Ambient air quality and the effects of air pollutants on otolaryngology in Beijing

Effects of pre-natal and post-natal exposures to air pollution on onset and recurrence of childhood otitis media

BACKGROUND

Despite mounting evidence linking outdoor air pollution with otitis media (OM), the role of air pollutant(s) exposure during which critical window(s) on childhood OM remains unknown.

OBJECTIVES

We sought to identify the key air pollutant(s) and critical window(s) associated with the onset and recurrent attacks of OM in kindergarten children.

METHODS

A combined cross-sectional and retrospective cohort study involving 8689 preschoolers aged 3-6 years was performed in Changsha, China. From 2013-2020, data on air pollutants were collected from ambient air quality monitoring stations in Changsha, and the exposure concentration to each child at their home address was calculated using the inverse distance weighted (IDW) method. The relationship between air pollution and OM in kindergarten children was studied using multiple logistic regression models.

RESULTS

Childhood lifetime OM was associated with PM2.5, SO2 and NO2, with ORs (95% CI) of 1.43 (1.19-1.71), 1.18 (1.01-1.37) and 1.18 (1.00-1.39) by per IQR increase in utero exposure and with PM2.5, PM2.5-10 and PM10, with ORs = 1.15 (1.00-1.32), 1.25 (1.13-1.40) and 1.49 (1.28-1.74) for entire post-natal exposure, respectively. The 2nd trimester in utero and the post-natal period, especially the 1st year, were key exposure time windows to PM2.5 and PM10 associated with lifetime OM and the onset of OM. Similarly, the 4th gestational month was a critical window for all pollutants except CO exposure in relation to lifetime OM and OM onset, but not recurrent OM attacks. PM2.5 exposure during the nine gestational months and PM10 exposure during the first three years had cumulative effects on OM development. Our subgroup analysis revealed that certain children were more susceptible to the OM risk posed by air pollution.

CONCLUSIONS

Early-life exposure to air pollution, particularly PM2.5 during the middle of gestation and PM10 during the early post-natal period, was associated with childhood OM.

COVID-19 Pandemic, Air Quality, and PM2.5 Reduction-Induced Health Benefits: A Comparative Study for Three Significant Periods in Beijing

Previous studies have estimated the influence of control measures on air quality in the ecological environment during the COVID-19 pandemic. However, few have attached importance to the comparative study of several different periods and evaluated the health benefits of PM2.5 decrease caused by COVID-19. Therefore, we aimed to estimate the control measures' impact on air pollutants in 16 urban areas in Beijing and conducted a comparative study across three different periods by establishing the least squares dummy variable model and difference-in-differences model. We discovered that restriction measures did have an apparent impact on most air pollutants, but there were discrepancies in the three periods. The Air Quality Index (AQI) decreased by 7.8%, and SO2, NO2, PM10, PM2.5, and CO concentrations were lowered by 37.32, 46.76, 53.22, 34.07, and 19.97%, respectively, in the first period, while O3 increased by 36.27%. In addition, the air pollutant concentrations in the ecological environment, including O3, reduced significantly, of which O3 decreased by 7.26% in the second period. Furthermore, AQI and O3 concentrations slightly increased compared to the same period in 2019, while other pollutants dropped, with NO2 being the most apparent decrease in the third period. Lastly, we employed health effects and environmental value assessment methods to evaluate the additional public health benefits of PM2.5 reduction owing to the restriction measures in three periods. This research not only provides a natural experimental basis for governance actions of air pollution in the ecological environment, but also points out a significant direction for future control strategies.

Monitoring history and change trends of ambient air quality in China during the past four decades

This study summarized the history of ambient air quality monitoring and air pollution prevention and control, and it analyzed the spatiotemporal patterns of ambient air pollutants during 1981-2017 in China. The results showed that monitoring of ambient air quality has changed dramatically in terms of determinants, sampling methods, monitoring extent, and evaluation basis during the previous four decades. Annual average concentrations of total suspended particulates, PM₁₀ and SO₂ have shown obvious decreasing trends during the studied period. These improvements have been closely related to the considerable efforts and various approaches undertaken to prevent and control air pollution. However, although policy implementation has been decisive and, at least in part, it has been enforced effectively, significant challenges remain. Air pollution control cannot be accomplished without a long-term strategy designed to achieve clean air in all parts of China.

A comprehensive review of otorhinolaryngological global health concerns

Background

ENT disease prevalence, risk factors and treatment vary between developed and developing countries. Health provision, particularly disease prevention strategies and surgery, in developing countries is poor, manifesting as a high frequency of common and preventable diseases. Healthcare systems in developing countries are unsustainable, and the technological advances that provide ENT surgery with novel diagnostic and treatment opportunities are inaccessible.

Conclusion

A multifaceted approach is essential to improve the care of patients with ENT diseases in developing countries. Public health efforts must focus on educating the local community, reducing high-risk behaviours and decreasing the frequency of preventable diseases. Governments must be pressured to prioritise the funding of long-term, sustainable efforts with effective disease prevention strategies. Providing local healthcare professionals with high-quality ENT training so that self-sustaining and low-cost care can be delivered, mainly in a primary care setting, is key.

The Effects of Air Pollutants on the Prevalence of Common Ear, Nose, and Throat Diseases in South Korea: A National Population-Based Study

Objectives

The effects of air pollutants on upper airway disease development have been seldom studied. In this study, we evaluated the effects of air pollution on the prevalence of ENT diseases.

Methods

We identified cases of ENT disease occurring in 2009, as recorded by the Korea National Health and Nutrition Examination Survey, and explored their associations with the levels of five air pollutants: sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), carbon monoxide (CO), and particulate matter (PM₁₀ particles; particulates ≤10 μm in aerodynamic diameter). Subjects diagnosed with at least one of the five studied ENT diseases were included in analysis, but those aged under 19 years were excluded. Linear associations between ENT disease frequency and pollutant levels were evaluated by calculating Spearman correlations. After adjusting for age, gender, and geographic region, multivariate logistic regression was used to obtain odds ratios (OR) with 95% confidence intervals (CI).

Results

A total of 7,399 subjects with ENT diseases were identified. A linear association was evident between PM₁₀ concentration and the frequency of septal deviation (Spearman coefficient, 0.507; P=0.045). After adjustment, the PM₁₀ level was associated with high odds ratios for chronic rhinosinusitis (1.22; 95% CI, 1.02 to 1.46) and septal deviation (1.43; 95% CI, 1.22 to 1.67). Both of these conditions were more prevalent in males.

Conclusion

We found that increased ambient concentrations of PM₁₀ particles were clearly associated with increased the risk of chronic rhinosinusitis and septal deviation; the exposure-response relationship was definitive.

Association of outdoor air pollution and indoor renovation with early childhood ear infection in China

BACKGROUND

Otitis media (OM) is a common infection in early childhood with repeated attacks that lead to long-term complications and sequelae, but its risk factors still remain unclear.

OBJECTIVE

To examine the risk of childhood OM for different indoor and outdoor air pollutants during different timing windows, with a purpose to identify critical windows of exposure and key components of air pollution in the development of OM.

METHODS

We conducted a retrospective cohort study of 1617 children aged 3-4 years in Changsha, China (2011-2012). Children's life-time prevalence of OM and exposure to indoor air pollution related to home renovation activities were surveyed by a questionnaire administered by the parents. Children's exposure to outdoor air pollution, including nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and particulate matter with an aerodynamic diameter ≤ 10 μm (PM₁₀), was estimated using the measured concentrations at municipal monitoring stations. The odds ratio (OR) and 95% confidence interval (CI) of childhood OM for prenatal and postnatal exposure to indoor and outdoor air pollution were examined by using logistic regression model.

RESULTS

Life-time prevalence of OM in preschool children (7.3%) was associated not only with prenatal exposure to industrial air pollutant with adjusted OR (95% CI) = 1.44 (1.09-1.88) for a 27 μg/m³ increase in SO₂ but also with postnatal exposure to indoor renovations with OR (95% CI) = 1.62 (1.05-2.49) for new furniture and 1.81 (1.12-2.91) for redecoration, particularly in girls. Combined exposure to outdoor SO₂ and indoor renovation significantly increased OM risk. Furthermore, we found that exposure to outdoor SO₂ and indoor renovation were significantly associated with the onset but not repeated attacks of OM.

CONCLUSION

Prenatal exposure to outdoor industrial air pollution and postnatal exposure to indoor renovation are independently associated with early childhood OM in China and may cause the OM onset.

Bayesian model averaging method for evaluating associations between air pollution and respiratory mortality: a time-series study

OBJECTIVE

To demonstrate an application of Bayesian model averaging (BMA) with generalised additive mixed models (GAMM) and provide a novel modelling technique to assess the association between inhalable coarse particles (PM10) and respiratory mortality in time-series studies.

DESIGN

A time-series study using regional death registry between 2009 and 2010.

SETTING

8 districts in a large metropolitan area in Northern China.

PARTICIPANTS

9559 permanent residents of the 8 districts who died of respiratory diseases between 2009 and 2010.

MAIN OUTCOME MEASURES

Per cent increase in daily respiratory mortality rate (MR) per interquartile range (IQR) increase of PM10 concentration and corresponding 95% confidence interval (CI) in single-pollutant and multipollutant (including NOx, CO) models.

RESULTS

The Bayesian model averaged GAMM (GAMM+BMA) and the optimal GAMM of PM10, multipollutants and principal components (PCs) of multipollutants showed comparable results for the effect of PM10 on daily respiratory MR, that is, one IQR increase in PM10 concentration corresponded to 1.38% vs 1.39%, 1.81% vs 1.83% and 0.87% vs 0.88% increase, respectively, in daily respiratory MR. However, GAMM+BMA gave slightly but noticeable wider CIs for the single-pollutant model (-1.09 to 4.28 vs -1.08 to 3.93) and the PCs-based model (-2.23 to 4.07 vs -2.03 vs 3.88). The CIs of the multiple-pollutant model from two methods are similar, that is, -1.12 to 4.85 versus -1.11 versus 4.83.

CONCLUSIONS

The BMA method may represent a useful tool for modelling uncertainty in time-series studies when evaluating the effect of air pollution on fatal health outcomes.