Burden of disease attributed to ambient PM2.5 and PM10 exposure in 190 cities in China

Exploring the nexus of urban form, transport, environment and health in large-scale urban studies: A state-of-the-art scoping review

BACKGROUND

As the world becomes increasingly urbanised, there is recognition that public and planetary health relies upon a ubiquitous transition to sustainable cities. Disentanglement of the complex pathways of urban design, environmental exposures, and health, and the magnitude of these associations, remains a challenge. A state-of-the-art account of large-scale urban health studies is required to shape future research priorities and equity- and evidence-informed policies.

OBJECTIVES

The purpose of this review was to synthesise evidence from large-scale urban studies focused on the interaction between urban form, transport, environmental exposures, and health. This review sought to determine common methodologies applied, limitations, and future opportunities for improved research practice.

METHODS

Based on a literature search, 2958 articles were reviewed that covered three themes of: urban form; urban environmental health; and urban indicators. Studies were prioritised for inclusion that analysed at least 90 cities to ensure broad geographic representation and generalisability. Of the initially identified studies, following expert consultation and exclusion criteria, 66 were included.

RESULTS

The complexity of the urban ecosystem on health was evidenced from the context dependent effects of urban form variables on environmental exposures and health. Compact city designs were generally advantageous for reducing harmful environmental exposure and promoting health, with some exceptions. Methodological heterogeneity was indicative of key urban research challenges; notable limitations included exposure and health data at varied spatial scales and resolutions, limited availability of local-level sociodemographic data, and the lack of consensus on robust methodologies that encompass best research practice.

CONCLUSION

Future urban environmental health research for evidence-informed urban planning and policies requires a multi-faceted approach. Advances in geospatial and AI-driven techniques and urban indicators offer promising developments; however, there remains a wider call for increased data availability at local-levels, transparent and robust methodologies of large-scale urban studies, and greater exploration of urban health vulnerabilities and inequities.

Inter-continental variability in the relationship of oxidative potential and cytotoxicity with PM2.5 mass

Most fine ambient particulate matter (PM2.5)-based epidemiological models use globalized concentration-response (CR) functions assuming that the toxicity of PM2.5 is solely mass-dependent without considering its chemical composition. Although oxidative potential (OP) has emerged as an alternate metric of PM2.5 toxicity, the association between PM2.5 mass and OP on a large spatial extent has not been investigated. In this study, we evaluate this relationship using 385 PM2.5 samples collected from 14 different sites across 4 different continents and using 5 different OP (and cytotoxicity) endpoints. Our results show that the relationship between PM2.5 mass vs. OP (and cytotoxicity) is largely non-linear due to significant differences in the intrinsic toxicity, resulting from a spatially heterogeneous chemical composition of PM2.5. These results emphasize the need to develop localized CR functions incorporating other measures of PM2.5 properties (e.g., OP) to better predict the PM2.5-attributed health burdens.

Control priority based on source-specific DALYs of PM2.5-bound heavy metals by PMF-PSCF-IsoSource model in urban and suburban Beijing

To determine the priority control sources, an approach was proposed to evaluate the source-specific contribution to health risks from inhaling PM2.5-bound heavy metals (PBHMs). A total of 482 daily PM2.5 samples were collected from urban and suburban areas of Beijing, China, between 2018 and 2019. In addition to the PMF-PSCF model, a Pb isotopic IsoSource model was built for more reliable source apportionment. By using the comprehensive indicator of disability-adjusted life years (DALYs), carcinogenic and noncarcinogenic health risks could be compared on a unified scale. The study found that the annual average concentrations of the total PBHMs were significantly higher in suburban areas than in urban areas, with significantly higher concentrations during the heating season than during the nonheating season. Comprehensive dust accounted for the largest contribution to the concentration of PBHMs, while coal combustion contributed the most to the DALYs associated with PBHMs. These results suggest that prioritizing the control of coal combustion could effectively reduce the disease burden associated with PBHMs, leading to notable public health benefits.

Association of PM2.5 mass and its components with ovarian reserve in a northern peninsular province, China: The critical exposure period and components

BACKGROUND

A possible role of PM2.5 components on ovarian reserve has not been adequately unexplored.

OBJECTIVE

To evaluate the association between PM2.5 components and women' ovarian reserve over critical exposure periods in northern China, where the level of air pollution is among the nation's highest.

METHODS

We included 15,102 women with serum anti-Müllerian hormone (AMH) measurements from the Center for Reproductive Medicine of Shandong University during 2015-2019. Concentrations of PM2.5 and its five major components (0.1° × 0.1°), including sulfate, nitrate, ammonium, organic matter, and black carbon, were assigned to each residential address. Multivariable linear mixed effect models combined with constituent-residual models were performed to estimate the effect sizes of essential components over six short- to long-term exposure periods.

RESULTS

The strength of association was stronger during the process from primary to small antral follicle compared with other longer windows. For every interquartile range increase in PM2.5 mass was associated with - 8.7% (95%CI: -12.3%, -4.9%) change in AMH and the effect size was greatest for sulfate. Women with the lower level of attained education and those living inland were more susceptible compared with other population subgroups.

CONCLUSION

Exposure to specific components of air pollution during critical exposure windows is associated with a decline in ovarian reserve. These data add to the growing body of evidence that environmental factors have adverse effects on reproductive health, particularly for vulnerable population subgroups.

Trends in the Burden of COPD Attributable to Ambient PM2.5 Exposure in China 1990-2019: An Age-Period-Cohort Analysis

Objective

Exposure to ambient particulate matter (PM_2.5) is the leading risk factor for developing chronic obstructive pulmonary disease (COPD) in China. The present study aimed to investigate the trends in COPD mortality attributable to ambient PM_2.5 exposure in China from 1990 to 2019.

Methods

Data on COPD burden attributable to ambient PM_2.5 exposure in China were extracted from the Global Burden of Disease (GBD) study 2019. The estimated annual percentage change (EAPC) was used to assess COPD mortality from 1990 to 2019. The APC model was used to analyze the temporal trends in the rate of COPD mortality attributable to ambient PM_2.5 exposure according to age, period, and cohort.

Results

Exposure to ambient PM_2.5 contributed to 192.4 thousand deaths in 1990 and 263.6 thousand deaths in 2019. The age-standardized mortality rate (ASMR) and the age-standardized disability-adjusted life year rate (ASDR) due to ambient PM_2.5 exposure showed a gradual downward trend, the ASMR and ASDR in 2019 decreased to 16.6 per 100,000 with an EAPC of -2.82 (95% CI: -8.61 to 3.34) and 278.6 per 100,000 with an EAPC of -2.02 (95% CI: -7.85 to 4.19), compared to those in 1990, respectively. The relative risk (RR) of COPD increased with age in females, while in males, mortality significantly increased from the levels among those in the 60-64 age group to that among those in the 90-94 age group. In the period group, the RR of COPD in males remained above 1.0 from the 2000 to 2004 period, but it gradually decreased in females. The cohort effect showed an overall downward trend.

Conclusion

Although the ASMR and ASDR are decreasing in Chinese patients with COPD, the number of deaths due to COPD is increasing. Ambient PM_2.5 exposure is more harmful in males and older people above 60 years of age.

High levels of indoor fine particulate matter during the cold season in Almaty prompt urgent public health action

INTRODUCTION

Almaty is the largest city of Kazakhstan with extreme air pollution, mostly in the cold season, but little is known whether staying indoors could lessen the exposure. The aim was to quantitatively characterize indoor fine PM levels and to verify the contribution of ambient pollution to it in a polluted city like Almaty.

METHODS

We collected forty-six 24-hour 15-min average samples of the ambient air and a similar number of paired indoor samples (total 92 samples). Predictors of both ambient and indoor PM2.5 mass concentrations in mg/m3, including ambient concentration, precipitation, minimal daily temperature and humidity, along with the indoor/outdoor (I/O) ratio were tested in the adjusted regression models at eight 15-min lags.

RESULTS

Ambient air PM2.5 15-min average mass concentrations were highly variable and ranged from 0.001 to 0.694 mg/m3 (geometric mean (GM) 0.090, geometric standard deviation (GSD) 2.285). Snowing was the strongest predictor of lower ambient PM2.5 24-hour mass concentrations (median 0.053 vs 0.135 mg/m3 (p<0.001)). Indoor mean 15-min PM2.5 concentrations ranged from 0.002 to 0.228 mg/m3 (GM 0.034, GSD 2.254). In adjusted models, outdoor PM2.5 concentration explained 0.58 of all variability of the indoor concentration with a 75-min delay (R2 0.67 at lag8 on snowing days). Median I/O ranged from 0.386 (IQR 0.264 to 0.532) at lag0 to 0.442 (IQR 0.339 to 0.584) at lag8.

CONCLUSION

During the cold season when fossil fuel is burnt for heating, the population in Almaty is exposed to very high fine PM levels even indoors. Urgent public health action is needed.

Differential effects of size-specific particulate matter on the number of visits to outpatient fever clinics: A time-series analysis in Zhuhai, China

Introduction

While many studies have investigated the adverse effects of particulate matter (PM), few of them distinguished the different effects of PM_2.5, PM₁₀, and coarse PM (PMc) on outpatients with fever. Our study aimed to estimate and compare the acute cumulative effects of exposure to three size-specific particles on the number of visits to outpatient fever clinics.

Methods

To examine the association between daily PM concentrations and outpatients in fever clinics, a generalized additive Poisson model was applied, stratified by sex, age, and season.

Results

Our study included 56,144 outpatient visits in Zhuhai, from January 2020 to June 2021. On the current day, each 10 mg/m³ increment of PM₁₀ and PMc were estimated to increase fever clinic visits by 1.74% (95% CI: 0.59%, 2.91%) and 4.42 % (2.30%, 6.58%), respectively. Cumulative effects enhanced from lag01 to lag05 for PM₁₀ and PMc, and PMc had the strongest impact [ER = 8.92% (5.91%, 12.01%) at lag05]. Female outpatients and outpatients aged 14 years and above had an increased PM-related risk. During the cold season, significant effects could be observed for the three-size PM, while only PMc showed the impact during the warm season.

Discussion

Overall, the three size-specific PM exerted different effects on the fever clinic visits. Strategies to control the concentrations of PM are still necessary, especially against PM₁₀ and PMc.

Air pollution-induced health impacts and health economic losses in China driven by US demand exports

Understanding how trade between regions or countries drives the transfer of air pollution has attracted considerable interest recently, but few studies have explored the various transfer pathways or evaluated economic losses due to the health impact of such air pollution. Here, we assess the air pollutant emissions and related health impacts and economic losses in China caused by export trade due to US demand by combining the linked multi-regional input-output (MRIO) model, GEOS-Chem model, integrated exposure-response model, and the willingness to pay method. We show that the air pollutant emissions embedded in China's export due to the US demand reached 5792.38 Kt in 2012 (2.48% of the total), which includes direct exports of intermediate (40.27%) and final (33.61%) products and indirect exports of intermediate products via domestic provinces (16.43%, domestic spillover) and other countries (9.69%, foreign spillover). The resulting increase in PM_2.5 (<2.8 μg m^-3) leads to additional 27,963 deaths in 30 provinces, with a higher death toll in coastal areas and the corresponding economic loss was higher in more developed regions and reached USD 2.08 billion. This study highlights the region-different air pollution and health impacts in China embedded in the US-demand trade, and provides a framework for the analysis of health and economic losses hidden in global trade, particularly between developing and developed countries.

Yangyinqingfei decoction attenuates PM2.5-induced lung injury by enhancing arachidonic acid metabolism

Yangyinqingfei Decoction (YYQFD), a traditional Chinese prescription, is well known in the treatment of diphtheria and lung-related diseases in clinic. However, whether it can be used to block the lung injury caused by air pollutant remains unclear. In the present study, the effect of YYQFD was addressed using a PM2.5-induced lung injury mice model. It was shown that YYQFD significantly improved pulmonary functions of mice exposed to PM2.5, the levels of IL-6, TNF-α and MDA were decreased while SOD levels were increased in serum and bronchoalveolar fluid. The potential mechanism of YYQFD was then delved using metabolomic and proteomic techniques. The protein-metabolite joint analysis showed that YYQFD regulated the biosynthesis of unsaturated fatty acids, linoleic acid and arachidonic acid metabolism, causing a significant decrement of pro-inflammatory mediator arachidonic acid with its downstream metabolites like 20-HETE, prostaglandin E2, accompanied by the up-regulation of PTGES2, GPX2 and CBR3 in lung tissue. These data were used to construct a regulatory metabolic network map in terms of the therapeutic role of YYQFD in PM2.5-induced lung injury, thereby provided a novel insight into potential application in the respiratory diseases caused by air pollutants.

Air pollution and innovation performance of Chinese cities: human capital and labour cost perspective

Environmental protection and innovation performance are key issues that affect the sustainable development and value growth of cities. Using data of 272 prefecture-level cities during 2002-2016 and 2,169 listed companies, and the air ventilation coefficient and government environmental regulations, as the instrumental variables for PM_2.5 concentrations, this paper applies two-stage OLS (2SLS) to investigate how air pollution affects China's technological innovation and its realization mechanism. The results indicate that the rise in air pollution significantly inhibits the technological innovation level of regions as a whole as well as individual enterprises. When considering the spatial effect of the spread of PM_2.5 concentrations, due to positive spillover effects on innovation activities, the spread of air pollution has negative impacts on technological innovation activities in surrounding cities. Human capital and labour costs are important channels through which air pollution influences China's technological innovation. The implementation of pilot carbon trading policies can effectively reduce air pollution and then contribute to the achievement of the goals of the green growth strategy.

Air Pollution, Socioeconomic Status, and Age-Specific Mortality Risk in the United States

IMPORTANCE

Prior studies on the association between fine particulate matter with diameters 2.5 μm or smaller (PM2.5) and probability of death have not applied multilevel analysis disaggregating data for US census tract, states, and counties, nor tested its interaction by socioeconomic status (SES). Such an approach could provide a more refined identification and targeting of populations exposed to increased risk from PM2.5.

OBJECTIVE

To assess the association between PM2.5 and age-specific mortality risk (ASMR) using disaggregated data at the census tract level and evaluate such association according to census tract SES.

DESIGN, SETTING, AND PARTICIPANTS

This nationwide cross-sectional study used a linkage of 3 different data sets. ASMR for the period of 2010 to 2015 was obtained from the National Center for Health Statistic, SES data covering a period from 2006 to 2016 came from the American Community Survey, and mean PM2.5 exposure levels from 2010 to 2015 were derived from well-validated atmospheric chemistry and machine learning models. Data were analyzed in April 2021.

EXPOSURES

The main exploratory variable was mean census tract-level long-term exposure to PM2.5 from 2010 to 2015.

MAIN OUTCOMES AND MEASURES

The primary outcome was census tract-level ASMR. Multilevel models were used to quantify the geographic variation in ASMR at levels of census tract, county, and state. Additional analysis explored the interaction of SES in the association of ASMR with PM2.5 exposure.

RESULTS

Data from 67 148 census tracts nested in 3087 counties and 50 states were analyzed. The association between exposure to PM2.5 and ASMR varied substantially across census tracts. The magnitude of such association also varied across age groups, being higher among adults and older adults. Census tracts accounted for most of the total geographic variation in mortality risk (range, 77.0%-94.2%). ASMR was higher in deciles with greater PM2.5 concentration. For example, ASMR for age 75 to 84 years was 54.6 per 1000 population higher in the decile with the second-highest PM2.5 concentration than in the decile with the lowest PM2.5 concentration. The ASMR, PM2.5 concentrations, and magnitude of the association between both were higher in the census tracts with the lowest SES.

CONCLUSIONS AND RELEVANCE

This cross-sectional study found that census tracts with lower SES presented higher PM2.5 concentrations. ASMR and air pollution varied substantially across census tracts. There was an association between air pollution and ASMR across all age groups in the United States. These findings suggest that equitable public policies aimed at improving air quality are needed and important to increase life expectancy.

Spatial-Temporal Evolution of Health Impact and Economic Loss upon Exposure to PM2.5 in China

Exposure to PM_2.5 can seriously endanger public health. Policies for controlling PM_2.5 need to consider health hazards under different circumstances. Unlike most studies on the concentration, distribution, and influencing factors of PM_2.5, the present study focuses on the impact of PM_2.5 on human health. We analysed the spatial-temporal evolution of health impact and economic loss caused by PM_2.5 exposure using the log-linear exposure-response function and benefit transfer method. The results indicate that the number of people affected by PM_2.5 pollution fluctuated and began to decline after reaching a peak in 2014, benefiting from the Air Pollution Prevention and Control Action Plan. Regarding the total economic loss, the temporal pattern continued to rise until 2014 and then declined, with an annual mean of 86,886.94 million USD, accounting for 1.71% of China’s GDP. For the spatial pattern, the health impact and economic loss show a strong spatial correlation and remarkable polarisation phenomena, with high values in East China, North China, Central China, and South China, but low values in Southwest China, Northwest China, and Northeast China. The spatial-temporal characterisation of PM_2.5 health hazards is visualised and analysed accordingly, which can provide a reference for more comprehensive and effective policy decisions.

Global urban temporal trends in fine particulate matter (PM2·5) and attributable health burdens: estimates from global datasets

BACKGROUND

With much of the world's population residing in urban areas, an understanding of air pollution exposures at the city level can inform mitigation approaches. Previous studies of global urban air pollution have not considered trends in air pollutant concentrations nor corresponding attributable mortality burdens. We aimed to estimate trends in fine particulate matter (PM_2·5) concentrations and associated mortality for cities globally.

METHODS

We use high-resolution annual average PM_2·5 concentrations, epidemiologically derived concentration response functions, and country-level baseline disease rates to estimate population-weighted PM_2·5 concentrations and attributable cause-specific mortality in 13 160 urban centres between the years 2000 and 2019.

FINDINGS

Although regional averages of urban PM_2·5 concentrations decreased between the years 2000 and 2019, we found considerable heterogeneity in trends of PM_2·5 concentrations between urban areas. Approximately 86% (2·5 billion inhabitants) of urban inhabitants lived in urban areas that exceeded WHO's 2005 guideline annual average PM_2·5 (10 μg/m³), resulting in an excess of 1·8 million (95% CI 1·34 million-2·3 million) deaths in 2019. Regional averages of PM_2·5-attributable deaths increased in all regions except for Europe and the Americas, driven by changes in population numbers, age structures, and disease rates. In some cities, PM_2·5-attributable mortality increased despite decreases in PM_2·5 concentrations, resulting from shifting age distributions and rates of non-communicable disease.

INTERPRETATION

Our study showed that, between the years 2000 and 2019, most of the world's urban population lived in areas with unhealthy levels of PM_2·5, leading to substantial contributions to non-communicable disease burdens. Our results highlight that avoiding the large public health burden from urban PM_2·5 will require strategies that reduce exposure through emissions mitigation, as well as strategies that reduce vulnerability to PM_2·5 by improving overall public health.

FUNDING

NASA, Wellcome Trust.

Systematic review of preclinical studies on the neutrophil-mediated immune response to air pollutants, 1980-2020

Preclinical evidence about the neutrophil-mediated response in exposure to air pollutants is scattered and heterogeneous. This has prevented the consolidation of this research field around relevant models that could advance towards clinical research. The purpose of this study was to systematic review the studies of the neutrophils response to air pollutants, following the recommendations of the Cochrane Collaboration and the PRISMA guide, through 54 search strategies in nine databases. We include 234 studies (in vitro, and in vivo), being more frequent using primary neutrophils, Balb/C and C57BL6/J mice, and Sprague-Dawley and Wistar rats. The most frequent readouts were cell counts, cytokines and histopathology. The temporal analysis showed that in the last decade, the use of mice with histopathological and cytokine measurement have predominated. This systematic review has shown that study of the neutrophils response to air pollutants started 40 years ago, and composed of 100 different preclinical models, 10 pollutants, and 11 immunological outcomes. Mechanisms of neutrophils-mediated immunopathology include cellular activation, ROS production, and proinflammatory effects, leading to cell-death, oxidative stress, and inflammatory infiltrates in lungs. This research will allow consolidating the research efforts in this field, optimizing the study of causal processes, and facilitating the advance to clinical studies.

Combined biochar and double inhibitor application offsets NH3 and N2O emissions and mitigates N leaching in paddy fields

The effects of combined biochar and double inhibitor application on gaseous nitrogen (N; nitrous oxide [N₂O] and ammonia [NH₃]) emissions and N leaching in paddy soils remain unclear. We investigated the effects of biochar application at different rates and double inhibitor application (hydroquinone [HQ] and dicyandiamide [DCD]) on NH₃ and N₂O emissions, N leaching, as well as rice yield in a paddy field, with eight treatments, including conventional urea N application at 280 kg N ha^-1 (CN); reduced N application at 240 kg N ha^-1 (RN); RN + 7.5 t ha^-1 biochar (RNB1); RN + 15 t ha^-1 biochar (RNB2); RN + HQ + DCD (RNI); RNB1 + HQ + DCD (RNIB1); RNB2 + HQ + DCD (RNIB2); and a control without N fertilizer. When compared with N leaching under RN, biochar application reduced total N leaching by 26.9-34.8% but stimulated NH₃ emissions by 13.2-27.1%, mainly because of enhanced floodwater and soil NH₄⁺-N concentrations and pH, and increased N₂O emission by 7.7-21.2%, potentially due to increased soil NO₃^--N concentrations. Urease and nitrification inhibitor addition decreased NH₃ and N₂O emissions, and total N leaching by 20.1%, 21.5%, and 22.1%, respectively. Compared with RN, combined biochar (7.5 t ha^-1) and double inhibitor application decreased NH₃ and N₂O emissions, with reductions of 24.3% and 14.6%, respectively, and reduced total N leaching by up to 45.4%. Biochar application alone or combined with double inhibitors enhanced N use efficiency from 26.2% (RN) to 44.7% (RNIB2). Conversely, double inhibitor application alone or combined with biochar enhanced rice yield and reduced yield-scaled N₂O emissions. Our results suggest that double inhibitor application alone or combined with 7.5 t ha^-1 biochar is an effective practice to mitigate NH₃ and N₂O emission and N leaching in paddy fields.

Acute effect of particulate matter pollution on hospital admissions for cause-specific respiratory diseases among patients with and without type 2 diabetes in Beijing, China, from 2014 to 2020

BACKGROUND

Scientific studies have identified various adverse effects of particulate matter (PM) on respiratory disease (RD) and type 2 diabetes (T2D). However, whether short-term exposure to PM triggers the onset of RD with T2D, compared with RD without T2D, has not been elucidated.

METHODS

A two-stage time-series study was conducted to evaluate the acute adverse effects of PM on admission for RD and for RD with and without T2D in Beijing, China, from 2014 to 2020. District-specific effects of PM_2.5 and PM₁₀ were estimated using the over-dispersed Poisson generalized addictive model after adjusting for weather conditions, day of the week, and long-term and seasonal trends. Meta-analyses were applied to pool the overall effects on overall and cause-specific RD, while the exposure-response (E-R) curves were evaluated using a cubic regression spline.

RESULTS

A total of 1550,154 admission records for RD were retrieved during the study period. Meta-analysis suggested that per interquartile range upticks in the concentration of PM_2.5 corresponded to 1.91% (95% CI: 1.33-2.49%), 2.16% (95% CI: 1.08-3.25%), and 1.92% (95% CI: 1.46-2.39%) increments in admission for RD, RD with T2D, and RD without T2D, respectively, at lag 0-8 days, lag 8 days, and lag 8 days. The effect size of PM_2.5 was statistically significantly higher in the T2D group than in the group without T2D (z = 3.98, P < 0.01). The effect sizes of PM₁₀ were 3.86% (95% CI: 2.48-5.27%), 3.73% (95% CI: 1.72-5.79%), and 3.92% (95% CI: 2.65-5.21%), respectively, at lag 0-13 days, lag 13 days, and lag 13 days, respectively, and no statistically significant difference was observed between T2D groups (z = 0.24, P = 0.81). Significant difference was not observed between T2D groups for the associations of PM and different RD and could be found between three groups for effects of PM₁₀ on RD without T2D. The E-R curves varied by sex, age and T2D condition subgroups for the associations between PM and daily RD admissions.

CONCLUSIONS

Short-term PM exposure was associated with increased RD admission with and without T2D, and the effect size of PM_2.5 was higher in patients with T2D than those without T2D.

Pricing air pollution: evidence from short-term exposure to air pollution on hospitalization of acute bronchitis and chronic obstructive pulmonary disease in southwestern China

Existing evidence suggests that ambient air pollution has serious adverse effects on respiratory diseases, yet there is little direct evidence from China regarding corresponding economic losses. Here we quantified air pollution-related acute health effects and related economic losses of the most common two respiratory diseases in southwestern China, acute bronchitis and chronic obstructive pulmonary disease (COPD). We applied a distributed lag non-linear model to analyse the relationship between ambient air pollutants and hospital admissions of acute bronchitis and COPD, then applied the cost of illness method to explore the attributing economic burden. During the study period, 528 334 and 99 419 hospital admissions of acute bronchitis and COPD, respectively, were recorded. As a result, during the study period the total hospitalization economic losses attributable to air pollution were 486.40 and 254.74 million yuan for acute bronchitis and COPD, respectively, accounting for 0.015% of local gross domestic product. Our research provides intuitive evidence on the health and economic impacts of short-term exposure to air pollution, which is a key basis for the formulation of environmental policies.

Assessing the health impacts attributable to PM2.5 and ozone pollution in 338 Chinese cities from 2015 to 2020

China has effectively reduced the fine particulate (PM_2.5) pollution from 2015 to 2020. Ozone pollution and related health impacts have become severe contemporaneously. The coordinated control of PM_2.5 and ozone is becoming a new issue for China's air pollution control. This study quantitatively assessed the health impacts attributed to PM_2.5 and ozone pollution in 338 Chinese cities from 2015 to 2020 and estimated the possible health benefits from achieving dual concentration targets during 2021-2025. Results show PM_2.5 caused a total health impact of 2.45 × 10⁷ disability-adjusted life years (DALYs) in 2020. All-cause and respiratory ozone-related health impact in 2020 was 1.04 × 10⁷ DALYs and 1.56 × 10⁶ DALYs. Between 2015 and 2020, the PM_2.5-related health impacts decreased by 14.97%, while those ozone-related increased by 94.61% and 96.54% for all-cause and respiratory. Cities in the North China Plain have suffered higher health impacts attributable to PM_2.5 and ozone pollution, indicating that the two-pollutant coordinated control is primarily needed. By achieving aggressive concentration target (decreasing 10%) between 2020 and 2025, China will reduce the PM_2.5-related health impacts in 338 cities by 1.56 × 10⁶ DALYs (improving 6.37%). By achieving general target (decreasing 10% or within the Interim target-1 of World Health Organization), the PM_2.5-related health benefit will be 7.98 × 10⁵ DALYs (improving 3.25%). The deteriorating ozone health risks will also be improved. Controlling air pollution in large cities and regional center cities can achieve remarkable health benefits. Due to the inter-region, inter-province, and inter-city difference of health impacts, targeted and differentiated pollution prevention and control need to be implemented.

Exploring short term spatio-temporal pattern of PM2.5 and PM10 and their relationship with meteorological parameters during COVID-19 in Delhi

Present study aims to examine the impact of lockdown on spatio-temporal concentration of PM2.5 and PM10 - categorized and recorded based on its levels during pre-lockdown, lockdown and unlock phases while noting the relationship of these levels with meteorological parameters (temperature, wind speed, relative humidity, rainfall, pressure, sun hour and cloud cover) in Delhi. To aid the study, a comparison was made with the last two years (2018 to 2019), covering the same periods of pre-lockdown, lockdown and unlock phases of 2020. Correlation analysis, linear regression (LR) was used to examine the impact of meteorological parameters on particulate matter (PM) concentrations in Delhi, India. The findings showed that (i) substantial decline of PM concentration in Delhi during lockdown period, (ii) there were substantial seasonal variation of particulate matter concentration in city and (iii) meteorological parameters have close associations with PM concentrations. The findings will help planners and policy makers to understand the impact of air pollutants and meteorological parameters on infectious disease and to adopt effective strategies for future.

IL-10 ameliorates PM2.5-induced lung injury by activating the AMPK/SIRT1/PGC-1α pathway

Exposure to fine particulate matter with a diameter ≤2.5 μm (PM2.5) can cause a number of respiratory diseases. However, there is currently no safe treatment for PM2.5-induced lung damage. This study investigated the protective effect of IL-10 against lung injury and the possible involvement of AMPK/SIRT1/PGC-1α signaling. The mean diameter, particle size distribution, and zeta potential of PM2.5 samples were assessed using a Zetasizer Nano ZS90 analyzer. Thereafter, Wistar rats were exposed to PM2.5 (1.8, 5.4, or 16.2 mg/kg) alone or high-dose PM2.5 with recombinant rat IL-10 (rrIL-10; 5 μg/rat). Treatment with rrIL-10 ameliorated PM2.5-induced acute lung injury, reduced mitochondrial damage, and inhibited inflammation, oxidative stress, and apoptosis in the PM2.5-treated rats. Moreover, the mRNA and protein expression of AMPK, SIRT1, and PGC-1α were upregulated by rrIL-10 treatment. In conclusion, rrIL-10 protected lung tissues against PM2.5-induced inflammation by reducing oxidative stress and apoptosis via activating AMPK/SIRT1/PGC-1α signaling.

Particulate Matter and Premature Mortality: A Bayesian Meta-Analysis

BACKGROUND

We present a systematic review of studies assessing the association between ambient particulate matter (PM) and premature mortality and the results of a Bayesian hierarchical meta-analysis while accounting for population differences of the included studies.

METHODS

The review protocol was registered in the PROSPERO systematic review registry. Medline, CINAHL and Global Health databases were systematically searched. Bayesian hierarchical meta-analysis was conducted using a non-informative prior to assess whether the regression coefficients differed across observations due to the heterogeneity among studies.

RESULTS

We identified 3248 records for title and abstract review, of which 309 underwent full text screening. Thirty-six studies were included, based on the inclusion criteria. Most of the studies were from China (n = 14), India (n = 6) and the USA (n = 3). PM_2.5 was the most frequently reported pollutant. PM was estimated using modelling techniques (22 studies), satellite-based measures (four studies) and direct measurements (ten studies). Mortality data were sourced from country-specific mortality statistics for 17 studies, Global Burden of Disease data for 16 studies, WHO data for two studies and life tables for one study. Sixteen studies were included in the Bayesian hierarchical meta-analysis. The meta-analysis revealed that the annual estimate of premature mortality attributed to PM_2.5 was 253 per 1,000,000 population (95% CI: 90, 643) and 587 per 1,000,000 population (95% CI: 1, 39,746) for PM₁₀.

CONCLUSION

253 premature deaths per million population are associated with exposure to ambient PM_2.5. We observed an unstable estimate for PM₁₀, most likely due to heterogeneity among the studies. Future research efforts should focus on the effects of ambient PM₁₀ and premature mortality, as well as include populations outside Asia. Key messages: Ambient PM_2.5 is associated with premature mortality. Given that rapid urbanization may increase this burden in the coming decades, our study highlights the urgency of implementing air pollution mitigation strategies to reduce the risk to population and planetary health.

Acute effect of particulate matter pollution on hospital admissions for stroke among patients with type 2 diabetes in Beijing, China, from 2014 to 2018

BACKGROUND

The health effect of particulate matter pollution on stroke has been widely examined; however, the effect among patients with comorbid type 2 diabetes (T2D) in developing countries has remained largely unknown.

METHODS

A time-series study was conducted to investigate the short-term effect of fine particulate matter (PM_2.5) and inhalable particulate matter (PM₁₀) on hospital admissions for stroke among patients with T2D in Beijing, China, from 2014 to 2018. An over-dispersed Poisson generalized additive model was employed to adjust for important covariates, such as weather conditions and long-term and seasonal trends.

RESULTS

A total of 159,298 hospital admissions for stroke comorbid with T2D were reported. Approximately linear exposure-response curves were observed for PM_2.5 and PM₁₀ in relation to stroke admissions among T2D patients. A 10 μg/m³ increase in the four-day moving average of PM_2.5 and PM₁₀ was associated with 0.14% (95% confidence interval [CI]: 0.05-0.23%) and 0.14% (95% CI: 0.06-0.22%) incremental increases in stroke admissions among T2D patients, respectively. A 10 μg/m³ increase in PM_2.5 in the two-day moving average corresponded to a 0.72% (95% CI: 0.02-1.42%) incremental increase in hemorrhagic stroke, and a 10 μg/m³ increase in PM₁₀ in the four-day moving average corresponded to a 0.14% (95% CI: 0.06-0.22%) incremental increase in ischemic stroke.

CONCLUSIONS

High particulate matter might be a risk factor for stroke among patients with T2D. PM_2.5 and PM₁₀ have a linear exposure-response relationship with stroke among T2D patients. The study provided evidence of the risk of stroke due to particulate matter pollution among patients with comorbid T2D.

Particulate Matter Exposures under Five Different Transportation Modes during Spring Festival Travel Rush in China

Serious traffic-related pollution and high population density during the spring festival (Chinese new year) travel rush (SFTR) increases the travelers’ exposure risk to pollutants and biohazards. This study investigates personal exposure to particulate matter (PM) mass concentration when commuting in five transportation modes during and after the 2020 SFTR: China railway high-speed train (CRH train), subway, bus, car, and walking. The routes are selected between Nanjing and Xuzhou, two major transportation hubs in the Yangtze Delta. The results indicate that personal exposure levels to PM on the CRH train are the lowest and relatively stable, and so it is recommended to take the CRH train back home during the SFTR to reduce the personal PM exposure. The exposure level to PM2.5 during SFTR is twice as high as the average level of Asia, and it is higher than the WHO air quality guideline (AQG).

Spatiotemporal assessment of health burden and economic losses attributable to short-term exposure to ground-level ozone during 2015-2018 in China

BACKGROUND

Ground-level ozone (O3) pollution is currently the one of the severe environmental problems in China. Although existing studies have quantified the O3-related health impact and economic loss, few have focused on the acute health effects of short-term exposure to O3 and have been limited to a single temporal and spatial dimension.

METHODS

Based on the O3 concentration obtained from ground monitoring networks in 334 Chinese cities in 2015-2018, this study used a two-stage exposure parameter weighted Log-linear exposure-response function to estimate the cause-specific mortality for short-term exposure to O3.

RESULTS

The value of statistical life (VSL) method that were used to calculate the economic loss at the city-level. Our results show that in China, the national all-cause mortality attributed to O3 was 0.27(95% CI: 0.14-0.55) to 0.39 (95% CI: 0.20-0.67) million across 2015-2018. The estimated economic loss caused by O3 was 387.76 (95% CI: 195.99-904.50) to 594.08 (95% CI: 303.34-1140.65) billion CNY, accounting for 0.52 to 0.69% of total reported GDP. Overall, the O3 attributed health and economic burden has begun to decline in China since 2017. However, highly polluted areas still face severe burden, and undeveloped areas suffer from high GDP losses.

CONCLUSIONS

There are substantial health impacts and economic losses related to short-term O3 exposure in China. The government should pay attention to the emerging ozone pollution, and continue to strengthen the intervention in traditional priority areas while solving the pollution problem in non-priority areas.

The associations of air pollution and socioeconomic factors with esophageal cancer in China based on a spatiotemporal analysis

Rapid urbanization and industrialization in China have incurred serious air pollution and consequent health concerns. In this study, we examined the modifying effects of urbanization and socioeconomic factors on the association between PM_2.5 and incidence of esophageal cancer (EC) in 2000-2015 using spatiotemporal techniques and a quasi-Poisson generalized linear model. The results showed a downward trend of EC and high-risk areas aggregated in North China and Huai River Basin. In addition, a stronger association between PM_2.5 and incidence was observed in low urbanization group, and the association was stronger for females than males. When exposure time-windows were adjusted as 0, 5, 10, 15 years, the incidence risk increased by 2.48% (95% CI: 2.23%, 2.73%), 2.20% (95% CI: 1.91%, 2.49%), 2.18% (95% CI%: 1.92%, 2.43%), 1.87% (95% CI%:1.64, 2.10%) for males, respectively and 4.03% (95% CI: 3.63%, 4.43%), 2.20% (95% CI: 1.91%, 2.49%), 3.97% (95% CI: 3.54%, 4.41%), 3.06% (95% CI: 2.71%, 3.41%) for females, respectively. The findings indicated people in low urbanization group faced with a stronger EC risk caused by PM_2.5, which contributes to a more comprehensive understanding of combating EC challenges related to PM_2.5 pollution.

Role of PKA/CREB/BDNF signaling in PM2.5-induced neurodevelopmental damage to the hippocampal neurons of rats

Exposure to fine particulate matter (PM2.5) is implicated in neurodevelopmental disorders including cognitive decline, attention-deficit/hyperactivity disorder, and autism spectrum disorder. However, the specific molecular mechanisms by which PM2.5 impacts neurodevelopment are poorly understood. Accordingly, in the present study, the role of protein kinase A (PKA)/cAMP response element binding protein (CREB)/brain-derived neurotrophic factor (BDNF) signaling in PM2.5-induced neurodevelopmental damage was investigated using primary cultured hippocampal neurons. When hippocampal neurons cultured for 3 days in vitro (DIV3) were exposed to PM2.5 for 24 h and 96 h, neuronal viability decreased by 18.8% and 32.7% respectively, percentage of TUNEL-positive neurons increased by 78.5% and 64.0% separately, caspase-9 expression increased, lower postsynaptic density and shorter active zones were observed by transmission electron microscopy, expression of synapse-related proteins including postsynaptic density-95 (PSD95), growth associated protein-43 (GAP43), and synaptophysin (SYP) were decreased, and the phosphorylation levels of PKA, CREB, and BDNF expression also decreased. However, the PM2.5-induced neuronal damage could be ameliorated or aggravated to varying degrees by up- or down-regulation of the PKA/CREB/BDNF signaling pathway, respectively. Our results indicate that PM2.5 exposure exerts neurodevelopmental toxicity as indicated by lower viability, apoptosis, and synaptic damage in primary cultured hippocampal neurons, and that the PKA/CREB/BDNF pathways could play a vital role in PM2.5-mediated neurodevelopmental toxicity.

Spatio-Temporal Characteristics of PM2.5, PM10, and AOD over the Central Line Project of China’s South-North Water Diversion in Henan Province (China)

The spatio-temporal characteristics of particulate matter with a particle size less than or equal to 2.5 μm (PM2.5), particulate matter with a particle size less than or equal to 10 μm (PM10), meteorological parameters from September 2018 to September 2019, and Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) aerosol optical depth (AOD) from 2007 to 2019 were investigated over the Central Line Project of China’s South-North Water Diversion (CSNWD) in Henan Province. To better understand the characteristics of the atmospheric environment over the CSNWD, air quality monitoring stations were installed in Nanyang (in the upper reaches), Zhengzhou (in the middle reaches), and Anyang (in the lower reaches). In this study, daily, monthly, and seasonal statistical analyses of PM2.5 and PM10 concentrations were performed and their relationship with meteorological parameters was investigated. The results show extremely poor air quality conditions over the Zhengzhou Station compared with the Nanyang and Anyang Stations. The annual average PM2.5 concentration did not meet China’s ambient air secondary standard (35 μg/m3 annual mean) over all the stations, while the annual average PM10 concentration satisfied China’s ambient air secondary standard (100 μg/m3 annual mean) over the Anyang and Nanyang Stations, except for the Zhengzhou Station. The highest PM2.5 and PM10 concentrations were observed during winter compared with the other seasons. The results show that PM2.5 and PM10 concentrations were negatively correlated with wind speed and temperature at the Nanyang and Zhengzhou Stations, but positively correlated with relative humidity. However, no significant negative or positive correlation was observed at Anyang Station. There is a strong linear positive correlation between PM2.5 and PM10 (R = 0.99), which indicates that the particulate matter at the three stations was mainly caused by local emissions. Additionally, the AOD values at the three stations were the highest in summer, which may be related to the residues of crops burned in Henan Province in summer.

The Impact of Air Pollution on Outpatient Visits of Children with Asthma in Xi'an, China

INTRODUCTION

The number of children with asthma has increased significantly in China. In recent years, there has been a steady increase in outpatient visits of children with asthma, attributed to poor air quality and environmental pollution reported regionally and at our institution. This study aimed to assess the association between air pollution and the number of outpatient visits of children with asthma in Xi'an, the largest city in northwest China.

METHODS

We searched the database of the largest children's hospital in Xi'an for related information from 2014 to 2018 and then acquired data on air pollution, including the daily average concentrations of fine particles (PM_2.5), inhalable particles (PM₁₀), nitrogen dioxide (NO₂), and sulfur dioxide (SO₂) of that same time period. Time-series generalized additive models were used to analyze the relationships.

RESULTS

Our results revealed that air pollution was very serious in Xi'an, with elevated average concentrations of PM_2.5, PM₁₀, and NO₂ from 2015 to 2018. The relative risk of outpatient visits due to asthma associated with PM_2.5, PM₁₀, and SO₂ pollution rose significantly and reached 1.11 (1.02-1.21), 1.25 (1.01-1.55), and 1.71 (1.31-2.25), respectively, when there was a 10 ug·m^-3 increase in concentration, during a lag of 21 d.

CONCLUSIONS

A high concentration of particulate matter (PM_2.5 and PM₁₀) was the prominent feature of air pollution in Xi'an. Exposure to air pollutant (PM_2.5, PM₁₀, SO₂) was positively associated with an increased risk of children's outpatient visits for asthma in Xi'an.

Characterising particulate matter source contributions in the pollution control zone of mining and related industries using bivariate statistical techniques

Na Phra Lan Subdistrict is a pollution control zone with the highest PM10 level in Thailand. Major mobile and industrial sources in the area are related to stone crushing, quarrying and mining. This study used statistical techniques to investigate the potential sources influencing high PM10 levels in Na Phra Lan. Hourly PM10 data and related parameters (PM2.5, PMcoarse and NOx) from 2014-2017 were analysed using time series, bivariate polar plot and conditional bivariate probability function (CBPF). Results of diurnal variation revealed two peaks of PM10 levels from 06:00-10:00 and 19:00-23:00 every month. For seasonal variation, high PM10 concentrations were found from October to February associated with the cool and dry weather during these months. The bivariate polar plot and CBPF confirmed two potential sources, i.e., resuspended dust from mobile sources close to the air quality monitoring station (receptor) and industrial sources of mining, quarrying and stone crushing far from the station on the northeast side. While the industrial source areas played a role in background PM10 concentrations, the influence of mobile sources increased the concentrations resulting in two PM10 peaks daily. From the study results, we proposed that countermeasure activities should focus on potential source areas, resuspended road dust from vehicles and the industrial sources related to quarrying and mining, rather than distributing equal attention to all sources.

Acute effect of ambient fine particulate matter on heart rate variability: an updated systematic review and meta-analysis of panel studies

Background

Decreased heart rate variability (HRV) is a predictor of autonomic system dysfunction, and is considered as a potential mechanism of increased risk of cardiovascular disease (CVD) induced by exposure to particulate matter less than 2.5 μm in diameter (PM_2.5). Previous studies have suggested that exposure to PM_2.5 may lead to decreased HRV levels, but the results remain inconsistent.

Methods

An updated systematic review and meta-analysis of panel studies till November 1, 2019 was conducted to evaluate the acute effect of exposure to ambient PM_2.5 on HRV. We searched electronic databases (PubMed, Web of Science, and Embase) to identify panel studies reporting the associations between exposure to PM_2.5 and the four indicators of HRV (standard deviation of all normal-to-normal intervals (SDNN), root mean square of successive differences in adjacent normal-to-normal intervals (rMSSD), high frequency power (HF), and low frequency power (LF)). Random-effects model was used to calculate the pooled effect estimates.

Results

A total of 33 panel studies were included in our meta-analysis, with 16 studies conducted in North America, 12 studies in Asia, and 5 studies in Europe. The pooled results showed a 10 μg/m³ increase in PM_2.5 exposure which was significantly associated with a − 0.92% change in SDNN (95% confidence intervals (95%CI) − 1.26%, − 0.59%), − 1.47% change in rMSSD (95%CI − 2.17%, − 0.77%), − 2.17% change in HF (95%CI − 3.24%, − 1.10%), and − 1.52% change in LF (95%CI − 2.50%, − 0.54%), respectively. Overall, subgroup analysis suggested that short-term exposure to PM_2.5 was associated with lower HRV levels in Asians, healthy population, and those aged ≥ 40 years.

Conclusion

Short-term exposure to PM_2.5 was associated with decreased HRV levels. Future studies are warranted to clarity the exact mechanism of exposure to PM_2.5 on the cardiovascular system through disturbance of autonomic nervous function.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12199-020-00912-2.

Burden of lung cancer attributable to ambient fine particles and potential benefits from air quality improvements in Beijing, China: A population-based study

OBJECTIVE

We aimed to establish a representative exposure response function between PM_2.5 and lung cancer to evaluate the impact on lung cancer burden and the benefits gained in association with the environmental policy change in Beijing, China.

METHODS

Based on population-based cancer registration data during 2001-2016, using a spatiotemporal Poisson regression model, long-term concentrations of PM_2.5 were linked to sex-age adjusted incidence rates of total lung cancer and its pathological subtypes. We calculated the health and monetary benefits associated with air quality improvement using the cost of illness method.

RESULTS

In the constructed regression model, a 10 μg/m³ increment of PM_2.5 was associated with increases of 6.0% (95% confidence interval [95% CI]: 4.3%, 7.7%), 14.8% (10.3%, 19.4%), and 6.5% (3.3%, 9.8%) in the incidence of total lung cancer, squamous cell carcinoma, and adenocarcinoma, respectively. The estimated associations indicate that long-term exposure to PM_2.5 contributed 1947 to 3059 incident cases of lung cancer per year among the residents in Beijing during the study period. Clean air actions saved 4978 (95% CI: 2711, 7417) lung cancer cases, which brought a savings of 218 (118, 324) million RMB (~31 [17, 46] million US dollars) in direct inpatient medical expenditures. If air quality had met national standards of long-term PM_2.5 (35 μg/m³) in 2014-2016, 10,003 (95% CI: 9325, 10,650) lung cancer cases could have been prevented and direct inpatient medical expenditures of 438 (409, 466) million RMB (~63 [58, 67] million US dollars) could have been saved.

CONCLUSIONS

This study enriches epidemiological study, confirming the association between exposure to PM_2.5 and lung cancer or its subtypes, and provides novel evidence for the notable reduction in lung cancer burden and medical expenditure savings that were achieved through air quality improvements in Beijing from 2014 to 2016.

Short-term effects of meteorological factors, air pollution, and sunspot on childhood hand, foot, and mouth disease in Tianjin, China: a new time series regression, 2014-2018

This study is aimed at defining the relationship between a set of environmental factors and childhood HFMD and then at estimating the related effect. The 16 environmental factors included meteorological, air pollution, and sunspot. A traditional TSR modified by using susceptible-infectious-recovery models and distribution lag nonlinear model was applied to estimate the short-term effects of daily environmental factors on children HFMD occurrence in 2014-2018 with adjustment of potential confounding factors. A total of 70,027 children aged 0-15 years with HFMD were enrolled. No significant effect was observed for daily sunspot numbers and average visibility. We found positive effects of the ambient average temperature, with an approximately m-shaped curve of the overall cumulative relationship, peaking at 25.6 °C with a relative risk (RR) of 1.45 (95% confidence intervals 1.21-1.73). The largest RR value of hot effect was achieved on the current day and then decreased by 2 days (total group, male group, and scatter group) or 1 day (female group and nursery group), and the effect lasted about 6 to 8 days from the lag 4 or lag 6 day. A greater association of temperature with HFMD for the female group and the scattered group was observed. This study suggests that ambient average temperature might be a risk factor for children HFMD in Tianjin. Further studies are warranted to confirm these findings.

Association between air pollutants and outpatient and emergency hospital visits for childhood asthma in Shenyang city of China

Effects of air pollution on asthma vary in different study areas, and long-term time series research on the effects of air pollution on asthma outpatients and emergency hospital visits has not been conducted in Northeast China. We assessed the impact of air pollutants on the risk of asthma outpatients and emergency hospital visits in Shenyang, China. A distributed lag non-linear model with a Poisson regression was used to assess the short-term effects of air pollutants on asthma outpatient and emergency hospital visits between January 1, 2013 and December 31, 2017. Confounding factors were adjusted using natural cubic splines. Ozone (O₃), carbon monoxide (CO), and suspended particulates < 10 μm in aerodynamic diameter (PM₁₀) were positively associated with the number of asthma hospital visits. The largest cumulative effects of O₃, CO, and PM₁₀ on hospital visits were on lag day 2 (RR = 1.163, 95% CI 1.051-1.287) for 0-5-year-old childhood asthma, on lag day 3 (RR = 1.386, 95% CI 1.136-1.69) for asthma in winter, and on lag day 10 (RR = 1.148, 95% CI 0.942-1.399) for female asthma, respectively. The cumulative effect of air pollution represented by the air quality index (AQI) was largest on lag day 10 for 0-5-year-old childhood asthma with an increase of 28.6% (95% CI 6.5-55.4) hospital visits every IQR increment of the AQI. CO, O₃, and PM₁₀ were the main air pollutants in Shenyang city. Children with bronchitis asthma were more vulnerable to air pollution during the cold season.

How Did Distribution Patterns of Particulate Matter Air Pollution (PM2.5 and PM10) Change in China during the COVID-19 Outbreak: A Spatiotemporal Investigation at Chinese City-Level

Due to the suspension of traffic mobility and industrial activities during the COVID-19, particulate matter (PM) pollution has decreased in China. However, rarely have research studies discussed the spatiotemporal pattern of this change and related influencing factors at city-scale across the nation. In this research, the clustering patterns of the decline rates of PM_2.5 and PM₁₀ during the period from 20 January to 8 April in 2020, compared with the same period of 2019, were investigated using spatial autocorrelation analysis. Four meteorological factors and two socioeconomic factors, i.e., the decline of intra-city mobility intensity (dIMI) representing the effect of traffic mobility and the decline rates of the secondary industrial output values (drSIOV), were adopted in the regression analysis. Then, multi-scale geographically weighted regression (MGWR), a model allowing the particular processing scale for each independent variable, was applied for investigating the relationship between PM pollution reductions and influencing factors. For comparison, ordinary least square (OLS) regression and the classic geographically weighted regression (GWR) were also performed. The research found that there were 16% and 20% reduction of PM_2.5 and PM₁₀ concentration across China and significant PM pollution mitigation in central, east, and south regions of China. As for the regression analysis results, MGWR outperformed the other two models, with R² of 0.711 and 0.732 for PM_2.5 and PM₁₀, respectively. The results of MGWR revealed that the two socioeconomic factors had more significant impacts than meteorological factors. It showed that the reduction of traffic mobility caused more relative declines of PM_2.5 in east China (e.g., cities in Jiangsu), while it caused more relative declines of PM₁₀ in central China (e.g., cities in Henan). The reduction of industrial operation had a strong relationship with the PM₁₀ drop in northeast China. The results are crucial for understanding how the decline pattern of PM pollution varied spatially during the COVID-19 outbreak, and it also provides a good reference for air pollution control in the future.

Attributable Risk and Economic Cost of Cardiovascular Hospital Admissions Due to Ambient Particulate Matter in Wuhan, China

Although the adverse effects of ambient particulate matter (PM) on cardiovascular disease (CVD) have been previously documented, information about their economic consequence was insufficient. This study aimed to evaluate the attributable risk and economic cost of cardiovascular hospitalizations due to ambient PM. Data of CVD hospitalizations and PM concentrations from 1 January 2015 to 31 December 2017 were collected in Wuhan, China. A generalized additive model was applied to quantify the PM-attributable CVD hospitalizations, and total attributable hospitalization costs were calculated via multiplying the total attributable cases by the case-average hospitalization costs. A total of 45,714 CVD hospitalizations were included in this study. The results showed that a 10 µg/m3 increase in PM2.5 and PM10 concentrations at lag7 day, respectively, contributed to a 1.01% (95% confidence interval: 0.67-1.34) and 0.48% (0.26-0.70) increase in CVD hospitalizations. During the study period, 1487 and 983 CVD hospitalizations were attributable to PM2.5 and PM10, equaling an economic cost of 29.27 and 19.34 million RMB (1 RMB = 0.1424 USD), respectively, and significant differences in PM-attributable hospitalizations and economic burden were found between gender and age groups. Our study added evidence in heavily polluted megacities regarding the increased health risk and economic cost of CVD hospitalizations associated with ambient particulate pollution.

Global nature of airborne particle toxicity and health effects: a focus on megacities, wildfires, dust storms and residential biomass burning

Since air pollutants are difficult and expensive to control, a strong scientific underpinning to policies is needed to guide mitigation aimed at reducing the current burden on public health. Much of the evidence concerning hazard identification and risk quantification related to air pollution comes from epidemiological studies. This must be reinforced with mechanistic confirmation to infer causality. In this review we focus on data generated from four contrasting sources of particulate air pollution that result in high population exposures and thus where there remains an unmet need to protect health: urban air pollution in developing megacities, household biomass combustion, wildfires and desert dust storms. Taking each in turn, appropriate measures to protect populations will involve advocating smart cities and addressing economic and behavioural barriers to sustained adoption of clean stoves and fuels. Like all natural hazards, wildfires and dust storms are a feature of the landscape that cannot be removed. However, many efforts from emission containment (land/fire management practices), exposure avoidance and identifying susceptible populations can be taken to prepare for air pollution episodes and ensure people are out of harm's way when conditions are life-threatening. Communities residing in areas affected by unhealthy concentrations of any airborne particles will benefit from optimum communication via public awareness campaigns, designed to empower people to modify behaviour in a way that improves their health as well as the quality of the air they breathe.

Particulate matter pollution and hospital outpatient visits for endocrine, digestive, urological, and dermatological diseases in Nanjing, China

Clinical or pathological evidence demonstrated that air pollution could undermine other organ systems of human body besides respiratory and circulation systems. Investigations that directly relate hospital outpatient visits for endocrine (ENDO), digestive (DIGE), urological (UROL), and dermatological (DERM) diseases categories with ambient particulate matter (PM) are still lacking, particularly in heavily polluted cities. Here, we conducted a time-series analysis using 812,624, 1,111,342, 539,803, and 741,662 hospital visits for ENDO, DIGE, UROL, and DERM, respectively, in Nanjing, China from 2013 to 2019. A generalized additive model was applied to estimate the exposure-response associations. Results showed that a 10 μg/m³ increase in PM_2.5 concentration on lag 0 day was significantly associated with 0.59% (95% CI: 0.30%, 0.88%), 0.43% (0.15%, 0.70%), 0.36% (0.06%, 0.66%), and 0.65% (0.42%, 0.87%) increase for ENDO, DIGE, UROL, and DERM hospital visits, respectively. The estimated effects of PM₁₀ were slightly smaller but still statistically significant. The magnitude and significance of the associations between PM and four health outcomes were sensitive to additional adjustment for co-pollutants. Exposure-response relationships were linear for PM concentrations lower than 100 μg/m³ but the curves became nonlinear across the full range of exposures due to a flatten slope at higher concentrations. We also explored the effect modifications by season (cold or warm), age (5-18, 18-64, 65-74, or 75+ years), and sex (male or female). Results showed that the DERM-related population aged 65 years or older was more vulnerable to PM exposure, compared with the 5 to 17-year age group; the DERM-related population aged 75 years or older and 65 years or older was more vulnerable to PM_2.5 and PM₁₀ exposure, respectively, compared with the 18 to 64-year age group. Our study provided suggestive evidence that ambient PM pollution was associated with ENDO, DIGE, UROL, and DERM outpatient hospital visits in Nanjing, China.

Effects of Population Weighting on PM10 Concentration Estimation

Particulate matter with an aerodynamic diameter of 10 μm or less (PM₁₀) pollution poses a considerable threat to human health, and the first step in quantifying health impacts of human exposure to PM₁₀ pollution is exposure assessment. Population-weighted exposure level (PWEL) estimation is one of the methods that provide a more refined exposure assessment as it includes the spatiotemporal distribution of the population into the pollution concentration estimation. This study assessed the population weighting effects on the estimated PM₁₀ concentrations in Malaysia for years 2000, 2008, and 2013. Estimated PM₁₀ annual mean concentrations with a spatial resolution of 5 kilometres retrieved from satellite data and population count obtained from the Gridded Population of the World version 4 (GPWv4) from the Centre for International Earth Science Information Network (CIESIN) were overlaid to generate the PWEL of PM₁₀ for each state. The calculated PWEL of PM₁₀ concentrations were then classified based on the World Health Organization (WHO) and the national Air Quality Guidelines (AQG) and interim targets (IT) for comparison. Results revealed that the annual mean PM₁₀ concentrations in Malaysia ranged from 31 to 73 µg/m³ but became generally lower, ranging from 20 to 72 µg/m³ after population weighting, suggesting that the PM₁₀ population exposure in Malaysia might have been overestimated. PWEL of PM₁₀ distribution showed that the majority of the population lived in areas that complied with the national AQG, but were vulnerable to exposure level 3 according to the WHO AQG and IT, indicating that the population was nevertheless potentially exposed to significant health effects from long-term exposure to PM₁₀ pollution.

REALizing and improving management of stable COPD in China: a multi-center, prospective, observational study to realize the current situation of COPD patients in China (REAL) - rationale, study design, and protocol

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of death in China with a reported prevalence of 8.2% people aged ≥40 years. It is recommended that Chinese physicians follow Global Initiative for Chronic Obstructive Lung Disease (GOLD) and national guidelines, yet many patients with COPD in China remain undiagnosed. Furthermore, missed diagnoses and a lack of standardized diagnosis and treatment remain significant problems. The situation is further complicated by a lack of large-scale, long-term, prospective studies of real-world outcomes, including exacerbation rates, disease severity, efficacy of treatment, and compliance of COPD patients in China.

METHODS/DESIGN

The REALizing and improving management of stable COPD in China (REAL) study is a 52-week multi-center, prospective, observational trial. REAL aims to recruit approximately 5000 outpatients aged ≥40 years with a clinical diagnosis of COPD per GOLD 2016. Outpatients will be consecutively recruited from approximately 50 tertiary and secondary hospitals randomly selected across six geographic regions to provide a representative population. Patients will receive conventional medical care as determined by their treating physicians. The primary objective is to evaluate COPD patient outcomes including lung function, health status, exacerbations, hospitalization rate, and dyspnea following 1 year of current clinical practice. Secondary objectives are to assess disease severity, treatment patterns, adherence to medication, and associated risk factors. Data will be collected at two study visits, at patients' usual care visits, and by telephone interview every 3 months.

DISCUSSION

Knowledge of COPD among physicians in China is poor. The REAL study will provide reliable information on COPD management, outcomes, and risk factors that may help improve the standard of care in China. Patient recruitment began on 30 June 2017 and the estimated primary completion date is 30 July 2019.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03131362. Registered on 20 March 2017.

Occupational exposure to particulate matter from air pollution in the outdoor workplaces in Almaty during the cold season

Background

A large fraction of population in Almaty and other Kazakhstan cities is employed in the outdoor jobs and likely exposed to high levels of particulate matter (PM) during the cold season. The magnitude of such occupational exposure remains unknown; therefore, the aim was to quantify the levels of exposure to PM₁₀ in the outdoor workplaces in Almaty in order to guide future interventions of primary prevention.

The Relationship Between Air Pollution and All-Cause Mortality in Singapore

Ambient air pollution is a risk factor for both acute and chronic diseases and poses serious health threats to the world population. We aim to study the relationship between air pollution and all-cause mortality in the context of a city-state exposed to the Southeast Asian haze problem. The primary exposure was ambient air pollution, as measured by the Pollutants Standards Index (PSI). The outcome of interest was all-cause mortality from 2010–2015. A time-stratified case-crossover design was performed. A conditional Poisson regression model, including environmental variables such as PSI, temperature, wind speed, and rainfall, was fitted to the daily count of deaths to estimate the incidence rate ratio (IRR) of mortality per unit increase in PSI, accounting for overdispersion and autocorrelation. To account for intermediate exposure effects (maximum lag of 10 days), a distributed lag non-linear model was used. There were 105,504 deaths during the study period. Increment in PSI was significantly associated with an increased risk of mortality. The adjusted IRR of mortality per the 10-unit increase in PSI was 1.01 (95%CI = 1.00–1.01). The lag effect was stronger when PSI was in the unhealthy range compared to the good and moderate ranges. At lag = 7 days, PSI appeared to have an adverse effect on mortality, although the effect was not significant. These findings provide evidence on the general health hazard of exposure to air pollution and can potentially guide public health policies in the region.

Particulate matter-attributable mortality and relationships with carbon dioxide in 250 urban areas worldwide

Urban air pollution is high on global health and sustainability agendas, but information is limited on associated city-level disease burdens. We estimated fine particulate matter (PM_2.5) mortality in the 250 most populous cities worldwide using PM_2.5 concentrations, population, disease rates, and concentration-response relationships from the Global Burden of Disease 2016 Study. Only 8% of these cities had population-weighted mean concentrations below the World Health Organization guideline for annual average PM_2.5. City-level PM_2.5-attributable mortality rates ranged from 13–125 deaths per 100,000 people. PM_2.5 mortality rates and carbon dioxide (CO₂) emission rates were weakly positively correlated, with regional influences apparent from clustering of cities within each region. Across 82 cities globally, PM_2.5 concentrations and mortality rates were negatively associated with city gross domestic product (GDP) per capita, but we found no relationship between GDP per capita and CO₂ emissions rates. While results provide only a cross-sectional snapshot of cities worldwide, they point to opportunities for cities to realize climate, air quality, and health co-benefits through low-carbon development. Future work should examine drivers of the relationships (e.g. development stage, fuel mix for electricity generation and transportation, sector-specific PM_2.5 and CO₂ emissions) uncovered here and explore uncertainties to test the robustness of our conclusions.

Analysis of National PM2.5 (FPM and CPM) Emissions by Past, Current, and Future Energy Mix Scenarios in the Republic of Korea

The main purpose of this study was to analyze the Korean PM2.5 emissions according to the past, present, and future energy mix scenarios from 1970 to 2035, with the aim of identifying a sustainable, future environmentally friendly energy mix scenario for Korea related to PM2.5 emissions. To calculate the PM2.5 emissions according to an energy mix plan, we assumed two scenarios: (1) Scenario 1 is based on an energy conversion scenario established by the Korean government’s 7th electric power demand supply program; and (2) Scenario 2 is enhancement of fuel cell usage. In Scenario 1, filterable PM2.5 (FPM2.5) emission was calculated as 61,158 ton/year, which includes contributions of anthracite (46.8%), petroleum (39.7%), natural gas (LNG) (10.0%), and LPG (0.1%). In Scenario 2, FPM2.5 emission was calculated as 36,917 ton/year, which includes contributions of petroleum (47.8%), anthracite (40.3%), bituminous coal (10.1%), and LNG (1.7%). Thus, we concluded that the FPM2.5 mitigation effect from fuel cell policy enforcement is about 38.13% higher than the Korean national energy conversion policy. PM2.5 (FPM2.5 + condensable PM2.5 (CPM2.5)) emissions dramatically increased in both energy mix scenarios so that CPM2.5 should be considered when estimating PM2.5 emissions and PM2.5 reduction.

Health burdens of ambient PM2.5 pollution across Chinese cities during 2006-2015

With frequent severe haze and smog episodes in Chinese cities, an increasing number of studies have focused on estimating the impact of fine particulate matter (PM_2.5) on public health. However, the current use of national and provincial demographic data might mask regional differences and lead to inaccurate estimations of pollution-related health impacts across cities. We applied the Global Burden of Disease methodology to develop a dataset of premature deaths attributed to ambient PM_2.5 in 129 Chinese cities in 2006, 2010 and 2015, based on the information of baseline mortality rates and population densities at the city level. Our results suggested that ambient PM_2.5 pollution led to 631,230 (95% confidence interval: 281,460-873,800) premature deaths in those cities in 2015, which was similar to that in 2010, but 42.8% higher than that in 2006. The reduction of premature deaths was not as obvious as the improvement in air quality in recent years, primarily owing to the aging Chinese population. For large and medium/small cities, the effects of PM_2.5 abatement on alleviating public health burdens were lower than those for megalopolises and metropolises; however, such large and medium/small cities are at risk of increasing future PM_2.5 pollution levels due to rapid development. Significant differences in PM_2.5-induced premature deaths indicated the need for specific policies to mitigate the health burden of air pollution in different types of Chinese cities.

Fine particulate matter (PM2.5) enhances airway hyperresponsiveness (AHR) by inducing necroptosis in BALB/c mice

OBJECTIVE

To observe the effects of prolonged exposure to high concentrations of PM_2.5 on the trachea and lungs of mice and to determine whether the damages to the trachea and lung are induced by necroptosis.

METHODS

Six- to eight-week-old female Balb/C mice of PM group were restrained in an animal restraining device using a nose-only "PM_2.5 online enrichment system" for 8 weeks, in Shijiazhuang, Hebei, China. Anti -Fas group was exposed to PM_2.5 inhalation and anti-Fas treatment via intranasal instillation. The mice in the control group inhaled filtered clean air. PM_2.5 sample was collected and analyzed. Airway Hyperresponsiveness (AHR) was tested. Lung tissue and bronchoalveolar lavage fluid (BALF) were analyzed for Hematoxylin and eosin (HE) staining, electron microscopy, cellular inflammation, cytokines, Tunel, Fas, RIPK3 and MLKL expression.

RESULTS

Compared to the other two groups, PM group displayed significantly increased AHR, neutrophils in BALF, significant bronchitis and alveolar epithelial hyperplasia and inflammation and necroptosis which were indicated by increased TUNEL, Fas, RIPK3 and MLKL measure.

CONCLUSION

Our findings suggest that PM_2.5 can enhance AHR and these changes are induced by necroptosis-related inflammation.

The economic benefits of fulfilling the World Health Organization's limits for particulates: A case study in Algeciras Bay (Spain)

Algeciras Bay is an important industrial and port zone in the south of Spain whose pollution by particulate matter surpasses the threshold levels recommended by the World Health Organization (WHO) in its 2005 Guide on Air Quality. This study analyses the mortality avoided and the economic benefit which would be derived from a reduction of the pollution of PM2.5 and PM10 to the levels recommended by the WHO in Algeciras Bay in the period 2005-2015. The analysis carried out shows that the industrial zones, such as Los Barrios and San Roque, are those which have greater levels of pollution and in which the relative risk is greater. The calculations for Algeciras Bay between 2000 and 2015 show 182 deaths which would be avoided if the particulate matter pollution were reduced to the levels recommended by the WHO. Likewise, the economic valuation which this impact has on health is carried out through two concepts: the cost of illness and the Value of Statistical Life (VSL). The result shows that the economic benefit that would come out with the cost of illness valuation is 5,329,110€ and from the VSL is 414,787,113€. Implications: PM_2.5 has a greater concentration in industrial localities and is linked to the industrial activity. When the particulate matter pollution is reduced to the levels recommended by the WHO in an industrialised area such as Algeciras (Spain), 182 deaths which would be avoided. The result shows that the economic benefit that would come out with the cost of illness valuation is 5,329,110€ and from the value of statistical life is 414,787,113€.

Fine Particulate Matter-Induced Exacerbation of Allergic Asthma via Activation of T-cell Immunoglobulin and Mucin Domain 1

Background:

Fine particulate matter (PM_2.5) exacerbates airway inflammation and hyperreactivity in patients with asthma, but the mechanism remains unclear. The aim of this study was to observe the effects of prolonged exposure to high concentrations of PM_2.5 on the pathology and airway hyperresponsiveness (AHR) of BALB/c mice undergoing sensitization and challenge with ovalbumin (OVA) and to observe the effects of apoptosis and T-cell immunoglobulin and mucin domain 1 (TIM-1) in this process.

Methods:

Forty female BALB/c mice were divided into four groups: control group, OVA group, OVA/PM group, and PM group (n = 10 in each group). Mice in the control group were exposed to filtered clean air. Mice in the OVA group were sensitized and challenged with OVA. Mice in the OVA/PM group were sensitized and challenged as in the OVA group and then exposed to PM_2.5 for 4 h per day and 5 days per week for a total of 8 weeks using a nose-only “PM_2.5 online enrichment system” in The Second Hospital of Hebei Medical University. Mice in the PM group were exposed to the PM_2.5 online enrichment system only. AHR was detected. Bronchoalveolar lavage fluid (BALF) was collected for cell classification. The levels of interleukin-4 (IL-4), IL-5, and IL-33 in BALF were measured using enzyme-linked immunosorbent assay. Changes in histological structures were examined by light microscopy, and changes in ultramicrostructures were detected by electron microscopy. Apoptosis was determined by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay in the lung tissues. Western blotting and immunohistochemistry were utilized to analyze the expression of Bcl-2, Bax, and TIM-1 in the lungs.

Results:

The results showed that AHR in the OVA/PM group was significantly more severe than that in the OVA and PM groups (P < 0.05). AHR in the PM group was also considerably more severe than that in the control group (P < 0.05). The BALF of OVA/PM group (28.00 ± 6.08 vs. 12.33 ± 4.51, t = 4.631, P = 0.002) and PM group (29.00 ± 3.00 vs. 12.33 ± 4.51, t = 4.927, P = 0.001) had more lymphocytes than the BALF of the control group. The number of neutrophils in the BALF of the OVA/PM group (6.67 ± 1.53 vs. 3.33 ± 1.53, t = 2.886, P = 0.020) and PM group (6.67 ± 1.53 vs. 3.33 ± 1.53, t = 2.886, P = 0.020) was much higher than those in the BALF of OVA group (P < 0.05). TUNEL assays showed that the number of apoptotic cells in the OVA/PM group was significantly higher than that in the OVA group (Tunel immunohistochemical scores [IHS%], 1.20 ± 0.18 vs. 0.51 ± 0.03, t = 8.094, P < 0.001) and PM group (Tunel IHS%, 1.20 ± 0.18 vs. 0.51 ± 0.09, t = 8.094, P < 0.001), and that the number of apoptotic cells in the PM group was significantly higher than that in the control group (Tunel IHS%, 0.51 ± 0.09 vs. 0.26 ± 0.03, t = 2.894, P = 0.020). The concentrations of IL-4 (77.44 ± 11.19 vs. 48.02 ± 10.02 pg/ml, t = 4.595, P = 0.002) and IL-5 (15.65 ± 1.19 vs. 12.35 ± 0.95 pg/ml, t = 3.806, P = 0.005) and the Bax/Bcl-2 ratio (1.51 ± 0.18 vs. 0.48 ± 0.10, t = 9.654, P < 0.001) and TIM-1/β-actin ratio (0.78 ± 0.11 vs. 0.40 ± 0.06, t = 6.818, P < 0.001) in the OVA/PM group were increased compared to those in the OVA group. The concentrations of IL-4 (77.44 ± 11.19 vs. 41.47 ± 3.40 pg/ml, t = 5.617, P = 0.001) and IL-5 (15.65 ± 1.19 vs. 10.99 ± 1.40 pg/ml, t = 5.374, P = 0.001) and the Bax/Bcl-2 ratio (1.51 ± 0.18 vs. 0.97 ± 0.16, t = 5.000, P = 0.001) and TIM-1/β-actin ratio (0.78 ± 0.11 vs. 0.31 ± 0.06, t = 8.545, P < 0.001) in the OVA/PM group were increased compared to those in the PM group. The concentration of IL-4 (41.47 ± 3.40 vs. 25.46 ± 2.98 pg/ml, t = 2.501, P = 0.037) and the Bax/Bcl-2 ratio (0.97 ± 0.16 vs. 0.18 ± 0.03, t = 7.439, P < 0.001) and TIM-1/β-actin ratio (0.31 ± 0.06 vs. 0.02 ± 0.01, t = 5.109, P = 0.001) in the PM group were also higher than those in the control group.

Conclusions:

Exacerbated AHR associated with allergic asthma caused by PM_2.5 is related to increased apoptosis and TIM-1 activation. These data might provide insights into therapeutic targets for the treatment of acute exacerbations of asthma induced by PM_2.5.

Applying Integrated Exposure-Response Functions to PM2.5 Pollution in India

Fine particulate matter (PM2.5, diameter ≤2.5 μm) is implicated as the most health-damaging air pollutant. Large cohort studies of chronic exposure to PM2.5 and mortality risk are largely confined to areas with low to moderate ambient PM2.5 concentrations and posit log-linear exposure-response functions. However, levels of PM2.5 in developing countries such as India are typically much higher, causing unknown health effects. Integrated exposure-response functions for high PM2.5 exposures encompassing risk estimates from ambient air, secondhand smoke, and active smoking exposures have been posited. We apply these functions to estimate the future cause-specific mortality risks associated with population-weighted ambient PM2.5 exposures in India in 2030 using Greenhouse Gas-Air Pollution Interactions and Synergies (GAINS) model projections. The loss in statistical life expectancy (SLE) is calculated based on risk estimates and baseline mortality rates. Losses in SLE are aggregated and weighted using national age-adjusted, cause-specific mortality rates. 2030 PM2.5 pollution in India reaches an annual mean of 74 μg/m³, nearly eight times the corresponding World Health Organization air quality guideline. The national average loss in SLE is 32.5 months (95% Confidence Interval (CI): 29.7⁻35.2, regional range: 8.5⁻42.0), compared to an average of 53.7 months (95% CI: 46.3⁻61.1) using methods currently applied in GAINS. Results indicate wide regional variation in health impacts, and these methods may still underestimate the total health burden caused by PM2.5 exposures due to model assumptions on minimum age thresholds of pollution effects and a limited subset of health endpoints analyzed. Application of the revised exposure-response functions suggests that the most polluted areas in India will reap major health benefits only with substantial improvements in air quality.

PM2.5-related health and economic loss assessment for 338 Chinese cities

China is in a critical stage of ambient air quality management after global attention on pollution in its cities. Industrial development and urbanization have led to alarming levels of air pollution with serious health hazards in densely populated cities. The quantification of cause-specific PM_2.5-related health impacts and corresponding economic loss estimation is crucial for control policies on ambient PM_2.5 levels. Based on ground-level direct measurements of PM_2.5 concentrations in 338 Chinese cities for the year 2016, this study estimates cause-specific mortality using integrated exposure-response (IER) model, non-linear power law (NLP) model and log-linear (LL) model followed by morbidity assessment using log-linear model. The willingness to pay (WTP) and cost of illness (COI) methods have been used for PM_2.5-attributed economic loss assessment. In 2016 in China, the annual PM_2.5 concentration ranged between 10 and 157 μg/m³ and 78.79% of the total population was exposed to >35 μg/m³ PM_2.5 concentration. Subsequently, the national PM_2.5-attributable mortality was 0.964 (95% CI: 0.447, 1.355) million (LL: 1.258 million and NPL: 0.770 million), about 9.98% of total reported deaths in China. Additionally, the total respiratory disease and cardiovascular disease-specific hospital admission morbidity were 0.605 million and 0.364 million. Estimated chronic bronchitis, asthma and emergency hospital admission morbidity were 0.986, 1.0 and 0.117 million respectively. Simultaneously, the PM_2.5 exposure caused the economic loss of 101.39 billion US$, which is 0.91% of the national GDP in 2016. This study, for the first time, highlights the discrepancies associated with the three commonly used methodologies applied for cause-specific mortality assessment. Mortality and morbidity results of this study would provide a measurable assessment of 338 cities to the provincial and national policymakers of China for intensifying their efforts on air quality improvement.