Mortality assessment attributed to long-term exposure to fine particles in ambient air of the megacity of Tehran, Iran

Two Decades of Air Pollution Health Risk Assessment: Insights From the Use of WHO's AirQ and AirQ+ Tools

Objectives

We evaluated studies that used the World Health Organization's (WHO) AirQ and AirQ+ tools for air pollution (AP) health risk assessment (HRA) and provided best practice suggestions for future assessments.

Methods

We performed a comprehensive review of studies using WHO's AirQ and AirQ+ tools, searching several databases for relevant articles, reports, and theses from inception to Dec 31, 2022.

Results

We identified 286 studies that met our criteria. The studies were conducted in 69 countries, with most (57%) in Iran, followed by Italy and India (∼8% each). We found that many studies inadequately report air pollution exposure data, its quality, and validity. The decisions concerning the analysed population size, health outcomes of interest, baseline incidence, concentration-response functions, relative risk values, and counterfactual values are often not justified, sufficiently. Many studies lack an uncertainty assessment.

Conclusion

Our review found a number of common shortcomings in the published assessments. We suggest better practices and urge future studies to focus on the quality of input data, its reporting, and associated uncertainties.

Evaluating the mortality and health rate caused by the PM2.5 pollutant in the air of several important Iranian cities and evaluating the effect of variables with a linear time series model

All over the world, the level of special air pollutants that have the potential to cause diseases is increasing. Although the relationship between exposure to air pollutants and mortality has been proven, the health risk assessment and prediction of these pollutants have a therapeutic role in protecting public health, and need more research. The purpose of this research is to evaluate the ill-health caused by PM2.5 pollution using AirQ + software and to evaluate the different effects on PM2.5 with time series linear modeling by R software version 4.1.3 in the cities of Arak, Esfahan, Ahvaz, Tabriz, Shiraz, Karaj and Mashhad during 2019-2020. The pollutant hours, meteorology, population and mortality information were calculated by the Environmental Protection Organization, Meteorological Organization, Statistics Organization and Statistics and Information Technology Center of the Ministry of Health, Treatment and Medical Education for 24 h of PM2.5 pollution with Excel software. In addition, having 24 h of PM2.5 pollutants and meteorology is used to the effect of variables on PM2.5 concentration. The results showed that the highest and lowest number of deaths due to natural deaths, ischemic heart disease (IHD), lung cancer (LC), chronic obstructive pulmonary disease (COPD), acute lower respiratory infection (ALRI) and stroke in The effect of disease with PM2.5 pollutant in Ahvaz and Arak cities was 7.39-12.32%, 14.6-17.29%, 16.48-8.39%, 10.43-18.91%, 12.21-22.79% and 14.6-18.54 % respectively. Another result of this research was the high mortality of the disease compared to the mortality of the nose. The analysis of the results showed that by reducing the pollutants in the cities of Karaj and Shiraz, there is a significant reduction in mortality and linear modeling provides a suitable method for air management planning.

In vitro exposure to PM2.5 of olfactory Ensheathing cells and SH-SY5Y cells and possible association with neurodegenerative processes

PM2.5 exposure represents a risk factor for the public health. PM2.5 is able to cross the blood-alveolar and blood-brain barriers and reach the brain through three routes: nasal olfactory pathway, nose-brain pathway, blood-brain barrier pathway. We evaluated the effect of PM2.5 to induce cytotoxicity and reduced viability on in vitro cultures of OECs (Olfactory Ensheathing Cells) and SH-SY5Y cells. PM2.5 samples were collected in the metropolitan area of Catania, and the gravimetric determination of PM2.5, characterization of 10 trace elements and 16 polycyclic aromatic hydrocarbons (PAHs) were carried out for each sample. PM2.5 extracts were exposed to cultures of OECs and SH-SY5Y cells for 24-48-72 h, and the cell viability assay (MTT) was evaluated. Assessment of mitochondrial and cytoskeleton damage, and the assessment of apoptotic process were performed in the samples that showed lower cell viability. We have found an annual average value of PM2.5 = 16.9 μg/m3 and a maximum value of PM2.5 = 27.6 μg/m3 during the winter season. PM2.5 samples collected during the winter season also showed higher concentrations of PAHs and trace elements. The MTT assay showed a reduction in cell viability for both OECs (44%, 62%, 64%) and SH-SY5Y cells (16%, 17%, 28%) after 24-48-72 h of PM2.5 exposure. Furthermore, samples with lower cell viability showed a decrease in mitochondrial membrane potential, increased cytotoxicity, and also impaired cellular integrity and induction of the apoptotic process after increased expression of vimentin and caspase-3 activity, respectively. These events are involved in neurodegenerative processes and could be triggered not only by the concentration and time of exposure to PM2.5, but also by the presence of trace elements and PAHs on the PM2.5 substrate. The identification of more sensitive cell lines could be the key to understanding how exposure to PM2.5 can contribute to the onset of neurodegenerative processes.

The impact of fine particulate matter on chronic obstructive pulmonary disease deaths in Pudong New Area, Shanghai, during a long period of air quality improvement

Chronic obstructive pulmonary disease (COPD) deaths attributed to fine particulate matter (with an aerodynamic equivalent diameter <2.5 μm, PM2.5) exposure are a common global public health concern. Recent improvements in air quality and the corresponding health benefits have received much attention. Thus, we have explored the trends of PM2.5 pollution improvement on COPD deaths during an important period of air pollution control (2008-2017) in Pudong New Area, Shanghai, China. Data, including daily COPD death counts, meteorological variables, and ambient air pollutants, were collected from 2008 to 2017. Generalized additive models were fitted to evaluate the percent change (%) in pollution-related COPD deaths. The results showed that the number of days with daily PM2.5 concentrations <35 μg/m3 increased from 19 days (5.19%) in 2008 to 166 days (45.48%) in 2017, and PM2.5 concentrations >75 μg/m3 decreased from 222 days (60.66%) in 2008 to 33 days (9.04%) in 2017. The associations in the overall period between 2008 and 2017 was significant. In subperiod analysis, each 10 μg/m3 increment in PM2.5 was associated with a percent change (%) of 0.89 (95% confidence interval [CI], 0.37, 1.42) at lag 5 and 0.78 (95% CI, 0.26, 1.30) at lag 6 during 2008-2013. Significant results were also found at lag 0-5 [percent change (%), 1.12 (95% CI, 0.09, 2.17)], lag 0-6 [percent change (%), 1.52 (95% CI, 0.43, 2.62)] and lag 0-7 [percent change (%), 1.72 (95% CI, 0.57, 2.88)] during 2008-2013. By contrast, no significant association was found between 2014 and 2017. In conclusion, the decreased COPD deaths associated with PM2.5 exposure were found, especially after the air quality improvement turning point in 2014.

Mortality and morbidity assessment attributed to short- and long-term exposure to fine particles in ambient air of Agadir city, Morocco: The AirQ model approach

It is well established that respiratory mortality and morbidity are associated with high concentrations of fine particles such as PM2.5. The aim of this study was to evaluate the long- and short-term impacts of PM2.5 on the population of Agadir, Morocco, using AirQ 2.1.1 software. The mean PM2.5 values were obtained from data collected at three sites. Baseline incidence data were obtained from the literature, and relative risk (RR) values were referenced from the World Health Organization. This study quantified long-term total mortality (LT-TM), lung cancer mortality (LT-LC), morbidity from acute lower respiratory tract infections (LT-ALRI), and morbidity from chronic obstructive pulmonary disease (LT-COPD), as well as short-term total mortality (ST-TM). The attributable proportions (AP) of LT-TM and LT-LC were estimated to 14.19% and 18.42%, respectively. Their excess deaths were estimated to 279 and 11 persons, respectively, and their RRs to 1.16 (95% CI: 1.10-1.22) and 1.23 (95% CI: 1.12-1.37), respectively. Furthermore, the AP of LT-ALRI and LT-COPD were estimated to 14.36% and 15.68%, respectively, their excess deaths to 33 and 4, and their RRs to 1.17 (95% CI: 1.11-1.31) and 1.19 (95% CI: 1.00-1.02), respectively. In comparison, the AP of ST-TM was estimated to 1.27%, with a 25-person excess death rate. This study was conducted to inform decision-making and to promote local policies on ambient air quality.

A Time Series Study for Effects of PM10 on Coronary Heart Disease in Ganzhou, China

Objective: To investigate the effect of PM10 exposure in low concentration areas on the daily hospitalized patients with coronary heart disease. Methods: Daily air quality monitoring data, meteorological monitoring data and daily hospitalization data of coronary heart disease during 2019−2021 in Ganzhou, China were collected. Generalized additive model and distributed lag nonlinear model were used to evaluate the association between environmental PM10 and daily hospital visits for coronary heart disease. Stratified by sex and age to see their potential impact on this association. Results: PM10 exposure was correlated with an increased risk of hospitalization in coronary heart disease patients. Single-pollutant model analysis shows that at the day of lag1, for every 10 µg/m3 increase in PM10, the risk of coronary heart disease hospitalization increased by 1.69% (95%CI 0.39~3.00%); Subgroup analysis showed that females and older adults (>65 years) were more sensitive to PM10 exposure. In addition, in the dual-pollutant model, by adjusting other pollutants (including SO2, CO and O3), it was found that the relationship between PM10 exposure and coronary heart disease hospitalization was robust. And with changing the model’s degree of freedom was still robust. Conclusion: Short-term exposure to low concentrations of PM10 is associated with hospitalization for coronary heart disease. These results are important for local environmental public health policy development, so as to protect vulnerable populations.

A Review of Studies Using Air Q Software for Prediction of Air Pollution Health Effects in Iran

PURPOSE OF REVIEW

Exposure to air pollutants may lead to various health effects and is a major public health issue. Concerns about these effects exist in both developed and developing countries. The Air Q software was developed to estimate the health impacts of air pollution based on reported levels of air pollutants in real world studies. In Iran several studies have been conducted to estimate human morbidity and mortality based on this software. We conducted this review to summarize articles which have predicted the effects of air pollution on human health in Iran using Air Q. We conducted a systematic search for relevant studies published until 24 April 2021 in Web of Science, PubMed, Scopus, and SID (Scientific Information Database which includes articles in Farsi language). We applied no time or language restrictions.

RECENT FINDINGS

A total of 44 studies out of 525 identified articles met our inclusion criteria. The main air pollutants under investigation were particulate matter (PM), NO₂, O₃, and SO₂. Most studies were conducted in metropolitan areas, such as Ahvaz (9 studies), Tehran (9 studies), and Shiraz (7 studies). In all studies, the levels of most air pollutants were higher than the 2005 WHO guideline levels and were predicted to be related to considerable health effects. However, it was not possible to aggregate the results and report the total number of casualties during these years, because studies were done in different cities with fluctuating levels of multiple pollutants and in different years and time frames. This systematic review showed that air pollution remains at unacceptably high levels resulting in substantial detrimental health effects in various Iranian cities. Using clean renewable energies, increasing human capital, and increasing green spaces and vegetation can help improve air pollution and decrease human casualties in Iran.

Transmission of COVID-19 pandemic (Turkey) associated with short-term exposure of air quality and climatological parameters

The study aims to investigate associations between air pollution, climate parameters, and the diffusion of COVID-19-confirmed cases in Turkey using Spearman's correlation test as an empirical methodology by Statgraphics Centurion XVI (version 16.1) and to determine the risk factors accelerating the spread of SARS-CoV-2 virus. The present study demonstrates the strong impacts of air pollutants and weather conditions on the transmission of COVID-19 morbidity. Particularly, O₃ and PM₁₀ from air quality parameters exhibited the strongest correlation with the number of daily cases in Kütahya (rs = -0.62; p < 0.05) and Sivas (rs = -0.62; p < 0.05) provinces, respectively. In meteorological parameters, rainfall showed the highest impact (rs = 0.76; p < 0.05) on the number of daily COVID-19 cases in Denizli distinct. Moreover, this study suggested that the diffusion of the novel coronavirus SARS-CoV-2 in regions with high levels of air pollution and low wind speed is dominant. To prevent the negative effects of the future pandemic crisis on public health and economic systems, manifold implications to encourage strategies to reduce air pollution in the polluted region such as being prevalent the usage of renewable energy technologies in particular electricity generation and sustainable policies such as improving the health system should be implemented by decision-makers.

Temporal profiles of ambient air pollutants and associated health outcomes in two polluted cities of the Middle East

Dust storms and particulate matters had been increased due to climate change in the Middle East. On the other hand, urbanization and industrialization raised levels of gaseous air pollutants in all big cities. In the current study, air pollution information collected from Environmental Protection Agency of Khuzestan and Tehran containing hourly O₃, NO₂, CO, SO₂, PM₁₀ and PM_2.5 concentrations between 2014 and 2015. This study evaluated the air quality of these two cities by Air Quality Index (AQI). As a result, mean concentrations of O₃, NO₂, PM₁₀ and PM_2.5 were higher in Ahvaz than Tehran while Tehran was more pollutant in terms of CO and SO₂. Diurnal variations of O₃ in weekend were the only trend located above weekday variations along the daytimes. Hourly variations of all pollutants changed with a wider range of concentrations in Ahvaz. Diurnal peaks of all pollutants showed their highest level on Monday as the busiest day in mega city, Tehran with the exception of SO₂. PM_2.5 was the worst and limiting pollutant for both cities. Accordingly, winter was the most polluted season by 77 and 33 μg m^-3 in Ahvaz and Tehran, respectively. Number of clean days was significantly lower in Ahvaz (no-day) than mega city, Tehran (<17 days). The number of unhealthy days was also presented significantly higher in Ahvaz (>186 days). Although, annual PM_2.5 concentrations were more in Ahvaz, the higher at-risk population in Tehran caused more health endpoints in the capital of Iran. Consequently, both cities should have their own especial pattern to control air pollution and attributed health damages.

Possible association between PM2.5 and neurodegenerative diseases: A systematic review

Air pollution is one of the most serious environmental problems that afflict our planet and one of the greatest risk factors for human health. In particular, PM_2.5 is able to cross the blood-alveolar and blood-brain barriers, thus increasing the onset of respiratory, cardiovascular and neurodegenerative diseases. Neurodegenerative disease is a progressive neuronal dysfunction that leads to neuronal lesions in both structure and function, and includes several diseases such as Alzheimer's disease (AD), Parkinson's disease (PD), vascular dementia (VaD), multiple sclerosis (MS), and others. We carried out a systematic review using PRISMA approach to investigate on the possible association between exposure to PM_2.5 and neurodegenerative diseases. The international databases (PubMed, Science Direct, Web of Sciences) were used to find published studies on the topic. The search period was between January 2011 and June 2021. About 2000 full research articles were selected, and finally, we included 20 full-research articles. Selected studies have highlighted how PM_2.5 exposure can be associated with the onset of neurodegenerative diseases (AD, PD, MS, VaD). This association depends not only on age, PM_2.5 levels and exposure time, but also on exposure to other air pollutants, proximity to areas with high vehicular traffic, and the presence of comorbidities. Exposure to PM_2.5 promotes neuroinflammation processes, because through breathing the particles can reach the nasal epithelial mucosa and transferred to the brain through the olfactory bulb. Furthermore, exposure to PM_2.5 has been associated with an increased expression of markers of neurodegenerative diseases (e.g. alpha-synuclein or beta-amyloid), which can contribute to the etiopathogenesis of neurodegenerative diseases. Although many studies have revealed the pathological relationship between PM_2.5 exposure and cognitive impairment, the potential cellular and molecular mechanisms of PM_2.5 leading to neurodegenerative disease remain not entirely clear, and then, further studies need to be carried out on the topic.

Health Endpoint of Exposure to Criteria Air Pollutants in Ambient Air of on a Populated in Ahvaz City, Iran

The presence of criteria air pollutants (CAP) in the ambient air of a populated inhalation region is one of the main serious public health concerns. The present study evaluated the number of cardiovascular mortalities (CM), hospital admissions with cardiovascular disease (HACD), and hospital admissions for respiratory disease (HARD) due to CAP exposure between 2010 and 2014. The study used the Air Q model and descriptive analysis to investigate the health endpoint attributed to the ground level of ozone (O₃), nitrogen dioxide (NO₂), sulfide dioxide (SO₂), and particle matter (PM₁₀). Baseline incidence (BI) and relative risk (RR) are the most important factors in the evaluation of health outcomes from exposure to CAP in the ambient air of a populated area according to EPA and the World Health Organization (WHO) guidelines. Our study showed that annual cases of cardiovascular mortality during the period 2010–2014 relating to particle mater were 478, 506, 469, 427, and 371; ozone was 19, 24, 43, 56, and 49; nitrogen dioxide was 18, 20, 23, 27, and 21; and sulfide dioxide was 26, 31, 37, 43 and 11, in the years 2010 to 2014, respectively. These results indicate that the number of hospital admissions for respiratory disease attributed to PM were 2054, 2277, 2675, 2042, and 1895; O₃ was 27, 35, 58, 73, and 63; NO₂ was 23, 24, 15, 25, and 18; and SO₂ was 23, 24, 25, 30, and 20, in the years from 2010 to 2014, respectively. The results also showed that the number of hospital admissions for cardiovascular disease related to particle mater was 560, 586, 529, 503, and 472; ozone was 22, 32, 38, 55, and 51; nitrogen dioxide was 19, 18, 13, 21, and 14; and sulfide dioxide was 12, 14, 16, 22, and 9, in the same period, respectively. Observations showed that most of the pollution was from outdoor air and in the human respiratory tract. Increased levels of sulfide dioxide, particle matter, nitrogen dioxide, and ozone can cause additional morbidity and mortality for exposed populations. According to the results, it is possible to help increase the level of public health. The use of these findings could also be of great help to health professionals and facilitators at regional and national levels.

Modeling Air Pollution Health Risk for Environmental Management of an Internationally Important Site: The Salt Range (Kallar Kahar), Pakistan

This study aimed to assess the health effects of emissions released by cement industries and allied activities, such as mining and transportation, in the salt range area of district Chakwal, Pakistan. DISPER was used to estimate dispersion and contribution of source emission by cement industries and allied activities to surface accumulation of selected pollutants (PM2.5, PM10, NOx, and O3). To assess the long-term effects of pollutants on human health within the radius of 500 m to 3 km, Air Q+ software was used, which was designed by the World Health Organization (WHO). One-year average monitoring data of selected pollutants, coordinates, health data, and population data were used as input data for the model. Data was collected on lung cancer mortality among different age groups (25+ and 30+), infant post-neonatal mortality, mortality due to respiratory disease, and all-cause mortality due to PM2.5 and NO2. Results showed that PM2.5 with the year-long concentration of 27.3 µg/m3 contributes a 9.9% attributable proportion (AP) to lung cancer mortality in adults aged 25+, and 13.8% AP in adults age 30+. Baseline incidence is 44.25% per 100,000 population. PM10 with the year-long concentration of 57.4 µg/m3 contributes 16.96% AP to infant post-neonatal mortality and baseline incidence is 53.86% per 1000 live births in the country. NO2 with the year-long concentration of 14.33 µg/m3 contributes 1.73% AP to all-cause mortality. Results obtained by a simulated 10% reduction in pollutant concentration showed that proper mitigation measures for reduction of pollutants’ concentration should be applied to decrease the rate of mortalities and morbidities. Furthermore, the study showed that PM2.5 and PM10 are significantly impacting the human health in the nearby villages, even after mitigation measures were taken by the selected cement industries. The study provides a roadmap to policymakers and stakeholders for environmental and health risk management in the area.

Forecasting PM2.5 concentration using artificial neural network and its health effects in Ahvaz, Iran

The main objective of the present study was to predict the associated health endpoint of PM_2.5 using an artificial neural network (ANN). The neural network used in this work contains a hidden layer with 27 neurons, an input layer with 8 parameters, and an output layer. First, the artificial neural network was implemented with 80% of data for training then with 90% of data for training. The value of R for the data validation of these two networks was 0.80 and 0.83 respectively. The World Health Organization AirQ ⁺ software was utilized for assessing Health effects of PM_2.5 levels. The mean PM_2.5 over the 9-year study period was 63.27(μg/m³), about six times higher than the WHO guideline. However, the PM_2.5 concentration in the last year decreased by about 25% compared to the first year, which is statistically significant (P-value = 0.0048). This reduced pollutant concentration led to a decrease in the number of deaths from 1785 in 2008 to 1059 in 2016. Moreover, a positive correlation was found between PM_2.5 concentration and temperature and wind speed. Considering the importance of predicting PM_2.5 concentration for accurate and timely decisions as well as the accuracy of the artificial neural network used in this study, the artificial neural network can be utilized as an effective instrument to reduce health and economic effects.

Effect of long-term exposure to PM2.5 on years of life lost in a populated Middle Eastern city

From a public health point of view, years of life lost (YLL) is a more important index than the number of deaths to evaluate the effect of risk factors. The objective of the present study was to estimate the burden of disease including years of life lost (YLL) and expected life remaining (ELR) attributed to long-term exposure to PM_2.5 in Ahvaz, one of the most polluted cities of the world, during March 2014 through March 2017. AirQ +  software was used for the estimation of YLL and ELR due to all natural causes of death. Hourly concentrations of PM_2.5 were acquired from the Department of Environment (DoE) of Ahvaz. Several steps were performed to validate the raw air quality data. Only the monitors were included that had minimum data completeness of 75%. Two age groups were selected for this study, including 0-64 and 65 < years. The life table approach was used to estimate YLL and ELR. Annual averages of PM_2.5 were 5.2-8 times higher than the air quality guideline (10 μg/m³) set by WHO for long-term exposure to PM_2.5. In total, PM_2.5 has caused 234,041 years of life lost due to mortality. About 84% of YLLs were attributed to people older than 65 years old. The YLLs of men were higher than those for women. The YLLs in the third year were greater than the first two years. PM_2.5 has caused the average age of total population, people aged 0-64 years old, and people > 65 years old decreased by 2.5, 3, and 1.6 years, respectively. These studies indicated that people in a city that the air quality is highly affected by dust storms, industrial emissions, and urban air pollution are significantly at risk. Air pollution control strategies and actions should be designed and executed to improve the quality of ambient air.

Relationship between ambient black carbon and daily mortality in Tehran, Iran: a distributed lag nonlinear time series analysis

PURPOSE

The aim of the present study was to investigate the effect of short-term exposure to ambient black carbon (BC) on daily cause-specific mortality, including mortality due to respiratory, cardiovascular, ischemic heart and cerebrovascular diseases in Tehran, Iran.

MATERIALS AND METHODS

Daily non-accidental death counts, meteorological data and hourly concentrations of air pollutants from 2014 to 2017 were collected in Tehran. A distributed lag non-linear model was used to assess the association between exposure to BC and daily mortality.

RESULTS

The mean daily BC concentration during the study period was 3.96 ± 1.19 µg/m³. The results indicated that BC was significantly associated with cardiovascular, ischemic heart disease, and cerebrovascular mortality, but not with respiratory mortality. In first model, each 10 µg/m³ increase in at lag 3, lag 4 and lag 5 were associated with cardiovascular mortality in 16-65 year age group with the relative risks (RRs) of 1.17 (95 % CI: 1.02-1.33), 1.17 (95 % CI: 1.04-1.31) and 1.12 (95 % CI: 1.02-1.24), respectively. The highest mortality rate per 10 µg/m³ increase in exposure was found for ischemic heart diseases with RR of 3.98 (95 % CI: 1.04-1.81, lag 01) for 16-65 age group. Cerebrovascular mortality was associated with 10 µg/m³ increases in non-cumulative exposure with RR of 1.17 (95 % 1.009-1.35, lag 5) in the age group ≥ 65 years. In the second model for a 10 µg/m³ increase in BC, cardiovascular mortality at specific lag days (5 and 6 days) in the age group ≤ 16 years were associated with RR of 1.34 (95 % CI 1.08-1.66) and 1.35(95 % CI 1.02-1.77), respectively.

CONCLUSIONS

This study in Tehran found significant effects of BC exposure on daily mortality for cardiovascular, ischemic heart disease, cerebrovascular disease.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40201-021-00659-0.

Spatial patterns and temporal variations of traffic-related air pollutants and estimating its health effects in Isfahan city, Iran

Isfahan as an important industrial city has faced with air pollution recently. Thus, we assessed the spatial and temporal trends of ambient PM_2.5, CO, SO₂, and O₃ and for estimating their health effect on Isfahan citizens between March 2018 and March 2019 through the AirQ+ software. Our results showed that citizens of Isfahan in almost 240, 167, and 134 of the days in the year has exposure to PM_2.5, SO₂, and O₃ higher than the WHO daily guideline, respectively. Daily variations of PM_2.5, CO, and SO₂ concentration showed the increasing trend of pollutants in the morning to evening. The maximum concentrations of O₃ were observed in the noonday. Also, the concentrations of these pollutants on Friday due to the holiday effect were higher than the weekdays. Except for O₃, the PM_2.5, CO, and SO₂ concentrations in the cold months and cold seasons was higher compared with the hot months and hot seasons. The total number of deaths because of lung cancer, natural mortality, ischemic heart disease, chronic obstructive pulmonary disease,, stroke associated with ambient PM_2.5 with the attributable proportion (AP) 11.43%, 11.63%, 15.96%, 15.15%, and 13.1% (95% CI) were 683, 19, 2, 202, and 55 cases, respectively. Therefore, the present study provides additional data for the provincial managers and politicians useful in planning proper strategies of air pollution control to decrease exposure and attributable mortalities.

The effect of nitrogen dioxide and atmospheric pressure on hospitalization risk for chronic obstructive pulmonary disease in Guangzhou, China

BACKGROUND

The relationship between air pollution and meteorological factors on diseases has become a research hotspot recently. Nevertheless, few studies have touched the inferences of nitrogen dioxide (NO₂) and atmospheric pressure (AP) on hospitalization risk for chronic obstructive pulmonary disease (COPD).

OBJECTIVES

To investigate the short-term impact of particulate air pollutants and meteorology factors on hospitalizations for COPD and quantify the corresponding risk burden of hospital admission.

METHODS

In our study, COPD cases were collected from Guangzhou Panyu Central Hospital (n = 11,979) from Dec of 2013 to Jun 2019. The 24-h average temperature, relative humidity (RH), wind speed (V), AP and other meteorological data were obtained from Guangzhou Meteorological Bureau. Air pollution data were collected from Guangzhou Air Monitoring Station. The influence of different NO₂ and AP values on COPD risk was quantified by a distributed lag nonlinear model (DLNM) combined with Poisson Regression and Time Series analysis.

RESULTS

We found that NO₂ had a non-linear relationship with the incidence of COPD, with an approximate "M" type, appearing at the peaks of 126 μg/m³ (RR = 1.32, 95%CI, 1.07 to 1.64) and 168 μg/m³ (RR = 1.21, 95%CI, 0.94 to 1.55), respectively. And the association between AP and COPD incidence exhibited an approximate J-shape with a peak occurring at 1035 hPa (RR = 1.16, 95% CI, 1.02 to 1.31).

CONCLUSIONS

The nonlinear relationship of NO₂ and AP on COPD admission risk in different periods of lag can be used to establish an early warning system for diseases and reduce the possible outbreaks and burdens of COPD in a sensitive population.

Health effects of particulate matter in major Indian cities

Background: Particulate matter (PM) is one among the crucial air pollutants and has the potential to cause a wide range of health effects. Indian cities ranked top places in the World Health Organization list of most polluted cities by PM. Objectives: Present study aims to assess the trends, short- and long-term health effects of PM in major Indian cities. Methods: PM-induced hospital admissions and mortality are quantified using AirQ+ software. Results: Annual PM concentration in most of the cities is higher than the National Ambient Air Quality Standards of India. Trend analysis showed peak PM concentration during post-monsoon and winter seasons. The respiratory and cardiovascular hospital admissions in the male (female) population are estimated to be 31,307 (28,009) and 5460 (4882) cases, respectively. PM_2.5 has accounted for a total of 1,27,014 deaths in 2017. Conclusion: Cities with high PM concentration and exposed population are more susceptible to mortality and hospital admissions.

The role of air pollution (PM and NO2) in COVID-19 spread and lethality: A systematic review

A new coronavirus (SARS-CoV-2) has determined a pneumonia outbreak in China (Wuhan, Hubei Province) in December 2019, called COVID-19 disease. In addition to the person-to person transmission dynamic of the novel respiratory virus, it has been recently studied the role of environmental factors in accelerate SARS-CoV-2 spread and its lethality. The time being, air pollution has been identified as the largest environmental cause of disease and premature death in the world. It affects body's immunity, making people more vulnerable to pathogens. The hypothesis that air pollution, resulting from a combination of factors such as meteorological data, level of industrialization as well as regional topography, can acts both as a carrier of the infection and as a worsening factor of the health impact of COVID-19 disease, has been raised recently. With this review, we want to provide an update state of art relating the role of air pollution, in particular PM_2.5, PM₁₀ and NO₂, in COVID-19 spread and lethality. The Authors, who first investigated this association, often used different research methods or not all include confounding factors whenever possible. In addition, to date incidence data are underestimated in all countries and to a lesser extent also mortality data. For this reason, the cases included in the reviewed studies cannot be considered conclusive. Although it determines important limitations for direct comparison of results, and more studies are needed to strengthen scientific evidences and support firm conclusions, major findings are consistent, highlighting the important contribution of PM_2.5 and NO₂ as triggering of the COVID-19 spread and lethality, and with a less extent also PM₁₀, although the potential effect of airborne virus exposure it has not been still demonstrated.

Concentrations and mortality due to short- and long-term exposure to PM2.5 in a megacity of Iran (2014-2019)

The present study aimed to survey the spatial and temporal trends of ambient concentration of PM_2.5 and to estimate mortality attributed to short- and long-term exposure to PM_2.5 in Isfahan from March 2014 to March 2019 using the AirQ⁺ software. The hourly concentrations of PM_2.5 were obtained from the Isfahan Department of Environment and Isfahan Air Quality Monitoring Center. Then, the 24-h mean concentration of PM_2.5 for each station was calculated using the Excel software. According to the results, the annual mean concentration of PM_2.5 in 2014-2019 was 29.9-50.9 μg/m³, approximately 3-5 times higher than the WHO guideline (10 μg/m³). The data showed that people of Isfahan in almost 58% to 96% of the days of a year were exposed to PM_2.5 higher than the WHO daily guideline. The concentrations of PM_2.5 in cold months such as October, November, December and January were higher than those in the other months. The zoning of the annual concentrations of PM_2.5 in urban areas showed that the highest PM_2.5 concentrations were related to the northern, northwestern, southern and central areas of the city. On average, from 2014 to 2019, the number of deaths due to natural mortality, lung cancer (LC), chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD) and stroke associated with ambient PM_2.5 were 948, 16, 18, 281 and 60, respectively. The present study estimated that on average, 14.29% of the total mortality, 17.2% of lung cancer (LC), 15.54% of chronic obstructive pulmonary disease (COPD), 17.12% of ischemic heart disease (IHD) and 14.94% of stroke mortalities were related to long-term exposure to ambient PM_2.5. So provincial managers and politicians must adopt appropriate strategies to control air pollution and reduce the attributable health effects and economic losses.

A study of cardiorespiratory related mortality as a result of exposure to black carbon

INTRODUCTION

Air pollution is a global phenomenon which invariably leads to a serious environmental and health related sequalae. "Black carbon" (BC), a subset of fine particulate matter ≤2.5 μm (PM_2.5), is a fossil fuel emission by-product and has more recently been recognized as a major health hazard. The objective of this study is to statistically analyze the BC concentration and its correlation with cardiorespiratory related mortality and to estimate the benefits of BC reduction on the health of the population in the capital city of Tehran.

METHODS

We analyzed the ambient air BC concentration and its correlation with cardiorespiratory related mortality and conducted health impact assessment of BC in Tehran (Jan 2018-Jan 2019). The data pertaining to BC concentration was obtained from Tehran's four major pollution monitoring stations. The mortality data was obtained from Tehran's cemetery registry. We calculated and analyzed BC concentration statistics including the mean, standard deviation, coefficient of variation, skewness, and kurtosis. We then assessed the cross-correlation and temporal relationship (0-7 days) between the daily mean concentration of BC for the entire city and cardiorespiratory related mortality. The BenMAP software was utilized to estimate the potential reduction in cardiorespiratory related mortality rates if BC concentration is reduced. Three hypothetical scenarios were employed in the analysis, utilizing the BenMAP software: (I) BC concentration was completely removed from the ambient air; (II) BC concentration was eliminated, and the remaining (non-BC portion of) PM_2.5 concentration was reverted to the United States Environmental Protection Agency (EPA)'s standard level (i.e., 35 μg/m³); and (III) The BC emission during the night (22:00 h-6:00 h, when heavy-duty vehicles (HDVs) are allowed to commute in the city) was distributed throughout the whole day. Since the planetary boundary layer during daytime is much higher than that of nighttime, with the same rate of emission, lower concentrations are spread during the whole day.

RESULTS

The trend of BC concentration variation revealed a persistently higher emission of BC during the nighttime, which is consistent with the large-scale operation of HDVs during these hours in the city of Tehran. We observed a direct correlation between BC concentration and cardiorespiratory related mortality. Analysis also showed a 1.4-day lag period from the time of exposure to BC polluted air and respiratory related deaths, and 2 days for cardiovascular related deaths. As a result, the reduction in BC has significant beneficial effects in reducing potentially preventable cardiorespiratory related mortality. The aforementioned three scenarios for age groups of 30 and above yielded the following results: (I) 11,369 (126 per 100,000 population), (II) 15,386 (171 per 100,000 population), and (III) 2552 (28 per 100,000 population) potentially preventable all-cause (including cardiorespiratory) related deaths annually.

CONCLUSIONS

The BC concentration is relatively high in Tehran and HDVs have a major role in emission of this pollutant. A direct correlation between BC concentration and cardiorespiratory related mortality is observed. There are considerable health benefits in reducing BC concentration in this city. Our findings highlight the urgent need to actively curtail emissions of this harmful pollutant. This can be achieved through utilizing control mechanisms such as particulate filters or amending traffic laws.

Role of air pollution by particulate matter in the pathogenesis of cardiovascular diseases. Prevention measures

The review highlights contemporary concepts about the role of atmospheric air pollution by particulate matter (PM) in pathogenesis of cardiovascular diseases (CVD). We used publications from the PubMed and Russian Science Citation Index databases. The influence of PM on the development and progression of CVD is considered depending on size, origin, chemical composition, concentration in air. PM with an aerodynamic diameter of ≤2,5 μm (PM2,5) are recognized as the most dangerous. Epidemiological studies have established a dose-dependent effect PM. Oxidative stress, damage of genome of cell and epigenetic changes associated with PM effect are the important component of CVD pathogenesis. Systematization of scientific data through a formalized description helps to understand the pathogenesis of CVD and facilitates its practical use for assessing the risk of occurrence, early diagnosing, prognostication, increasing the effectiveness of treatment, and developing preventive measures.

Evaluation of phenotypes and genotypes of airborne Fungi during middle eastern dust storms

Microbial species such as bacteria and fungi can be transported by dust storms over long distances, and may change the mycobiota in downwind. This study aimed to evaluate phenotypes and genotypes of airborne fungi during the Middle Eastern dust (MED) events and normal days in Khorramabad, Iran. The samples were collected regularly every six days at three locations during April 2018-March 2019, with additional samplings during MED days. For phenotypic analyses, the Petri dishes were incubated at 25 °C for 72-120 h. Molecular identification of fungi was carried out using polymerase chain reaction (PCR). The average (±SD) of total fungal concentration was 460.9 (±493.2) CFU/m³. The fungi with the highest average concentrations included Cladosporium cladosporioides, Penicillium brevicompactum, and Cladosporium iridis, respectively. The average concentration of fungi during dust days (967.65 CFU/m³) was 3.6 times higher than those in normal days (267.10 CFU/m³). During normal and dust days, 61 and 45 species were detected, respectively. Aspergillus and Cladosporium spp. were relatively more dominant during normal and dust days, respectively. Eight fungal species were only observed during MED days, including Talaromyces albobiverticillius that was detected for the first time in Iran. Despite air temperature, relative humidity and wind speed were associated to the fungal concentrations. Dust events lead to the changes in the air pollutants composition and mycobiota, identification of new fungi, and elevated fungal concentrations that may extremely affect the public health.

Diffusion charging measurements on exhaust solid particle number and lung deposited surface area of compressed natural gas and diesel buses

Because of their direct contact with society, urban buses are prioritized targets for air quality improvement. In this study, a sample group of in-use urban old buses powered by compressed natural gas (CNG) and diesel engines was chosen for particle emission analysis. The CNG buses do not have any type of after-treatment, while diesel ones are equipped with a diesel particulate filter (DPF). To measure the lung deposited surface area (LDSA), a possible physical metric of exhaust particles' toxicity, a diffusion charger-based analyzer was utilized. The measurements were done at different engine speeds in stationary conditions. The results revealed that although the particle mass emission of CNG buses remains at a low level, the number of emitted particles for 75% of the CNG buses (depending on their maintenance conditions) is 10 to 100 times more than the retrofitted diesel ones, with the range of 10⁶ to 10⁷ p/cm³. The rest 25% of the CNG buses were performing the same as the retrofitted diesel ones in terms of exhaust particle number in the range of 10⁵ p/cm³. In addition, the lowest LDSA parameter at low idle engine speed was measured to be 97.8 and 229.4 μm²/cm³ for a CNG and a DPF retrofitted diesel bus, respectively. This result indicates the same and even lower LDSA and surface area and thus the lower possible toxic potentiality of exhaust particles of CNG buses compared to diesel vehicles at DPF downstream. Investigation on the different behavior of the CNG buses in the emission of particles showed the correlation of some aging parameters such as lubricant oil aging mileage with the released particles and the importance of periodic maintenance interval. Graphical abstract.

Fine particulate air pollution and human mortality: 25+ years of cohort studies

Much of the key epidemiological evidence that long-term exposure to fine particulate matter air pollution (PM_2.5) contributes to increased risk of mortality comes from survival studies of cohorts of individuals. Although the first two of these studies, published in the mid-1990s, were highly controversial, much has changed in the last 25 + years. The objectives of this paper are to succinctly compile and summarize the findings of these cohort studies using meta-analytic tools and to address several of the key controversies. Independent reanalysis and substantial extended analysis of the original cohort studies have been conducted and many additional studies using a wide variety of cohorts, including cohorts constructed from public data and leveraging natural experiments have been published. Meta-analytic estimates of the mean of the distribution of effects from cohort studies that are currently available, provide substantial evidence of adverse air pollution associations with all-cause, cardiopulmonary, and lung cancer mortality.

Utilizing daily excessive concentration hours to estimate cardiovascular mortality and years of life lost attributable to fine particulate matter in Tehran, Iran

BACKGROUND

Evidence for associations between fine particulate matter (PM_2.5) and cardiovascular diseases (CVDs) in Iran is scarce. Given large within-day variations of PM_2.5 concentration, using the daily mean of PM_2.5 (PM_2.5mean) as exposure metric might bias the health-related assessment. This study applied a novel indicator, daily excessive concentration hours (DECH), to evaluate the effect of ambient PM_2.5 on CVD mortality and years of life lost (YLL) in Tehran, the capital city of Iran.

METHODS

Hourly concentration data for PM_2.5, daily information for meteorology and records of registered cardiovascular deaths from 2012 to 2016 were obtained from Tehran, Iran. Daily excessive concentration hours of PM_2.5 (PM_2.5DECH) was defined as daily total concentration-hours exceeding 35 μg/m³. Using a time-series design, we applied generalized linear models to assess the attributable effects of PM_2.5DECH and PM_2.5mean on CVD mortality and YLL.

RESULTS

For an interquartile range (IQR) rise in PM_2.5DECH, total CVD mortality at lag 0-10 days and YLL at lag 0-8 days increased 2.26% (95% confidence interval (CI): 0.85-3.69%) and 23.24 (6.07-40.42) person years, respectively. Corresponding increases were 3.45% (1.44-5.49%) and 35.21 (10.85-59.58) person years for an IQR rise in PM_2.5mean. Significant associations between PM_2.5 pollution (i.e., PM_2.5mean and PM_2.5DECH) and cause-specific cardiovascular health (i.e., mortality and YLL) were only identified in stroke. Subgroup analyses showed that male and people aged 0-64 years suffered more from PM_2.5 pollution. Furthermore, we attributed a greater CVD burden to PM_2.5DECH (1.67% for mortality and 2.67% for YLL) than PM_2.5mean (0.63% for mortality and 0.70% for YLL) during the study period.

CONCLUSIONS

This study strengthened the evidence for the aggravated CVD mortality burden associated with short-term exposure to PM_2.5. Our findings also suggested that PM_2.5DECH might be a potential alternative indicator of exposure assessment in PM_2.5-related health investigations.

Short-term effects of particulate matter during desert and non-desert dust days on mortality in Iran

BACKGROUND

Increased atmospheric particulate matter (PM) concentrations are commonly observed during desert dust days in Iran, but there is still no evidence of their effects on human health. We aimed to evaluate the association between daily mortality and exposure to PM₁₀ and PM_2.5 during dust and non-dust days in Tehran and Ahvaz, two major Middle Eastern cities with different sources, intensity, and frequency of desert dust days.

METHODS

We identified desert dust days based on exceeding a daily PM₁₀ concentration threshold of 150 µg/m³ between 2014 and 2017, checking for low PM_2.5/PM₁₀ ratio typical of dust days. We used a time-stratified case-crossover design to estimate the short-term effects of PM₁₀ and PM_2.5 concentrations on daily mortality during dust and non-dust days. Data was analyzed using conditional Poisson regression models.

RESULTS

Higher concentrations of PM and frequency of desert dust days were observed in Ahvaz rather than Tehran. In Ahvaz, the effect of PM₁₀ at lag 0 was much higher during dust days, an increment of 10 μg/m³ was associated with 3.28% (95%CI = [2.42, 4.15]) increase of daily mortality, than non-dust days, 1.03% (95%CI = [-0.02, 2.08]), while in Tehran, was slightly higher during non-dust days, 0.72% (95%CI = [0.23, 1.23]), than in dust days, 0.49% (95%CI = [-0.22, 1.20]). No statistically significant associations were observed between PM_2.5 and daily mortality in Ahvaz, while in Teheran the effect of PM_2.5 increased significantly during non-dust days at lag 2, 1.89% (95%CI = [0.83, 1.2.95] and lag 3, 1.88% (95%CI = [0.83, 1.2.95]).

CONCLUSION

The study provides evidence that exposure to PM during Middle East dust days is an important risk factor to human health in arid regions and areas affected by desert dust events.

The hospitalization attributable burden of acute exacerbations of chronic obstructive pulmonary disease due to ambient air pollution in Shijiazhuang, China

Few studies have investigated the acute exacerbations of chronic obstructive pulmonary disease (AECOPD)-associated attributable burden under exposure to high levels of air pollution among Asians. Data on hospitalization for AECOPD, air pollution and meteorological factors from 1 January 2013 to 31 December 2016 were collected in Shijiazhuang, China. We used a Poisson generalized linear regression model combined with a distributed lag nonlinear model (DLNM) to evaluate the relative cumulative risk for a lag of 0-7 days and examined the potential effect modifications by age and sex via stratification analyses, controlling for long-term trends, seasonal patterns, meteorological factors, and other possible confounders. Then, we computed hospitalization percentages attributable to air pollutants. The AECOPD-associated relative cumulative risks for PM_2.5, PM₁₀, NO₂, SO₂, and CO for a lag of 0-7 days were significantly positively correlated with hospitalization. The associations were stronger in females and retired patients. The NO₂ Cum RR of AECOPD admission was the greatest. A 10μg/m³ increase in daily NO₂ concentration was associated with 6.7% and 5.7% increases in COPD hospitalizations in the retired and female groups, respectively. The results showed that 13%, 9.4%, 1.7%, 9.7%, and 8.8% of AECOPD hospitalizations were attributable to exposure to PM_2.5, PM₁₀, SO₂, NO₂, and CO, respectively. If the air pollutant concentration was reduced to the 24-h average grade II levels of NAAQS of China, the AECOPD attributable percentage for PM_2.5 and PM₁₀ would decrease by 80%. The air pollutants PM_2.5, PM₁₀, SO₂, NO₂, and CO were significantly relevant to AECOPD-associated hospitalization. The associations differed by individual characteristics. The retired and female populations were highly vulnerable.

Concentrations and health effects of short- and long-term exposure to PM2.5, NO2, and O3 in ambient air of Ahvaz city, Iran (2014-2017)

The primary objective of the present study was to evaluate the concentrations and short and long-term excess mortality attributed to PM_2.5, NO₂, and O₃ observed in ambient air of Ahvaz during March 2014 to March 2017 period using the AirQ + software developed by the World Health Organization (WHO), which is updated in 2016 by WHO European Centre for Environment and Health. The hourly concentrations of PM_2.5, O₃, and NO₂ measured at different regulatory monitoring network stations in Ahvaz city were obtained from the Department of Environment (DOE) of the city. Then, for various air quality monitoring stations, the 24-h average concentration of PM_2.5, 1-h average of NO₂ concentration, and maximum daily 8-h O₃ concentrations were calculated using Excel 2010 software. When the maximum daily 8-h ozone means exceeding the value of 35, it was subtracted from 35 to calculate SOMO35 indicator for modeling. Validation of air quality data was performed according to the Aphekom and WHO's methodologies for health impact assessment of air pollution. Year-specific city population and baseline incidence of the health outcomes were obtained. The three-year averages of PM_2.5, NO₂, and O₃ concentrations were 68.95 (±39.86) μg/m³, 135.90 (±47.82) μg/m³, and 38.63 (±12.83) parts-per-billion-volume (ppbv), respectively. SOMO35 values of ozone were 6596.66, 3411.78, and 470.88 ppbv in 2014-2015, 2015-2016, and 2016-2017 years, respectively. The AP and number of natural deaths due to NO₂ were higher than PM_2.5 except the last year (2016-2017), causing about 39.18%, 40.73%, and 14.39% of deaths within the first, the second, and the third year, respectively. However, for the last year, the natural mortality for PM_2.5 was higher than NO₂ (34.46% versus 14.39%). The total number of natural mortality caused by PM_2.5 and NO₂ in all years was 4061 and 4391, respectively. A significant number of deaths was estimated to be attributed to the given air pollutants. It can be concluded that by designing and implementing air pollution control strategies and actions, both health effects and economic losses will be prevented.

Health impact and related cost of ambient air pollution in Tehran

Ambient air pollution represents one of the biggest environmental risks to health. In this study, we estimated the avoidable mortality burden attributable to ambient air pollution in Tehran, and derived the economic impact associated with these health effects. Using PM_2.5 data from ground-level air pollution measurements in Tehran, we estimated PM_2.5 exposure for 349 neighborhoods in Tehran, by the Environmental Benefits Mapping and Analysis Program (BenMAP-CE). We considered five scenarios related to PM_2.5 levels: an increase to 35 μg/m³; a reduction to 25 μg/m³; a reduction to 15 μg/m³; a reduction to 10 μg/m³ (the WHO's air quality guideline value); and a full roll-back, assuming a reduction to 2.4 μg/m³. All scenarios used 2017 p.m._2.5 levels as a starting point. Using the concentration response function of the Global Exposure Mortality Model (GEMM), we estimated a total of 7146 (95% CI: 6596-7513) adult (age ≥25 years) deaths attributable to PM_2.5 in 2017. The leading causes of death were ischemic heart disease (3437; 95% CI: 3315-3516), stroke (886; 95% CI: 693-1002), lower respiratory infections (531: 95% CI: 414-589), chronic obstructive pulmonary disease (364; 95% CI: 271-420), and lung cancer (274; 95% CI: 236-298). The estimated total annual economic benefit (2017) of reducing PM_2.5 concentration levels to 2.4 μg/m³ was USD 0.591 (95% CI: 0.447-0.624) billion per year, using the value of a life year (VOLY) approach, and USD 2.894 (95% CI: 2.671-3.043) billion per year, using the value of a statistical life (VSL) approach.

Estimate annual and seasonal PM1, PM2.5 and PM10 concentrations using land use regression model

Exposure to ambient particulate matter (PM) can increase mortality and morbidity in urban area. In this study, annual and seasonal spatial pattern of PM₁, PM_2.5 and PM₁₀ pollutants were assessed using land use regression (LUR) models in Sabzevar, Iran. The studied pollutants were measured at 26 monitoring stations of different microenvironments in the study area. Sampling was conducted during four campaigns from April 2017 to February 2018. LUR models were developed based on 104 potentially predictive variables (PPVs) subdivided in six categories and 22 sub-categories. The annual mean (standard deviation) of PM₁, PM_2.5 and PM₁₀ were 36.46 (8.56), 39.62 (10.55) and 51.99 (16.25) μg/m³, respectively. The R² values and root mean square error for leave-one-out cross validations (RMSE for LOOCV) of PM₁ models ranged from 0.23 to 0.79 and 3.43-22.5, respectively. Further, R² and RMSE for LOOCV of PM_2.5 models ranged from 0.56 to 0.93 and 3.66-28.3, respectively. For PM₁₀ models the R² ranged from 0.31 to 0.82 and the RMSE for LOOCV ranged from 9.16 to 33.9. The generated models can be useful for population based epidemiologic studies and to estimate these pollutants in different parts of the study area for scientific decision making.

A general method for evaluating the effects of air pollutants on lung cancer prevalence

It is widely accepted that some air pollutants are related to lung cancer prevalence. An effective method is proposed to quantitatively evaluate the effects of air pollutants and the interactions between them. The method consisted of three parts: data decomposition, comparable data generation and relationship inference. Firstly, very limited monitoring data published by Geographic Information System were applied to calculate the inhalable air pollution of relatively massive patient samples. Then the investigated area was partitioned into a number of districts, and the comparable data containing air pollutant concentrations and lung cancer prevalence in all districts were generated. Finally, the relationships between pollutants and lung cancer prevalence were concluded by an information fusion tool: Choquet integral. As an example, the proposed method was applied in the investigation of air pollution in Tianjin, China. Overall, SO₂, O₃ and PM_2.5 were the top three factors for lung cancer. And there was obvious positive interaction between O₃ and PM_2.5 and negative interaction among SO₂, O₃ and PM₁₀. The effect of SO₂ on men was larger than on women. O₃ and SO₂ were the most important factors for the adenocarcinoma and squamous cell carcinoma, respectively. The effect of SO₂ or NO₂ on squamous cell carcinoma is obviously larger than that on adenocarcinoma, while the effect of O₃ or PM_2.5 on adenocarcinoma is obviously larger than that on squamous cell carcinoma. The results provide important suggestions for management of pollutants and improvement of environmental quality. The proposed method without any parameter is general and easily realized, and it sets the foundation for further researches in other cities/countries. Implications: For total lung cancer prevalence, male and female lung cancer prevalence, and adenocarcinoma and squamous cell carcinoma prevalence, the proposed method not only quantify the effect of single pollutant (SO₂, NO₂, CO, O₃, PM_2.5, and PM₁₀) but also reveals the correlations between different pollutants such as positive interaction or negative interaction. The proposed method without any geographic predictor and parameter is much easier to realize, and it sets the foundation for further research in other cities/countries. The study results provide important suggestions for the targeted management of different pollutants and the improvement of human lung health.

Healthy Design and Urban Planning Strategies, Actions, and Policy to Achieve Salutogenic Cities

Starting from a previous experience carried out by the working group "Building and Environmental Hygiene" of the Italian Society of Hygiene and Preventive Medicine (SItI), the aim of the present work is to define new strategic goals for achieving a "Healthy and Salutogenic City", which will be useful to designers, local governments and public bodies, policy makers, and all professionals working at local health agencies. Ten key points have been formulated: 1. climate change and management of adverse weather events; 2. land consumption, sprawl, and shrinking cities; 3. tactical urbanism and urban resilience; 4. urban comfort, safety, and security perception; 5. strengths and weaknesses of urban green areas and infrastructures; 6. urban solid waste management; 7. housing emergencies in relation to socio-economic and environmental changes; 8. energy aspects and environmental planning at an urban scale; 9. socio-assistance and welfare network at an urban scale: importance of a rational and widespread system; and 10. new forms of living, conscious of coparticipation models and aware of sharing quality objectives. Design strategies, actions, and policies, identified to improve public health and wellbeing, underline that the connection between morphological and functional features of urban context and public health is crucial for contemporary cities and modern societies.

Chronic obstructive pulmonary diseases related to outdoor PM10, O3, SO2, and NO2 in a heavily polluted megacity of Iran

This study was conducted to quantify, by an approach proposed by the World Health Organization (WHO), the daily hospital admissions for chronic obstructive pulmonary disease (COPD) related to exposure to particulate matter (PM₁₀) and oxidants such as ozone (O₃), sulfur dioxide (SO₂), and nitrogen dioxide (NO₂) in a heavily polluted city in Iran. For the health impact assessment, in terms of COPD, the current published relative risk (RR) and baseline incidence (BI) values, suggested by the WHO, and the 1-h O₃ concentrations and daily PM₁₀, NO₂, and SO₂ concentrations were compiled. The results showed that 5.9, 4.1, 1.2, and 1.9% of the COPD daily hospitalizations in 2011 and 6.6, 1.9, 2.3, and 2.1% in 2012 were attributed to PM₁₀, O₃, SO₂, and NO₂ concentrations exceeding 10 μg/m³, respectively. This study indicates that air quality and the high air pollutant levels have an effect on COPD morbidity. Air pollution is associated with visits to emergency services and hospital admissions. A lower relative risk can be achieved if some stringent control strategies for reducing air pollutants or emission precursors are implemented.