The effect of ambient air pollution on circulatory mortality: a short-term exposure assessment in Xi'an, China

Short-term exposure to ambient ozone and cardiovascular mortality in China: a systematic review and meta-analysis

Air pollution is a major public health concern in China. Notwithstanding this, there is limited evidence regarding the impact of short-term exposure to ambient ozone on cardiovascular mortality in the Chinese population. Therefore, we conducted this meta-analysis to address this important question. The random-effects model was applied to pool the results from individual studies. Finally, 32 effect estimates extracted from 19 studies were pooled in this meta-analysis. The pooled relative risk for cardiovascular mortality for each 10 µg/m3 increment in ozone concentration was 1.0068 (95% CI: 1.0049, 1.0086). Ths significant positive association between ozone exposure and cardiovascular mortality was also observed in different two-pollutant models. This meta-analysis revealed that exposure to ozone was associated with an increased risk of cardiovascular mortality in China, and more efforts on controlling the population from ozone are needed to improve cardiovascular health of Chinese population.

Short-term effects of ambient ozone exposure on daily hospitalizations for circulatory diseases in Ganzhou, China: A time-series study

Adverse health effects of ambient ozone are getting widespread attention, but the evidence on the relationship between ozone levels and circulatory system diseases are limited and inconsistent. Daily data for ambient ozone levels and hospitalizations for total circulatory diseases and five subtypes in Ganzhou, China from January 1, 2016 to December 31, 2020 were collected. We constructed a generalized additive model with quasi-Poisson regression accounting for lag effects to estimate the associations between ambient ozone levels and the number of hospitalized cases of total circulatory diseases and five subtypes. The differences among gender, age, and season subgroups were furtherly assessed through stratified analysis. A total of 201,799 hospitalized cases of total circulatory diseases were included in the present study, including 94,844 hypertension (HBP), 28,597 coronary heart disease (CHD), 42,120 cerebrovascular disease (CEVD), 21,636 heart failure (HF), and 14,602 arrhythmia. Significantly positive associations were observed between ambient ozone levels and daily hospitalizations for total circulatory diseases and all subtypes except arrhythmia. Each 10 μg/m³ increase in ozone concentration, the risk of hospitalizations for total circulatory diseases, HBP, CHD, CEVD, and HF increased by 0.718% (95% confidence interval, 0.156%-1.284%), 0.956% (0.346%-1.570%), 0.499% (0.057%-0.943%), 0.386% (0.025%-0.748%), and 0.907% (0.118%-1.702%), respectively. The above associations remained significant after adjusting for other air pollutants. The risk of hospitalization for circulatory diseases was higher in warm season (May to October) and varied in gender and age subgroups. This study suggested that short-term exposure to ambient ozone may increase the risk of hospitalizations for circulatory diseases. Our findings reinforce the importance of reducing ambient ozone pollution levels for protecting public health.

Circulatory health risks from additive multi-pollutant models: short-term exposure to three common air pollutants in Canada

Numerous studies have reported adverse health effects of ambient air pollution on circulatory health outcomes mainly based on single-pollutant models. However, limited studies have focused on adjusted effect of multi-pollutant exposures on public health. This study aimed to examine short-term effects of three common air pollutants-ground-level ozone (ozone), nitrogen dioxide (NO2), and fine particulate matter (PM2.5)-through multi-pollutant models for mixed effect of adjustment. Daily data (circulatory hospitalization and mortality) and hourly data (air pollutants and temperature) were collected for 24 Canadian cities for 2001-2012. We applied generalized additive over-dispersion Poisson regression models with 1, 2, or 3 pollutants for city-specific risks, and Bayesian hierarchical models for national risks. This study found little mixed effect of adjustment through multi-pollutant models (ozone and/or NO2 and/or PM2.5) for circulatory hospitalization or mortality in Canada for 2001-2012, indicating that the 1-pollutant model did not result in considerable under- or over-estimates. It seemed weak-to-moderate correlations among air pollutants did not change the significant effect of one air pollutant after accounting for others. Inconsistent findings between other previous studies and this study indicate the need of comparable study design for multi-pollutant effect analysis.

Alterations of IL-1beta and TNF-alpha expression in RAW264.7 cell damage induced by two samples of PM2.5 with different compositions

Fine particulate matter 2.5 (PM2.5) has been demonstrated by previous studies to be associated with cell damage. To explore the impact of the composition of PM2.5 on PM2.5-mediated inflammation, this study investigated the composition of PM2.5 collected during the wintertime indoor heating season and observed its inflammatory effect. Samples were collected during the heating season from December 5, 2017, to January 8, 2018, in Xi'an. Compositions of organic carbon (OC), elemental carbon (EC), and water-soluble ions were analysed. Two representative samples (sample 1 and 2) were selected with significant differences in compositions. They were configured into four concentrations (0.1 μg/mL, 1 μg/mL, 10 μg/mL, 20 μg/mL) and used as interventions on RAW264.7 cells for 4 h and 24 h separately. Cell viability was detected by CCK-8. Tumour necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) gene and protein expression levels were detected by real-time quantitative real-time polymerase chain reaction (RT-qPCR) and western blotting. The results showed that the cell viability of sample 1 intervened cells at 4 h and 24 h was lower than that of sample 2. IL-1β gene in most PM2.5 intervention groups was lower than in the control group. Protein expression was higher at 4 h than at 24 h. In conclusion, PM2.5 components influence cell viability and expression of IL-1β and TNF-α, while high concentrations of NO3-, Cl-, Na+, K+, Mg2+, Ca2+, and others in the PM2.5 composition have a significant harmful effect.

Sex-difference in air pollution-related acute circulatory and respiratory mortality and hospitalization

BACKGROUND

Numerous studies have estimated adverse effects of short-term exposure to ambient air pollution on public health. Few have focused on sex-differences, and results have been inconsistent. The purpose of this study was three-fold: to identify sex-differences in air pollution-related health outcomes; to examine sex-differences by cause and season; and to examine time trends in sex-differences.

METHODS

Daily data were collected on circulatory- and respiratory-related mortality (for 29 years) and cause-specific hospitalization (for 17 years) with hourly concentrations of ozone (O3), nitrogen dioxide (NO2), and fine particulate matter (PM2.5). For hospitalization, more specific causes were examined: ischemic heart disease (IHD), other heart disease (OHD), cerebrovascular disease (CEV), chronic lower respiratory diseases (CLRD), and Influenza/Pneumonia (InfPn). Generalized Poisson models were applied to 24 Canadian cities, and the city-specific estimates were combined for nationwide estimates for each sex using Bayesian hierarchical models. Finally, sex-differences were tested statistically based on their interval estimates, considering the correlation between sex-specific national estimates.

RESULTS

Sex-differences were more frequently observed for hospitalization than mortality, respiratory than circulatory health outcomes, and warm than cold season. For hospitalization, males were at higher risk (M > F) for warm season (OHD and InfPn from O3; IHD from NO2; and InfPn from PM2.5), but F > M for cold season (CEV from O3 and OHD from NO2). For mortality, we found F > M only for circulatory diseases from ozone during the warm season. Among the above-mentioned sex-differences, three cases showed consistent time trends over the years: while M > F for OHD from O3 and IHD from NO2, F > M for OHD from NO2.

CONCLUSIONS

We found that sex-differences in effect of ambient air pollution varied over health outcome, cause, season and time. In particular, the consistent trends (either F > M or M > F) across 17 years provide stronger evidence of sex-differences in hospitalizations, and warrant investigation in other populations.

Dose-response relationships between polycyclic aromatic hydrocarbon exposure and blood cell counts among coke oven workers: a sex-stratified analysis

OBJECTIVES

To explore sex differences and dose-response relationships between nine urinary polycyclic aromatic hydrocarbon (PAH) metabolites and neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and complete blood counts among coke oven workers.

DESIGN AND SETTING

A cross-sectional study with stratified sex was conducted in Shanxi, China.

PARTICIPANTS

A total of 458 male workers and 226 female workers were selected.

PRIMARY AND SECONDARY OUTCOME MEASURES

General linear models, p values for trend tests and natural cubic spline models were used to explore the dose-response relationships between nine urinary PAH metabolites and NLR, PLR and complete blood counts.

RESULT

Compared with male workers, female workers had lower exposure level of PAH (0.95 ng/mL vs 1.38 ng/mL). Only among female workers did we observe that a 1-unit increase in lg(1-OHPyr) was related to a 0.149 (95% CI: 0.055 to 0.242; p for trend=0.041) and 0.103 (95% CI: 0.025 to 0.181; p for trend=0.007) increase in lg(NLR) and lg(PLR), and a 0.116 (95% CI: -0.179 to -0.054; p for trend=0.007) decrease in lg(lymphocyte counts (LYMs)). A 1-unit increase in lg(2-OHNap) was related to a 0.045 (95% CI: 0.003 to 0.086; p for trend=0.037) increase in lg(PLR) and a 0.029 (95% CI: -0.056 to -0.002; p for trend=0.030) and 0.016 (95% CI: -0.029 to -0.003; p for trend=0.010) decrease in lg(white blood cell counts (WBCs)) and lg(haemoglobin (HGB)).

CONCLUSION

Female workers' NLR, PLR, WBCs, HGB and LYMs may be more susceptible than those of male workers when affected by PAH.

How mobility restrictions policy and atmospheric conditions impacted air quality in the State of São Paulo during the COVID-19 outbreak

Mobility restrictions are among actions to prevent the spread of the COVID-19 pandemic and have been pointed as reasons for improving air quality, especially in large cities. However, it is crucial to assess the impact of atmospheric conditions on air quality and air pollutant dispersion in the face of the potential variability of all sources. In this study, the impact of mobility restrictions on the air quality was analyzed for the most populous Brazilian State, São Paulo, severely impacted by COVID-19. Ground-based air quality data (PM₁₀, PM_2.5, CO, SO₂, NO_x, NO₂, NO, and O₃) were used from 50 automatic air quality monitoring stations to evaluate the changes in concentrations before (January 01 - March 25) and during the partial quarantine (March 16 - June 30). Rainfall, fires, and daily cell phone mobility data were also used as supplementary information to the analyses. The Mann-Whitney U test was used to assess the heterogeneity of the air quality data during and before mobility restrictions. In general, the results demonstrated no substantial improvements in air quality for most of the pollutants when comparing before and during restrictions periods. Besides, when the analyzed period of 2020 is compared with the year 2019, there is no significant air quality improvement in the São Paulo State. However, special attention should be given to the Metropolitan Area of São Paulo (MASP), due to the vast population residing in this area and exposed to air pollution. The region reached an average decrease of 29% in CO, 28% in NO_x, 40% in NO, 19% in SO₂, 15% in PM_2.5, and 8% in PM₁₀ concentrations during the mobility restrictions period compared to the same period in 2019. The only pollutant that showed an increase in concentration was ozone, with a 20% increase compared to 2019 during the mobility restrictions period. Before the mobility restrictions period, the region reached an average decrease of 30% in CO, 39% in NO_x, 63% in NO, 12% in SO₂, 23% in PM_2.5, 18% in PM₁₀, and 16% in O₃ concentrations when compared to the same period in 2019. On the other hand, Cubatão, a highly industrialized area, showed statistically significant increases above 20% for most monitored pollutants in both periods of 2020 compared to 2019. This study reinforces that the main driving force of pollutant concentration variability is the dynamics of the atmosphere at its various time scales. An abnormal rainy season, with above average rainfall before the restrictions and below average after it, generated a scenario in which the probable significant reductions in emissions did not substantially affect the concentration of pollutants.

Impact of Ambient Air Quality Standards revision on the exposure-response of air pollution in Tianjin, China

To improve air quality, China issued a new version of Ambient Air Quality Standards in 2012, and Tianjin officially implemented these new standards in 2013. In order to observe whether the atmospheric quality and health had been improved after the release of the new standards, this study compared the exposure-response relationships between pollutant concentrations and daily deaths (and years of life lost, YLL) in the six central districts of Tianjin in 2007-2010 and 2014-2017, which were the two periods around the release of the new standards. The exposure-response coefficients were calculated by using the generalized additive model with the time series data. The results showed that the effects of PM₁₀ and NO₂ during 2014-2017 were lower than those during 2007-2010 (PM₁₀: 0.10<0.30, 2.07<4.52; NO2: 0.24<0.87, 6.39<11.98), while the results of SO₂ were opposite (SO₂: 0.61>0.31, 10.31>1.64). And the excess deaths and YLL caused by the portion of the pollutants that exceeded the new standards also declined (PM₁₀: 156<206 persons, 3493<3913 person-years; NO₂: 64<136 persons, 1844<2895 person-years; SO₂ did not exceed the new standards). The results proved that the new standards had a certain protective effect on the health of the population in the central districts of Tianjin. These findings may provide evidence for the formulation of public health policies and further improvement and development of the Ambient Air Quality Standards.

Seasonal Variation Characteristics of Bacteria and Fungi in PM2.5 in Typical Basin Cities of Xi’an and Linfen, China

Microorganisms existing in airborne fine particulate matter (PM2.5) have key implications in biogeochemical cycling and human health. In this study, PM2.5 samples, collected in the typical basin cities of Xi’an and Linfen, China, were analyzed through high-throughput sequencing to understand microbial seasonal variation characteristics and ecological functions. For bacteria, the highest richness and diversity were identified in autumn. The bacterial phyla were dominated by Proteobacteria, Actinobacteria, Firmicutes, and Bacteroidetes. Metabolism was the most abundant pathway, with the highest relative abundance found in autumn. Pathogenic bacteria (Pseudomonas, Acinetobacter, Serratia, and Delftia) were positively correlated with most disease-related pathways. Besides, C cycling dominated in spring and summer, while N cycling dominated in autumn and winter. The relative abundance of S cycling was highest during winter in Linfen. For fungi, the highest richness was found in summer. Basidiomycota and Ascomycota mainly constituted the fungal phyla. Moreover, temperature (T) and sulfur dioxide (SO2) in Xi’an, and T, SO2, and nitrogen dioxide (NO2) in Linfen were the key factors affecting microbial community structures, which were associated with different pollution characteristics in Xi’an and Linfen. Overall, these results provide an important reference for the research into airborne microbial seasonal variations, along with their ecological functions and health impacts.

Interaction Effects of Air Pollution and Climatic Factors on Circulatory and Respiratory Mortality in Xi'an, China between 2014 and 2016

Several studies have reported that air pollution and climatic factors are major contributors to human morbidity and mortality globally. However, the combined interactive effects of air pollution and climatic factors on human health remain largely unexplored. This study aims to investigate the interactive effects of air pollution and climatic factors on circulatory and respiratory mortality in Xi’an, China. Time-series analysis and the distributed lag non-linear model (DLNM) were employed as the study design and core statistical method. The interaction relative risk (IRR) and relative excess risk due to interaction (RERI) for temperature and Air Quality Index (AQI) interaction on circulatory mortality were 0.973(0.969, 0.977) and −0.055(−0.059, −0.048), respectively; while for relative humidity and AQI interaction, 1.098(1.011, 1.072) and 0.088(0.081, 0.107) respectively, were estimated. Additionally, the IRR and RERI for temperature and AQI interaction on respiratory mortality were 0.805(0.722, 0.896) and −0.235(−0.269, −0.163) respectively, while 1.008(0.965, 1.051) and −0.031(−0.088, 0.025) respectively were estimated for relative humidity and AQI interaction. The interaction effects of climatic factors and AQI were synergistic and antagonistic in relation to circulatory and respiratory mortality, respectively. Interaction between climatic factors and air pollution contributes significantly to circulatory and respiratory mortality.

Acute effects of ambient air pollution on hospital outpatients with chronic pharyngitis in Xinxiang, China

We present results on a time-series study that analyzed the acute effects of six criteria air pollutants on hospital outpatient with chronic pharyngitis (CP) in Xinxiang, China. Data on the concentration of air pollutants and CP outpatient records were collected daily in Xinxiang, China, from January 1, 2015 to December 31, 2018. This study identified 62,823 outpatients with CP. The annual average concentrations of PM_2.5, PM₁₀, SO₂, NO₂, CO, and O₃ are 75.7, 132.1, 33.2, 48.4, 1377, and 59.4 μg/m³, respectively. Further, a 10 μg/m³ increment in the concentration of PM₁₀, SO₂, NO₂, and CO corresponds to an increase of 0.28% (95% confidence interval (CI): 0.03-0.53%), 1.10% (95% CI: 0.09-2.11%), 1.82% (95% CI: 0.84-2.80%), and 0.03% (95% CI: 0.01-0.06%) in daily CP hospital outpatients, respectively. Furthermore, results indicated that outpatients under the age of 15 are more susceptible to the air pollutants, excluding O₃. Meanwhile, males might be more susceptible, and effect estimates appear slightly stronger in the cool season. Therefore, we should implement effective measures to manage air pollutants and reinforce protection of the high-risk population.

Association between PM2.5 and mortality of stomach and colorectal cancer in Xi'an: a time-series study

Globally, fine particulate matter has been associated with several health problems including cancer. However, most studies focused mainly on lung cancer. Stomach and colorectal cancers play significant roles in increasing public health's cancer globally. This study focused on investigating a possible significant association between exposure to fine particulate matter (PM_2.5) and mortality due to stomach and colorectal cancer in Xi'an from 2014 to 2016. Using time-series analysis, the study applied both single and multi-pollutant(s) approaches for investigations; PM_2.5 was the pollutant of interest. Generalized additive model (GAM) was the core statistical method used with the addition of distributed lag model (DLM) to observe delayed effects. As a single pollutant, PM_2.5 was significantly associated with stomach cancer mortality only RR (95%CI): 1.0003 (1.0001, 1.002). For the multi-pollutant analysis, PM_2.5 combinations with NO₂ were significantly associated with both stomach and colorectal cancer mortality RR (95%CI): 1.0103 (1.009, 1.021) and 1.054 (1.0324, 1.0667), respectively. Also, PM_2.5 combination with O₃ was significantly associated with colorectal cancer mortality, RR (95%CI): 1.0151 (1.0091, 1.0172), but no association was noted for combination with SO₂. Though this study has reported significant associations, it will be beneficial for the public's health if more studies further investigate the relationship between exposure to PM_2.5 and other cancer mortality.