexpression of TNF-α, IL-6 and HO-1 versus the control; (3) induced liver ER stress and cell apoptosis via activating the GRP78/ATF6/CHOP/TRB3/caspase 12 pathway. The data also indicated that the liver injury induced by winter PM2.5 in Taiyuan was more serious compared to that induced by summer PM2.5. This work provides new insight into the mechanisms of PM2.5-induced liver injury, and aids the understanding of the underlying mechanisms by which PM2.5 might affect liver diseases.

Instillation of particulate matter 2.5 induced acute lung injury and attenuated the injury recovery in ACE2 knockout mice

Inhaled particulate matter 2.5 (PM_2.5) can cause lung injury by inducing serious inflammation in lung tissue. Renin-angiotensin system (RAS) is involved in the pathogenesis of inflammatory lung diseases and regulates inflammatory response. Angiotensin-converting enzyme II (ACE2), which is produced through the angiotensin-converting enzyme (ACE)/angiotensin II (Ang II) axis, protects against lung disease. However, few studies have focused on the relationships between PM_2.5 and ACE2. Therefore, we aimed to explore the role of ACE2 in PM_2.5-induced acute lung injury (ALI). An animal model of PM_2.5-induced ALI was established with wild type (C57BL/6, WT) and ACE2 gene knockout (ACE2 KO) mice. The mice were exposed to PM_2.5 through intratracheal instillation once a day for 3 days (6.25 mg/kg/day) and then sacrificed at 2 days and 5 days after PM_2.5 instillation. The results show that resting respiratory rate (RRR), levels of inflammatory cytokines, ACE and MMPs in the lungs of WT and ACE2 KO mice were significantly increased at 2 days postinstillation. At 5 days postinstillation, the PM_2.5-induced ALI significantly recovered in the WT mice, but only partially recovered in the ACE2 KO mice. The results hint that PM_2.5 could induce severe ALI through pulmonary inflammation, and the repair after acute PM_2.5 postinstillation could be attenuated in the absence of ACE2. Additionally, our results show that PM_2.5-induced ALI is associated with signaling p-ERK1/2 and p-STAT3 pathways and ACE2 knockdown could increase pulmonary p-STAT3 and p-ERK1/2 levels in the PM_2.5-induced ALI.

Long-term exposure to PM2.5 lowers influenza virus resistance via down-regulating pulmonary macrophage Kdm6a and mediates histones modification in IL-6 and IFN-β promoter regions

Atmospheric particulates, especially PM2.5, not only damage the respiratory system, but also play important roles in pulmonary immunity. China is influenced by atmospheric diffusion conditions, industrial manufacturers, and heating and discharging. PM2.5 levels in the air rise substantially in the winter, which is also a period of flu high-incidence. Although an epidemiological link exists between PM2.5 and flu, we do not understand how long-term PM2.5 inhalation affects pulmonary immunity and the influenza virus response. Our study has prepared an in vivo PM2.5 mouse pharyngeal wall drop-in model and has found that PM2.5 exposure leads to mouse inflammatory injuries and furthers influenza A infection. Our results suggest that short-term exposure to PM2.5 significantly enhances the survival rate of influenza A-contaminated mice, while long-term PM2.5 inhalation lowers the capacity of pulmonary macrophages to secrete IL-6 and IFN-β. A disorder in the pulmonary innate defense system results in increased death rates following influenza infection. On a macromolecular level, this mechamism involves Kdm6a down-regulation after long-term exposure to PM 2.5 and a resultant increase in H3K4 and H3K9 methylation in IL-6 and IFN-β promoter regions. In summary, PM2.5 causes injuries of lung tissue cells and downregulates immune defense mechanisms in the lung.