Ambient Air Pollution and Morbidity in Chinese

Impact of desert dust storms, PM10 levels and daily temperature on mortality and emergency department visits due to stroke

Objective

It is known that the inhalation of air pollutants adversely affects human health. These air pollutants originated from natural sources such as desert storms or human activities including traffic, power generating, domestic heating, etc. This study aimed to investigate the impacts of desert dust storms, particulate matter ≤10 μm (PM10) and daily maximum temperature (MT) on mortality and emergency department (ED) visits due to stroke in the city of Gaziantep, Southeast Turkey.

Method

The data on mortality and ED visits due to stroke were retrospectively recruited from January 1, 2009, to March 31, 2014, in Gaziantep City Centre.

Results

PM10 levels did not affect ED visits or mortality due to stroke; however, MT increased both ED visits [adjusted odds ratio (OR) = 1.002, 95% confidence interval (CI) = 1.001-1.003] and mortality (OR = 1.006, 95% CI = 0.997-1.014) due to stroke in women. The presence of desert storms increased ED visits due to stroke in the total population (OR = 1.219, 95% CI = 1.199-1.240), and all subgroups. It was observed that desert dust storms did not have an increasing effect on mortality.

Conclusion

Our findings suggest that MT and desert dust storms can induce morbidity and mortality due to stroke.

Effect of neighbourhood greenness on the association between air pollution and risk of stroke first onset: A case-crossover study in shandong province, China

BACKGROUND

Higher neighbourhood greenness is associated with beneficial health outcomes, and short-term exposure to air pollution is associated with an elevated risk of stroke onset. However, little is known about their interactions.

METHODS

Daily data on stroke first onset were collected from 20 counties in Shangdong Province, China, from 2013 to 2019. The enhanced vegetation index (EVI) and concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), ozone (O3), carbon monoxide (CO), and sulfur dioxide (SO2) were calculated for each individual at the village or community level based on their home address to measure their neighbourhood exposure to greenness and air pollution. EVI was categorised as low or high, and a time-stratified case-crossover design was used to estimate the percent excess risk (ER%) of stroke associated with short-term exposure to air pollution. We further stratified greenness on the basis of EVI values into quartiles and introduced interaction terms between air pollutant concentrations and the median EVI values of the quartiles to assess the effect of greenness on the associations between short-term exposure and stroke.

RESULTS

Individuals living in the high-greenness areas had weaker associations between total stroke risk and exposure to NO2 (low greenness: ER% = 1.765% [95% CI 1.205%-2.328%]; high greenness: ER% = 0.368% [95% CI -0.252% to 0.991%]; P = 0.001), O3 (low greenness: 0.476% [95% CI 0.246%-0.706%]; high greenness: ER% = 0.085% [95% CI -0.156% to 0.327%]; P = 0.011), and SO2 (low greenness: 0.632% [95% CI 0.138%-1.129%]; high greenness: ER% = -0.177% [95% CI -0.782% to 0.431%]; P = 0.035).

CONCLUSION

Residence in areas with higher greenness was related to weaker associations between air pollution and stroke risk, suggesting that effectively planning green spaces can improve public health.

Estimating the Impact of Air Pollution on Healthcare-Seeking Behaviour by Applying a Difference-in-Differences Method to Syndromic Surveillance Data

Syndromic surveillance data were used to estimate the direct impact of air pollution on healthcare-seeking behaviour, between 1 April 2012 and 31 December 2017. A difference-in-differences approach was used to control for spatial and temporal variations that were not due to air pollution and a meta-analysis was conducted to combine estimates from different pollution periods. Significant increases were found in general practitioner (GP) out-of-hours consultations, including a 98% increase (2–386, 95% confidence interval) in acute bronchitis and a 16% (3–30) increase in National Health Service (NHS) 111 calls for eye problems. However, the numbers involved are small; for instance, roughly one extra acute bronchitis consultation in a local authority on a day when air quality is poor. These results provide additional information for healthcare planners on the impacts of localised poor air quality. However, further work is required to identify the separate impact of different pollutants.

Astragaloside IV pre-treatment attenuates PM2.5-induced lung injury in rats: Impact on autophagy, apoptosis and inflammation

BACKGROUND

Fine particulate matter (PM2.5) with an aerodynamic diameter of less than 2.5 μm, exerts serious lung toxicity. At present, effective prevention measures and treatment modalities for pulmonary toxicity caused by PM2.5 are lacking. Astragaloside IV (AS-IV) is a natural product that has received increasing attention from researchers for its unique biological functions.

PURPOSE

To investigate the protective effects of AS-IV on PM2.5-induced pulmonary toxicity and identify its potential mechanisms.

METHODS

The rat model of PM2.5-induced lung toxicity was created by intratracheal instillation of PM2.5 dust suspension. The investigation was performed with AS-IV or in combination with autophagic flux inhibitor (Chloroquine) or AMP-sensitive protein kinase (AMPK)-specific inhibitor (Compound C). Apoptosis was detected by terminal deoxy-nucleotidyl transferase dUTP nick end labeling (TUNEL) and western blotting. Autophagy was detected by immunofluorescence staining, autophagic flux measurement, western blotting, and transmission electron microscopy. The AMPK/mTOR pathway was analyzed by western blotting. Inflammation was analyzed by western blotting and suspension array.

RESULTS

AS-IV prevented histopathological injury, inflammation, autophagy dysfunction, apoptosis, and changes in AMPK levels induced by PM2.5. AS-IV increased autophagic flux and inhibited apoptosis and inflammation by activating the AMPK/ mammalian target of rapamycin (mTOR) pathway. However, AS-IV had no protective effect on PM2.5-induced lung injury following treatment with Compound C or Chloroquine.

CONCLUSION

AS-IV prevented PM2.5-induced lung toxicity by restoring the balance among autophagy, apoptosis, and inflammation in rats by activating the AMPK/mTOR signaling pathway.

Air pollution increased risk of reproductive system diseases: a 5-year outcome analysis of different pollutants in different seasons, ages, and genders

Air pollution remains a serious environmental problem worldwide, and the effects of air pollutants with reproductive system diseases have already attracted extensive attention. The present study investigated the risk of air pollutants on reproductive system diseases, based on daily medical visits (DMV) of the past 5 years in central China. Data of DMV outpatients with reproductive system diseases were obtained from a general hospital in Zhengzhou, October 28, 2013 to May 31, 2018, as well as atmospheric pollutants data. Correlation of air pollutants and DMV was analyzed with distributed lag nonlinear model (DLNM), including total cases of reproductive system diseases, and in different seasons (spring, summer, autumn, and winter), genders (male and female), and age groups (<26, 26-35, and >35 years old). A total of 374,558 visits were included. NO2 was most closely relevant to incidence risk of total cases analysis with each increased interquartile ranges (IQRs) in the 6 pollutants, with 30-day lag. Relationship to pollutants was more sensitive in fall, >35 years old, and male groups than in other seasons, ages, and females, and NO2 had the highest risk on reproductive diseases. Air pollution increased risk of reproductive system diseases, and different pollutants played different roles in different seasons, ages, and genders. The results of this study will provide evidence for effective air quality controlling and human reproductive protection.

Association Between the Ambient Fine Particulate Pollution and the Daily Internal Medicine Outpatient Visits in Zhoushan, China: A Time-Series Study

Background: There has been a recent worsening of air pollution in China, which poses a huge threat to public health by inducing and promoting circulatory and respiratory diseases. This study aimed to explore the association between the concentration of air pollution and daily internal medicine outpatient visits registered for the treatment of circulatory and respiratory symptoms in Zhoushan, China using a time-series method.

Methods: We validated and acquired the daily internal medicine outpatient visits records between January 1, 2014, and December 31, 2019, from the Zhoushan Center for Disease Control and Prevention in Zhejiang, China. Further, we collected the daily average records of the ambient air pollutants from the Zhoushan Environmental Monitoring Centre within the same duration. A generalized additive model with the natural splines was constructed to explore the association between the ambient air pollutants and daily internal medicine outpatient visits. Further, we conducted a lag analysis by using the distributed lag non-linear model to estimate the time-delayed effects of the air pollutants on the daily internal medicine outpatient visits.

Results: A total of 2,190,258 daily internal medicine outpatient visits with a mean of 202.4 visits per day were recorded. The non-linear relationships were found among particulate matter_2.5 (PM_2.5), sulfur dioxide (SO₂), and the daily internal medicine outpatient visits. Overall, PM_2.5 was positively correlated with the daily internal medicine outpatient visits. Both ozone (O₃) and SO₂ had significant delayed effects on the daily internal medical outpatient numbers; however, PM_2.5 only showed a short-term risk.

Conclusion: Short-term exposure to PM_2.5 was associated with an increase in the daily internal medicine outpatient visits for circulatory and respiratory diseases/symptoms in Zhoushan, China. SO₂ and O₃ were shown to induce significant effects after a concentration-dependent time lag.

Effect of probiotics on nasal and intestinal microbiota in people with high exposure to particulate matter ≤ 2.5 μm (PM2.5): a randomized, double-blind, placebo-controlled clinical study

Background

Extended exposure to high concentrations of PM2.5 changes the human microbiota profile, which in turn may increase morbidity and mortality due to respiratory system damage. A balanced microecosystem is crucial to human health, and certain health-related problems may be addressed by effective microecosystem regulation. Recent studies have confirmed that probiotics may reduce the incidence of respiratory diseases. However, few studies have investigated probiotic treatment outcomes in subjects exposed to high concentrations of PM2.5.

Methods

This study is designed as a prospective, randomized, participants- and assessor-blinded, placebo-controlled trial. One hundred and twenty eligible volunteers recruited from October 2019 to July 2020 in downtown Chengdu, China, will be treated with either probiotics or placebo over 4 consecutive weeks. The primary outcome will be 16SrRNA sequencing assay data from nasal and intestinal secretions. Secondary outcomes will be pulmonary function, score on a gastrointestinal symptom rating scale, COOP/WONCA charts, and the Short-Form Health Survey 36 for quality of life. Results will be analyzed to assess differences in clinical efficacy between groups. Six-month follow-up examinations will evaluate the long-term value of probiotics on cardiovascular and respiratory disease end-point events.

Discussion

We will explore the characteristics of nasal and intestinal microbiota in a population with high exposure to PM2.5. Probiotics and placebo interventions will be tested for efficacy in microbial balance regulation, effects on lung and physical functions, and quality of life improvement. This study is expected to provide reliable evidence to support the widespread promotion of probiotics in clinical practice for the protection of individuals with high exposure to PM2.5.

Trial registration

Chinese Clinical Trial Registry ChiCTR1900025469. Registered on 27 August 2019.

Associations between air pollution and outpatient visits for allergic rhinitis in Xinxiang, China

Several epidemiological studies have investigated the adverse health effects of air pollution, but studies reporting its effects on allergic rhinitis (AR) are limited, especially in developing countries having the most severe pollution. Limited studies have been conducted in China, but their results were inconsistent. So, we conducted a time-series study to evaluate the acute effect of six air pollutants (fine particulate matter [PM_2.5], particulate matter with diameter less than 10 μm [PM₁₀], sulfur dioxide [SO₂], nitrogen dioxide [NO₂], ozone [O₃], and carbon monoxide [CO]) on hospital outpatient visits for AR in Xinxiang, China from January 1, 2015, to December 31, 2018. An over-dispersed Poisson generalized additive model adjusting for weather conditions, long-term trends, and day of the week was used. In total, 14,965 AR outpatient records were collected during the study period. Results found that each 10 μg/m³ increase in PM_2.5, PM₁₀, SO₂, NO₂, O₃, and CO corresponded to 0.70% (95% confidence interval 0.00-1.41%), 0.79% (0.35-1.23%), 3.43% (1.47-5.39%), 4.54% (3.01-6.08%), 0.97% (- 0.11-2.05%), and 0.07% (0.02-0.12%) increments in AR outpatients on the current day, respectively. In the stratification analyses, statistically stronger associations were observed with PM_2.5, PM₁₀, SO₂, NO₂, and CO for AR outpatients < 15 years of age than in those 15-65 and ≥ 65 years of age, whereas the opposite result was found with O₃. Associations between PM₁₀, SO₂, NO₂, O₃, and AR outpatients were higher in the warm season than those in the cool season. This study suggests that exposure to PM_2.5, PM₁₀, SO₂, NO₂, and CO was associated with increased AR risk and children younger than 15 years might be more vulnerable.