Health status, mental health and air quality: evidence from pensioners in Europe

A measurement study of the environmental quality and medical expenditures of elderly individuals: causal inference based on machine learning

BACKGROUND

The global surge of environmental pollution exacerbates health issues, disease incidence, and economic strain. In China, the increasing healthcare costs of the elderly population necessitate addressing this challenge as part of the "Healthy China" strategy. We explore the impact of environmental quality on elderly healthcare expenses.

METHODS

This study devised a comprehensive environmental quality index for 30 Chinese provinces, excluding Tibet, which was correlated with medical expenses for individuals older than 60 years, using China Family Panel Studies (CFPS) data. Because the traditional econometric model cannot solve the endogeneity problem and the selection of instrumental variables is subjective, a new machine learning algorithm is adopted based on the traditional ordinary least squares (OLS) model and the fixed effect model to conduct causal analysis to ensure the reliability of the results. Finally, heterogeneity analysis was conducted based on the generalized random forest algorithm.

RESULTS

Southern provinces such as Jiangxi and Guangxi exhibited superior environmental qualities. A regional analysis revealed a gradient where environmental quality decreased from west to east and from south to north. Both conventional and machine learning methodologies underscored a pivotal finding: enhanced environmental qualities significantly curtail elderly healthcare expenses. A heterogeneity assessment revealed that such improvements predominantly benefit elderly people in the eastern and central regions, with marginal impacts in the west. For different groups, the improvement of environmental quality can significantly reduce the medical expenditure of people aged 60 to 75, with bedtime hours between 9 and 11 PM and a lower household income.

CONCLUSIONS

This study, employing machine learning and traditional models, demonstrates that enhancements in environmental quality significantly reduce medical costs for the elderly in China, especially in the eastern and central regions, and among demographics such as individuals aged 60-75 and low-income households. These findings underscore the potential of environmental policies to lower medical costs within the "Healthy China" initiative framework. However, the study's scope is limited by the environmental quality index and the extent of data coverage, indicating a need for further research expansion.

Exploring the relationship between air quality and health shocks to the elderly: A retrospective cross-sectional study in China

Methods

We selected 5,172 microdata on individuals from the China Health and Retirement Longitudinal Study (CHARLS) 2018. The binary logit model, the ordered logit model, and the stepwise regression were employed to compare the effects of air pollution on self-rated health (SRH) and activities of daily living (ADL) in an elderly population. The effects on health shocks were explored in different age groups, different gender groups, different regions and different sources of pollutants, respectively.

Results

We found that air pollution significantly increased the risk of health shocks in the elderly population, especially in the 60–69 year age group, and the eastern/central region, where NO2 and O3 were important pollutant sources.

Conclusion

Targeted management of the environment is necessary to improve the health status of China's elderly population. In addition, paying attention to the health status of vulnerable populations is needed to achieve social equity.

Association between short-term exposure to ambient air pollution and heart failure: An updated systematic review and meta-analysis of more than 7 million participants

Introduction

Exposure to air pollution has been linked to the mortality of heart failure. In this study, we sought to update the existing systematic review and meta-analysis, published in 2013, to further assess the association between air pollution and acute decompensated heart failure, including hospitalization and heart failure mortality.

Methods

PubMed, Web of Science, EMBASE, and OVID databases were systematically searched till April 2022. We enrolled the studies regarding air pollution exposure and heart failure and extracted the original data to combine and obtain an overall risk estimate for each pollutant.

Results

We analyzed 51 studies and 7,555,442 patients. Our results indicated that heart failure hospitalization or death was associated with increases in carbon monoxide (3.46% per 1 part per million; 95% CI 1.0233-1.046, P < 0.001), sulfur dioxide (2.20% per 10 parts per billion; 95% CI 1.0106-1.0335, P < 0.001), nitrogen dioxide (2.07% per 10 parts per billion; 95% CI 1.0106-1.0335, P < 0.001), and ozone (0.95% per 10 parts per billion; 95% CI 1.0024-1.0166, P < 0.001) concentrations. Increases in particulate matter concentration were related to heart failure hospitalization or death (PM_2.5 1.29% per 10 μg/m³, 95% CI 1.0093-1.0165, P < 0.001; PM₁₀ 1.30% per 10 μg/m³, 95% CI 1.0102-1.0157, P < 0.001).

Conclusion

The increase in the concentration of all pollutants, including gases (carbon monoxide, sulfur dioxide, nitrogen dioxide, ozone) and particulate matter [(PM_2.5), (PM₁₀)], is positively correlated with hospitalization rates and mortality of heart failure.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021256241.

Do energy consumption and environmental quality enhance subjective wellbeing in G20 countries?

G20 countries are responsible for more than 80% of global energy consumption and the largest CO2 emissions in the world. Literature related to the energy consumption-environmental quality-subjective wellbeing nexus is limited and lacks consensus. This paper analyses the impact of energy consumption and environmental quality on subjective wellbeing in G20 countries from 2006 to 2019 using a panel-corrected standard error (PCSE) model. Cantril life ladder data is used as a proxy of subjective wellbeing. For robustness, the Newey-West standard error model is used. The findings reveal that renewable energy consumption and environmental quality, i.e. lesser carbon emissions, enhance subjective wellbeing in G20 countries. In contrast, non-renewable energy consumption degrades subjective wellbeing. Moreover, the study also finds bidirectional causality between renewable energy consumption, non-renewable energy consumption, and economic growth. The policymakers of these countries should encourage renewable energy production and its consumption to reduce carbon emissions for conserving the environment and enhancing their people's subjective wellbeing.

Effects of Environmental Quality Perception on Depression: Subjective Social Class as a Mediator

Although the relationship between environment and public depression has aroused heated debate, the empirical research on the relationship between environmental quality perception and public depression is still relatively insufficient. This paper aims to explore the influence of environmental quality perception on public depression and the mediating role of subjective social class between environmental quality perception and public depression. Using the China Family Panel Studies data of 2016 for empirical analysis, this study’s results show that environmental quality perception has a significant effect on public depression and subjective social class also has a significant effect on public depression. In addition, we found that subjective social class can play a partial mediating role between environmental quality perception and public depression, and the intermediary effect only comes from the contribution of the perception of living environmental quality, not the perception of overall environmental quality. That is to say, the perception of living environment quality deeply affects the subjective social class, and then induces public depression. In order to alleviate the relationship between environmental quality and public depression, it is recommended that the state environmental protection department and civil affairs department strengthen the improvement of public living environment so as to promote individual subjective social class and reduce the risk of public depression. Moreover, it is suggested that research with longitudinal design and comprehensive indicators be undertaken in the future.

Innovations strategy for moving from created regional clusters to co-creation in life sciences for health care and well-being ecosystems

Over the last decades, the demographic changes have all altered the population structure and influenced the social, economic, and political characteristics of countries over the world. Therefore, the creation of novel ecosystems, new clusters and systems which involved technology and industry, business, education, science, and innovation are increased rapidly. However, in order to solve the future global challenges, the created various types of clusters, public and private sector systems should cooperate and work together as a unit. Therefore, one of the proposed solutions is unified regional ecosystems' building. The Interreg European Life Science Ecosystems (ELISE) project addresses the societal challenge which is common to the European regions: to promote better health for all. This covers the need to improve health and well-being outcomes, to promote market growth, job creation, and EU competitiveness. Based on the project, three different regions of the European countries-Poland, Italy, and Germany-are selected in order to perform the analysis of drivers directly influencing the move from the existing clusters to unified regional ecosystem. The performed analysis showed that the government of a country and regional public authorities have the direct influence and play the central role in shaping unified regional ecosystems. The common economic, social, and political situation in a country is dependent on the government and it is influenced by the regional public authorities. Therefore, the collaboration and conversation among such institutions is the important factor defining how quickly different countries will create unified ecosystems and will solve the future problems.

Wearable Devices in Health Monitoring from the Environmental towards Multiple Domains: A Survey

The World Health Organization (WHO) recognizes the environmental, behavioral, physiological, and psychological domains that impact adversely human health, well-being, and quality of life (QoL) in general. The environmental domain has significant interaction with the others. With respect to proactive and personalized medicine and the Internet of medical things (IoMT), wearables are most important for continuous health monitoring. In this work, we analyze wearables in healthcare from a perspective of innovation by categorizing them according to the four domains. Furthermore, we consider the mode of wearability, costs, and prolonged monitoring. We identify features and investigate the wearable devices in the terms of sampling rate, resolution, data usage (propagation), and data transmission. We also investigate applications of wearable devices. Web of Science, Scopus, PubMed, IEEE Xplore, and ACM Library delivered wearables that we require to monitor at least one environmental parameter, e.g., a pollutant. According to the number of domains, from which the wearables record data, we identify groups: G1, environmental parameters only; G2, environmental and behavioral parameters; G3, environmental, behavioral, and physiological parameters; and G4 parameters from all domains. In total, we included 53 devices of which 35, 9, 9, and 0 belong to G1, G2, G3, and G4, respectively. Furthermore, 32, 11, 7, and 5 wearables are applied in general health and well-being monitoring, specific diagnostics, disease management, and non-medical. We further propose customized and quantified output for future wearables from both, the perspectives of users, as well as physicians. Our study shows a shift of wearable devices towards disease management and particular applications. It also indicates the significant role of wearables in proactive healthcare, having capability of creating big data and linking to external healthcare systems for real-time monitoring and care delivery at the point of perception.

A Scoping Review of Non-Occupational Exposures to Environmental Pollutants and Adult Depression, Anxiety, and Suicide

PURPOSE OF REVIEW

Despite a call for better understanding of the role of environmental pollutant influences on mental health and the tremendous public health burden of mental health, this issue receives far less attention than many other effects of pollutants. Here we summarize the body of literature on non-occupational environmental pollutant exposures and adult depression, anxiety, and suicide-in PubMed, Embase, Web of Science, and PsychINFO through the end of year 2018.

RECENT FINDINGS

One hundred twelve articles met our criteria for further review. Of these, we found 88 articles on depression, 33 on anxiety, and 22 on suicide (31 articles covered multiple outcomes). The earliest article was published in 1976, and the most frequent exposure of interest was air pollution (n = 33), followed by secondhand smoke (n = 20), metals (n = 18), noise (n = 17), and pesticides (n = 10). Other exposures studied less frequently included radiation, magnetic fields, persistent organic pollutants (POPs), volatile organic compounds, solvents, and reactive sulfur compounds. The current literature, although limited, clearly suggests many kinds of environmental exposures may be risk factors for depression, anxiety, and suicide. For several pollutants, important limitations exist with many of the studies. Gaps in the body of research include a need for more longitudinal, life-course studies, studies that can measure cumulative exposures as well as shorter-term exposures, studies that reduce the possibility of reverse causation, and mechanistic studies focused on neurotoxic exposures.

Access to an Electronic Health Record: A Polish National Survey

In Poland, as in many countries around the world, e-health services are becoming more and more popular. Obligatory e-sick leave was implemented, followed by e-prescriptions and e-referrals. Therefore, it is worth considering the introduction of a complete electronic health record (EHR) that can be accessed by doctors and patients. The main aim of the study is to find out whether patients want to have access to their EHRs and if they would agree to pay for such a service. The research was based on three surveys conducted among 1000 Polish adults in 2007, 2012, and 2018. The sample collection was carried out by the national opinion poll agency, with the use of computer-assisted telephone interviews. Over 60% of respondents were interested in the possibility of accessing EHRs in general, and almost 50% of them were ready to pay for it. Nevertheless, when analyzing all the year-on-year trends, they were subject to a gradual decrease. The youngest age group was the one most interested in EHRs, while the group comprising respondents in middle age was the one most willing to pay for it. There is still great potential in implementing EHRs on a bigger scale.

The impact of particulate matter on allergy risk among adults: integrated exposure assessment

Exposure assessment is an important part in environmental epidemiology for determining the associations of environmental factors with health effects. One of the greatest challenges for personal exposure assessment is associated with peoples' mobility during the day and spatial and temporal dynamics of air pollution. In this study, the impact of PM₁₀ (particulate matter less than 10 μm) on allergy risk among adults was assessed using objective methods of exposure assessment. The primary objective of the present study was to estimate personal exposure to PM₁₀ based on individual daily movement patterns. Significant differences between the concentration of PM₁₀ in different microenvironments (MEs) and personal exposure to PM₁₀ were determined. Home exposure accounted for the largest part of PM₁₀ exposure. Thirty-five percent of PM₁₀ exposure was received in other non-home MEs. Allergy risk increased significantly with increasing exposure to PM₁₀. Adults exposed to the highest levels of PM₁₀ exposure had a twice-higher risk of allergies than adults exposed to the lowest levels of PM₁₀ exposure. The study results have practical relevance for exposure assessment to environmental factors and its impact on health effects.

Relationship among pollution concerns, attitudes toward social problems, and environmental perceptions in abandoned sites using Bayesian inferential analysis

How do local community perceive pollution risk and social problems in abandoned areas? Which factors affect these risk perceptions? Among several factors affecting environmental perceptions, familiarity to places has long been known to positively affect landscape perception, but is this also true for abandoned area with scruffy vegetation and industrial remnants? Will long-term residents eventually adapt to and accept these neglected landscapes? In the past, efforts have largely been devoted to the cleanup of large, highly polluted areas. This left many smaller, less polluted sites, often in urban or suburban areas, relatively neglected. These areas, which typically consist of small abandoned industrial and commercial sites and vacant lots in neighborhoods, are problematic since people living nearby continue to suffer from urban blight. Recently, there has been a shift in the focus of brownfield programs from highly polluted post-industrial cleanup to local brownfield reuse. In this new environment, a participatory planning process that engages the community seems to have become more important. In order to better understand factors affecting community people's risk perception and effectively engage community support for the better management of derelict sites, this study investigated the factors on local community perceptions of abandoned landscapes including the effect of familiarity (the length of residency) and other sociodemographic (gender and age). For the study, the 200 study participants in eight neighborhoods along the Rail Corridor Revitalization Project in the city of Roanoke, VA, were asked to participate in survey and evaluate scenes of three types of abandoned landscapes focusing on two aspects, preference and pollution concerns. The results of scene ratings showed that lower scene preferences were associated with scene concerns related to higher pollution. However, although age and gender were associated with participants' preference ratings and attitudes toward social problems and pollution, there was no significant effect for the length of residency.

Economic value of traffic noise reduction depending on residents' annoyance level

Noise is the most frequently encountered type of environmental pollution in everyday life and has a direct negative effect on humans. Individuals who are constantly exposed to noise tend to have a high incidence of cardiovascular disease and hypertension. Noise sources range from construction sites to political rallies and assemblies, but traffic is one of the most long-lasting and chronic sources of noise. Previously, researchers have conducted valuations of road traffic noise reduction, but they did not consider residents' annoyance levels in response to traffic noise. However, individuals' annoyance levels affect the economic value of noise reduction policies and thus must be considered to obtain an accurate estimate. Therefore, this study investigated residents' willingness to pay for traffic noise reduction depending on their annoyance level. We used the contingent valuation method and a survey to analyze how much 1022 respondents in Korea were willing to pay for noise reduction. We found that people who were annoyed and extremely annoyed by noise had a willingness to pay KRW 8422 (US $7.55) and KRW 9848 (US $8.83) annually per household, respectively, to reduce their annoyance level to zero. In addition, we determined the economic benefits of noise reduction policies using the respondents' willingness to pay to reduce noise by 1 dB(A), which totaled KRW 3.28 billion (US $2.91 million) per year. The results of this study provide estimates of the annual benefits of traffic noise reduction considering residents' annoyance level.